In my answer I will refer to “female genital cutting” (FGC), instead of FGM. For reasons why, refer to [22] and [28]. Suffice to say – Many women who *have* had their genitalia cut do not feel “mutilated”, and feel this is a value-laden term which they would rather not have applied to their bodies, and it leads to stigma and shame [22]. I choose to respect these women’s wishes, given their voice is not often heard. Furthermore [22], this term does actual, active harm to women who have been cut.
A TLDR (without citations, citations are found in the more extensive answer):
1. Across much of the western world knowledge about the form and reasons for FGC is poor, relying on poorly-research and unsubstantiated tropes. It is perceived that western reasons for male circumcision are "medical" and "civilised" whilst FGC is done for "barbaric" reasons.
2. A "zero-tolerance" approach to FGM has been adopted by the UN/WHO, and is incorporated into western law. This bans *all* forms of FGC, however minor or medicalized, as a human rights violation, as it denies girls bodily autonomy and integrity. (The author believes this to be correct path to take, but suggests that such an argument should logically extend to intersex & male children also).
3. Anthropologists have found deep parallels between FGC and male circumcision across cultures. Both encompass a spectrum of practices of varying severity, with the two practices commonly serve as parallel "initiation" rites into adulthood. Women with FGC will often (although not always) consider their genitalia to have been enhanced and beautified by the practice. FGC serves to transition girls into women and earns them the respect of their elders and peers.
4. The connection of FGC to patriarchy is poorly-established. In most socities FGC is performed and upheld by women. In many societies men oppose the continuation of FGC, whilst women continue to support it. In only a relatively few countries (Sudan, Somalia, Djibouti) is the connection of the most extreme form of FGC (infibulation) connected to problematic social norms regarding female sexuality. Patriarchy is not a good explanation for FGC - for example the Kikuyu in Kenya, and women in Sierra Leone are not oppressed sexually - there is no cultural obsession with female chastity/virginity - yet undergo FGC as a form of initiation.
5. Male circumcision is considerably more invasive than minor forms of FGC which are performed for analogous reasons. In the Dawoodi Bohra sect of Islam both boys and girls are "circumcised" to mark their presence in the Abrahamic covenenant. The cutting for girls consists of a ritual nick with no removal of flesh, whereas for boys it entails removal of the foreskin. Notably the first FGM case in the US concerned Dr Jamala Nagarwala of the Dawoodi Bohra, on trial for performing this type of FGC.
6. Cultural bias (particularly in the US) prevents recognition of the parallels between the practices. This culture bias is most pronounced in English-speaking countries, where neonatal circumcision was routine (and still is in USA), where law-makers themselves are typically circumcised. Throughout history people have acccepted their own childhood bodily modifications, whilst rejecting those of "foreign" cultures. (Chinese foot-binding, ritual scarification/tatooing of minors, corsetting etc.) There is a tendency to rationalise familiar practices, whilst rejecting foreign practices (the so-called "yuck" factor).
7. The firewall between FGC and male circumcision may be breaking down, as recognition of the potential harms of MC, and recognition of the prevalence of minor, medicalized forms of FGC increases. These forms are prevalent across SE Asia in the Muslim populations of Malaysia, Indonesia and Singapore, where an estimated 60-70 million girls/women have had a "minor" form of FGC performed on them.
8. The political ramifications of this are likely to play out differently in different countries. Countries in Northern Europe already recognise the harms of MC, and seem likely to further censure it, with the aim of procuring a total ban when this is deemed safe. (Indeed Iceland and Finland have already had attempts at a ban). In USA, it seems more likely that minor, medicalized forms of FGC will be legalised, as the parallel to the culturally endemic MC are recognised (as seen in the 1st FGM trial in the US, where the federal FGM bill was struck down as unconstitutional, for further analysis see: https://www.youtube.com/watch?v=GBH0g_Cl7Rk).
