Trigger warnings: Descriptions of Female Genital Cutting; male circumcision; child abuse; sexual abuse; gender-based violence; sexism

Hoda Ali highlighted the importance of language when describing FGC. For instance, the Somali word for FGC, ‘Gudiniin’ (pronounced: good-neen), directly translates as ‘circumcision’.

The word ‘circumcision’… doesn’t sound as harmful as when we say ‘Female Genital Cutting’. This is why it’s important to actually use the right terminology [FGC], especially in a medical setting- Hoda Ali

Believing FGC is akin to male circumcision is a surprisingly common misunderstanding, perpetuated by our general ignorance when it comes to human reproductive anatomy. So, let’s start with a quick introduction to human genitalia…

Human genitalia- a primer

All embryos start off looking and functioning the same way, for the first 8-9 weeks after conception [first image in the figure below] [1].

Then, as a result of genetic coding of the embryo’s sex chromosomes (XX (female), XY (male), ‘intersex’ variations such as XXY, XO)- or physiological conditions such as congenital adrenal hyperplasia (CAH)- or sex chromosome reversal disorders (XX or XY)–  the embryo will begin to differentiate in the structure of its genitalia.

The figure below shows the development of typical male and female external genitalia phenotypes (what they look like), revealing how the same structures grow into different but corresponding parts in all human bodies [1].

Source: Wikipedia ‘Development of the Human Genitalia’ https://upload.wikimedia.org/wikipedia/commons/1/14/Human_genitalia_-_development_1.png

FYI- The Prader Scale is a visual chart that is depicts human genitalia along its full spectrum- with the most common infant presentations being shown at either end of the scale, female on the left and male on the right [2]. Male and female bodies are more similar to one another than you might have been taught at (med) school, since it is our differences that are prioritised in most cultures (in part to help ‘justify’ gender inequalities) [3].

Source: Wikipedia, ‘The Prader Scale’ [2]

Circumcision is the removal of the foreskin from the human penis, usually in infancy (although sometimes in adolescence or adulthood) and for cultural rather than medical reasons [4]. A medical doctor or religious/ traditional practitioner usually carries out the procedure [4]. The foreskin is stretched out, then a circumcision device or blade is used to remove the loose skin and expose the prepuce (the top part of the penis) [4].

In many countries, anaesthesia is used to reduce pain and physiological stress. However, in some places, especially where circumcision is practiced as a rite of puberty or adulthood (rather than in infancy), there may be no pain-relieving medication or topical treatments available [5].

Source: Wikipedia: ‘Line drawing illustration of circumcision with scissors’.

The health implications of circumcision…

In geographic contexts with access to medical treatment, sterile tools, and anaesthesia the rate of complications due to circumcision is around 4% (4 in 100 children and adults) [6]. Adhesions (problematic tissue growth), meatal stenosis (when the opening at the end of the penis becomes narrow, causing problems with urination) and infections were the most frequent complications associated with circumcisions carried out for medical reasons [6]. Bleeding, cutting device removal damage, and infections occurred more frequently in ‘cultural’ circumcisions [6]. However, it is worth noting that these statistics do not consider any longer term or psychological complications- only the immediate result of the surgery [7].

In geographic contexts where non-medical and adolescent/ young adult (ages 10-24) circumcision is the norm, much higher rates of health complications are suspected. Research is limited but two studies found a complication prevalence rate of between 35% to 48% (from a third to nearly half of all boys/ men) in this context [5]. The most common complications were infection, incomplete circumcision requiring re-circumcision and delayed wound healing. Mortality related to traditional male circumcision was 0.2% (2 boys dying out of every 1000) [5].

And FGC…

Sadly, we do not know the prevalence of health complications for FGC. Partly because nobody has funded or carried out such a study, but also because it is a taboo topic (criminalised in many countries) and so people are understandably reluctant to talk about their experiences [8]. I think we can assume that the complication rates are likely to be similar to (if not worse than) those of non-medical male circumcision carried out on adolescents, given the lack of sterile instruments, age of child, and similar types of immediate complication- infections and heavy blood loss.

However, one good quality study has estimated that around 44K girls die unnecessarily each year due to FGC, and that is not including subsequent maternal mortality (cut girls and women are more likely to die in pregnancy and childbirth) [8].