The longer version of my answer follows:
1. Male circumcision and FGC are in fact far more similar than many
people would think. Many bioethicists and anthropologists argue that
the current discussion around FGC revolves around poorly-researched
and un-scrutinised tropes, which do not hold up to scrutiny. These
bioethicists believe that treating FGC and MC together (along with
intersex normalisation surgery) is both the ethical and pragmatic
way forward [21,27]. The WHO and UN definition of FGM (incorporated
into law across the developed world) encompass *any* cutting done to
a girls’ genitalia without medical necessity. This is a key point – the “zero tolerance” approach promoted by UN/WHO, and which has been adopted into the laws on FGM in western nations, means that *any* cutting done to a girl’s genitalia is classified as FGM, condemned as a human rights abuse, and is illegal. On this basis, there *is* a discrepancy in the law, as male circumcision *if* performed on a girl, would indeed be illegal. Later in my answer I will address the politics which lead to this discrepancy.
2. FGC is a wide range of practices across many disparate cultures
[1,2,5,7], with varying levels of invasiveness and varying cultural
justifications. The perception that FGC is due to patriarchy/male
suppression of female sexuality is an over-simplification
[1,5,11,12,13], and is not well justified by empirical evidence. Severe forms of cutting are comparatively rare[1], with more minor forms of cutting being more standard. In Malaysia and Indonesia[2,3,4] the clitoral hood is nicked/pricked, and usually little/no tissue is removed. There are “no significant health related risks and physical examination failed to show any evidence of injury to the clitoris nor the labia and no signs of excised tissue”. According to the WHO and UN, this is classified as FGM. There is no evidence this causes sexual dysfunction [5] and many women are unaware of the fact they were cut [2]. This is not purely a pedantic point – this is one of the more common forms of FGC (60-70 million across SE Asia - Indonesia, Malaysia and Singapore). Until quite recently it was not recognised that FGC was a cultural practice in SE Asia, and it was thought to be confined to Africa. The Western conception of FGC as a drastic mutilation is (partially) a reflection of the evidence we have on it, and the particular countries which have been most extensively studied - in Obermeyer’s systematic review of the evidence on FGC[5], she states:
> “It is rarely pointed out that the frequency and severity of
> complications are a function of the extent and circumstances of the
> operation, and it is not usually recognized that much of [our]
> information comes from studies of the Sudan, where most women are
> infibulated. The ill-health and death that these practices are thought
> to cause are difficult to reconcile with the reality of their
> persistence in so many societies, and raises the question of a
> possible discrepancy between our “knowledge” of their harmful effects
> and the behaviour of millions of women and their families.”
It is worth noting that across Africa a range of practices are performed – from the most severe (infibulation), through less severe (clitoridectomy), to far more minor practices (so called “sunat”). In the Sudan and Somalia, the cutting *has* moved from a rather severe practice (infibulation), to increasingly minor and medicalized forms (such as “sunat”) as a result of a “harm-minimization” approach by some activists[6,15]. However minor or medicalised the cutting is, it is still classified as FGM by all international bodies, and the law in all developed countries. Reasons for this are addressed later. In all cultures which practice FGC, males are also cut, usually in the same conditions for parallel reasons. For males this can result in death and deformity [19,20], just the same as FGC.
The perception that FGC is associated strongly with patriarchy and male suppression of female sexuality is not well-established [1]:
> “The empirical association between patriarchy and genital surgeries is
> not well established. The vast majority of the world’s societies can
> be described as patriarchal, and most either do not modify the
> genitals of either sex or modify the genitals of males only. There are
> almost no patriarchal societies with customary genital surgeries for
> females only. Across human societies there is a broad range of
> cultural attitudes concerning female sexuality—from societies that
> press for temperance, restraint, and the control of sexuality to those
> that are more permissive and encouraging of sexual adventures and
> experimentation—but these differences do not correlate strongly with
> the presence or absence of female genital surgeries.”
In almost all cultures which practice FGC, it is done by women, who typically see it as hygienic, beautifying and an important rite of passage with cultural value[7,8,9,10]. Amongst the Kono tribe in Sierra Leone[7]: “
> "there is no cultural obsession with feminine chastity, virginity, or
> women’s sexual fidelity, perhaps because the role of the biological
> father is considered marginal and peripheral to the central
> ‘matricentric unit.’ … Kono culture promulgates a dual-sex ideology …
> [The] power of Bundu, the women’s secret sodality [i.e., initiation
> society that manages FGC ceremonies], suggest positive links between
> excision, women’s religious ideology, their power in domestic
> relations, and their high profile in the ‘public arena."
As a general point – the cultural *meaning* of FGC tends to be of a rite of passage, from childhood to adulthood. In some cultures, this is derived from the idea that children are naturally partially androgynous. To become fully male/female it is necessary to remove the female/male component – to this end circumcision/excision of clitoris is practiced on male/female initiates. Across the many cultures which practice FGC as a rite of passage it’s meaning takes many forms, but is not generally found to correspond to “sexual suppression”. It is the case in *some* cultures that FGC is done to suppress female sexuality, but these cultures are the exception not the rule[5,23].This misconception is rooted in the over-representation of FGC practices in Sudan [5].
To conclude in the words of Zachary Aldrous [13]:
> “The fact of the matter is that what’s done to some girls [in some
> cultures] is worse than what’s done to some boys, and what’s done to
> some boys [in some cultures] is worse than what’s done to some girls.
> By collapsing all of the many different types of procedures performed
> into a single set for each sex, categories are created that do not
> accurately describe any situation that actually occurs anywhere in the
> world.”
3. Another common misconception is that women
subject to FGC are rendered incapable of experiencing sexual
pleasure. This varies with the severity of cutting [5], but as
remarked by Sara Johnsdotter [14] there is no “one-to-one”
correspondence of the severity of cutting to sexual pleasure
experienced. Even women cut in the most severe manner can still
experience sexual pleasure [14,16,22]. [16] is a study on women who have had infibulation performed on them, the results show:
> “58 mutilated young women reported orgasm in 91.43%, always 8.57%;
> after defibulation 14 out of 15 infibulated women reported orgasm; the
> group of 57 infibulated women investigated with the FSFI questionnaire
> showed significant differences between group of study and an
> equivalent group of control in desire, arousal, orgasm, and
> satisfaction with mean scores higher in the group of mutilated women.
> No significant differences were observed between the two groups in
> lubrication and pain.”
And the study concludes:
> “embryology, anatomy, and physiology of female erectile organs are
> neglected in specialist textbooks. In infibulated women, some erectile
> structures fundamental for orgasm have not been excised. Cultural
> influence can change the perception of pleasure, as well as social
> acceptance. Every woman has the right to have sexual health and to
> feel sexual pleasure for full psychophysical well-being of the person.
> In accordance with other research, the present study reports that
> FGM/C women can also have the possibility of reaching an orgasm.
> Therefore, FGM/C women with sexual dysfunctions can and must be cured;
> they have the right to have an appropriate sexual therapy.”
On the possibility of male circumcision harming sexual it is worth noting that the foreskin is itself richly endowed with sensory nerves [17], and there does appear to be some link with sexual dysfunction, though this is disputed [18]. Again, as Sara Johnsdotter remarks [14], there appears to be no one-to-one mapping of tissue removed onto sexual pleasure/dysfunction. Instead the picture is a more complex and nuanced one. A large determining factor is whether or not that person is happy with their cut genitalia or not, and hence an international assembly has proposed a human rights argument against *all* (male, female and intersex) genital cutting practices [21].
4. The difference in perception is due to cultural bias [12,13,23,24,25] across much of the West. Familiarity with male circumcision, and the foreignness of FGC lead many to think the practices are far more disconnected than they actually are. In the words of Hanny Lightfoot-Klein (a renowned anti-FGM activist) [23]:
> “… the mainstream anti-FGC position is premised upon an orientalizing
> construction of FGC societies as primitive, patriarchal, and barbaric,
> and of female circumcision as a harmful, unnecessary cultural practice
> based on patriarchal gender norms and ritualistic beliefs. …
> Lambasting African societies and practices (while failing to critique
> similar practices in the United States) … essentially implies that
> North American understandings of the body are “scientific” (i.e.,
> rational, civilized, and based on universally acknowledged expertise),
> while African understandings are “cultural” (i.e., superstitious,
> un-civilized, and based on false, socially constructed beliefs). [Yet]
> neither of these depictions is accurate. North American medicine is
> not free of cultural influence, and FGC practices are not bound by
> culture—at least not in the uniform way imagined by opponents.”
In America (and a number of English speaking countries) male circumcision was a widespread practice in the 20th Century. In America today, male circumcision is still a widespread, common practice, with around 50-60% of newborn males undergoing it. Across the west in general there are substantial Jewish and Muslim minorities, who practice male circumcision for religious/cultural reasons. It is this familiarity, along with political pressure from religious minorities in the face of any restrictions, which has led to male circumcision being a normalised, accepted practice across the west. It is easier to condemn a “foreign” practice such as FGC than a practice which is familiarised. Parallels to Chinese foot-binding, facial scarification and other bodily modifications imposed on children can be made – we are quick to judge other cultures for their particular form of bodily modification, whilst judging our own such bodily modifications to be” normal” and “natural”.