If male circumcision was the same as Female Genital Cutting (FGC)…

While some of the immediate health complications may be similar, the practices of circumcision and FGC are quite different when it comes to physiological damage, reproductive health, and pain.

Male equivalent to FGC Type 1

FCG type 1 -Clitoridectomy (if an equivalent cut was made on male genitalia).

The removal of the clitoris is akin to the removal of the entire glans, prepuce, and the top part of the penis shaft (numbers 1, 5, and 12). So, already this type of cutting is considerably more painful and damaging than just the removal of the penis foreskin.

Male equivalent to FGC Type 2

FGC Type 2- Excision (if equivalent cuts were made on male genitalia).

The removal of the clitoris plus the soft tissue of the labia, is akin to the removal of the entire glans, prepuce, the top part of the penis shaft, and most of the tissue of the scrotum (numbers 1, 5, 12, and 15). Yikes!

FGC Type 3- Infibulation (if equivalent cuts were made on male genitalia).

Male equivalent of FGC Type 3

The removal of the clitoris plus the soft tissue of the labia, which is then sewn shut except for a small hole to allow pee (and hopefully menstrual fluid) to pass… is akin to the removal of the entire glans, prepuce, the top part of the penis shaft, most of the tissue of the scrotum, and then sewing what remains over the penis shaft so that only the urethra and (now tightly enclosed) testes are visible.

Good luck weeing, getting erections, having sex, ejaculating semen, being fertile, and avoiding urinary infections, guys! So much unnecessary pain and reproductive health issues this operation would bring… And yet, this is akin to what has been done to millions of girls and women around the world. It needs to stop.

Next blog in the FGC series: The health implications of FGC

Resources:

• List of NHS specialist services for FGC in the UK
• UK government FGC resource pack
• NSPCC FGC helpline and information
• ChildLine: UK-based children worried about or experiencing FGC can get free anonymous support from ChildLine, online or by phoning 0800 1111.

FGC Organisations

• Daughters of Eve: support for women who have undergone FGC.
• FORWARD UK: tackles discriminatory practices, focusing on FGC and child marriage. They can also offer guidance and support for emergency support for parents and girls facing FGC.
• The Dahlia Project: provide free support groups and individual counselling for women who have undergone FGC.
• Leila Hussein’s discussion of her experience of FGC.

Please cite as: King, S. and Dajani, J. (2025) ‘FGC is not circumcision’ Menstrual Matters www.menstrual-matters.com/ part-3-fgc-is-not-circumcision  [Accessed DATE]

References and notes:

1. Free image from Wikipedia- ‘Development of the reproductive system’ https://en.wikipedia.org/wiki/Development_of_the_reproductive_system
2. The Prader Scale- free image from: Yau M, Khattab A, Yuen T, et al. Congenital Adrenal Hyperplasia. [Updated 2022 Nov 3]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Figure 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278953/figure/congn-adren-hyprplsa.F3/
3. I am currently writing a journal article about this issue- please watch this space for further info… King, S. (Forthcoming) ‘Pronatalist Bias in Medical Education: What we are not taught about our bodies’.
4. Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G (2007). Male circumcision: global trends and determinants of prevalence, safety, and acceptability
5. Wilcken A, Keil T, Dick B. Traditional male circumcision in eastern and southern Africa: a systematic review of prevalence and complications. Bull World Health Organ. (2010) Dec 1;88(12):907-14. doi: 10.2471/BLT.09.072975. Epub (2010) Oct 29. PMID: 21124715; PMCID: PMC2995181.
6. Shabanzadeh DM, Clausen S, Maigaard K, Fode M. ‘Male Circumcision Complications – A Systematic Review, Meta-Analysis and Meta-Regression’. (2021) Urology Jun;152:25-34. doi: 10.1016/j.urology.2021.01.041
7. It is difficult to find studies on longer-term complications and psychological, sexual and other health impacts of childhood circumcision but many people believe this is a real problem for some cis men. Here is an article summarises the main concerns: https://www.scirp.org/journal/paperinformation?paperid=55727
8. Ghosh A, Flowe H, Rockey J. Estimating excess mortality due to female genital mutilation. Sci Rep. (2023) Aug 16;13(1):13328. doi: 10.1038/s41598-023-38276-6.