5. Whilst it is true that male circumcision has some health benefits – most notably a lower chance of contracting HIV from heterosexual sex – across much of the industrialized world these health benefits are not deemed sufficient justification to recommend male circumcision. A large reason for this is – the health benefits mostly apply only to sexually active adults, and can be obtained in far less invasive ways (condoms, practicing safe sex). It is a fundamental tenet of medical ethics that the risks surgery are only justified when there is no less invasive way of treating the pathology. The presence of a foreskin is not a pathological defect, it is natural tissue. The KNMG (Royal Dutch Medical Society, Netherlands) states [29]:
> “There are good reasons for a legal prohibition of non-therapeutic
> circumcision of male minors, as exists for female genital mutilation.
> However, the KNMG fears that a legal prohibition would result in the
> intervention being performed by non-medically qualified individuals in
> circumstances in which the quality of the intervention could not be
> sufficiently guaranteed. This could lead to more serious complications
> than is currently the case.”
On the matter of health benefits they also state –
> “There is no convincing evidence that circumcision is useful or
> necessary in terms of prevention or hygiene. Partly in the light of
> the complications which can arise during or after circumcision,
> circumcision is not justifiable except on medical/therapeutic grounds.
> Insofar as there are medical benefits, such as a possibly reduced risk
> of HIV infection, it is reasonable to put off circumcision until the
> age at which such a risk is relevant and the boy himself can decide
> about the intervention, or can opt for any available alternatives.”
The evidence available to both European and American health professionals are the same, and yet they reach opposite conclusions. Additionally, across both China, Japan and South America, male infant circumcision is not recommended on health grounds. The US stands alone in this matter and it has been suggested that the US in particular is biased (Hanny Lightfoot-Klein above) in their perception of the medical evidence by the high rate of male circumcision in the US. In response to the promotion of male circumcision in America, a number of health professionals across Northern Europe published a response, stating they believe the American view is seriously biased [30]:
> "Seen from the outside, cultural bias reflecting the normality of
> nontherapeutic male circumcision in the United States seems
> obvious,[…] the report’s conclusions are different from those reached[
> …] in other parts of the Western world, including Europe, Canada, and
> Australia. […], only 1 of the arguments put forward by the American
> Academy of Pediatrics has some theoretical […]; namely, the possible
> protection against urinary tract infections in infant boys, which can
> easily be treated with antibiotics without tissue loss. The other
> claimed health benefits, including protection against HIV/AIDS,
> genital herpes, genital warts, and penile cancer, are questionable,
> weak, and likely to have little public health relevance in a Western
> context, and they do not represent compelling reasons for surgery
> before boys are old enough to decide for themselves.”
It is worth bearing in mind that the default for any medical professional should be to be opposed to unnecessary surgery due to fundamental tenet of medical ethics. And to conclude with, I quote their statement on the justifiability and ethics of prophylactic surgery [30]:
> “The most important criteria for the justification of medical
> procedures are necessity, cost-effectiveness, subsidiarity,
> proportionality, and consent. For preventive medical procedures, this
> means that the procedure must effectively lead to the prevention of a
> serious medical problem, that there is no less intrusive means of
> reaching the same goal, and that the risks of the procedure are
> proportional to the intended benefit. In addition, when performed in
> childhood, it needs to be clearly demonstrated that it is essential to
> perform the procedure before an age at which the individual can make a
> decision about the procedure for him or herself.”
6. The continual misrepresentation of FGC as “incomparable to male circumcision” harms efforts to *end* FGC [27]. Numerous times women in practicing communities will say “how is this any different to Westerners (Americans) cutting their sons?” The insistence on a firewall between the two practices will continue to prevent progress in ending FGC. Whilst I appreciate people’s intentions are noble enough, it is not helpful to end FGC to have this firewall between the practices. The argument is all the stronger for including male circumcision and intersex normalisation surgeries under a single umbrella. The argument is significantly weakened by (well-intentioned) attempts to separate the two practices. I cannot persuade African women to not cut their daughters, if Americans continue to cut their sons.
I’m going to finish with a personal finish, which definitely breaks moderator rules. I work to end *all* genital cutting performed on children, whether male, female or intersex. It is a persistent struggle to change the minds of women who perform FGC on their daughters, when they will ask “Why is this wrong, but Americans circumcising their children is fine?” They ask this because they see these two practices as one and the same – cutting cultures almost invariably see MGC and FGC as two sides of the same coin. It proves significantly harder to end FGC if male circumcision is seen as acceptable. Moreover – the ethical arguments proposed for why FGC is wrong, *also* apply to male circumcision. If we are to declare bodily autonomy and integrity as human rights, they apply to *all* humans - male, female and intersex. And if we wish to judge other cultures, we should check that our culture is consistent with the measure we use.
Citations:
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[14] Johnsdotter, Sara. “Discourses on Sexual Pleasure after Genital Modifications: the Fallacy of Genital Determinism (a Response to J. Steven Svoboda).” Circumcision, Public Health, Genital Autonomy and Cultural Rights, May 2017, pp. 46–55., doi:10.4324/9781315095684-6.
[15] http://www.aleciashepherd.com/writings/articles/other/The%20medicalization%20of%20female%20circumcision%20harm%20reduction.pdf
[16]Catania L, Abdulcadir O, Puppo V, Verde JB, Abdulcadir J, Abdulcadir D. Pleasure and orgasm in women with female genital mutilation/cutting (FGM/C). The Journal of Sexual Medicine. 2007;4(6):1666–1678.
[17] Cold CJ, Taylor JR. The prepuce. BJU International. 1999;83(S1):34–44.
[18] Shindel, Alan. “Evaluation for Male Circumcision and Sexual Function in Men and Women: a Survey-Based, Cross-Sectional Study in Denmark.” F1000 - Post-Publication Peer Review of the Biomedical Literature, June 2011, doi:10.3410/f.13200013.14542135.
[19] Gonzalez L. South Africa: over half a million initiates maimed under the knife. All Africa. 2014. Available at http://allafrica.com/stories/201406251112.html.
[20] http://ulwaluko.co.za/
[21] “Medically Unnecessary Genital Cutting and the Rights of the Child: Moving Toward Consensus.” The American Journal of Bioethics, vol. 19, no. 10, 2019, pp. 17–28., doi:10.1080/15265161.2019.1643945.
[22] Earp, Brian D. “Protecting Children from Medically Unnecessary Genital Cutting Without Stigmatizing Women’s Bodies: Implications for Sexual Pleasure and Pain.” Archives of Sexual Behavior, 2020, doi:10.1007/s10508-020-01633-x.
[23] Lightfoot-Klein, Hanny. “Similarities in Attitudes and Misconceptions about Male and Female Sexual Mutilations.” Sexual Mutilations, 1997, pp. 131–135., doi:10.1007/978-1-4757-2679-4_12.
[24] Earp, Brian D., et al. “False Beliefs Predict Increased Circumcision Satisfaction in a Sample of US American Men.” Culture, Health & Sexuality, vol. 20, no. 8, June 2017, pp. 945–959., doi:10.1080/13691058.2017.1400104.
[25] Earp, Brian & Shaw, David. (2017). Cultural bias in American medicine: the case of infant male circumcision. Journal of Pediatric Ethics. 1. 8-26.
[26] Earp, Brian & Shaw, David. (2017). Cultural bias in American medicine: the case of infant male circumcision. Journal of Pediatric Ethics. 1. 8-26.
[27] Earp, Brian. (2020). Gender or genital autonomy? Why framing nontherapeutic genital cutting as a children's rights issue is both ethically and pragmatically necessary. Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC. 42. e17. 10.1016/j.jogc.2019.11.023.
[28] Cook, R.j, et al. “Female Genital Cutting (Mutilation/Circumcision): Ethical and Legal Dimensions.” International Journal of Gynecology & Obstetrics, vol. 79, no. 3, 2002, pp. 281–287., doi:10.1016/s0020-7292(02)00277-1.
[29] https://www.knmg.nl/circumcision/
[30] http://artemide.bioeng.washington.edu/InformationIsPower/Pediatrics-2013-Frisch-peds.2012-2896.pdf