In the United States, female circumcision (the removal of the clitoral hood) and clitoridectomy (the removal of the external nub of the clitoris) are nearly always regarded as practices that happen someplace else. When their presence within the United States is acknowledged, these procedures are positioned as having come from the outside, as originating with immigrants from parts of the world where they are performed as an “initiation rite” for young girls. Indeed, termed FGM/C (female genital mutilation/cutting) by the WHO and USAID, the practices are deemed to be cultural and performed for “non-medical reasons.”
There are a couple of problems with this framing of FGM/C. First, labeling these procedures as cultural and not medical serves not only to invalidate them, but it also suggests that if they were performed for medical reasons, then the procedures would be acceptable. Secondly, framing FGM/C as performed for cultural but not medical reasons implies that medical reasons can be separated from their cultural context. Finally, this framing fails to account for the practice of the two procedures that fall under the broad category of FGM/C — female circumcision and clitoridectomy — that have been performed in the United States for medical reasons.
Medicine is practiced within a culture, and medical reasons are both influenced by, and influence, the culture in which those reasons are formed. As I was writing this blog, I also was working on a lecture for first-year medical students on cholera in the 19th century, and I wanted to situate this disease in its cultural context. I pulled Charles Rosenberg’s The Cholera Years off my shelf, and, reading through it, landed on his recollections of his undergraduate course. In that course, “The History and Geography of Disease,” Rosenberg recalled learning that disease was “defined and framed in ways appropriate both to the clinical manifestations of a specific disease and to the more general contours and needs of the culture in which it appeared.” I decided to include this in my cholera lecture to introduce my students to the ways in which disease is both a physiological and a social entity. But rereading this quotation, I also was struck by how it could be used as a way to frame the history of female circumcision and clitoridectomy in the United States.
As I discuss in my recent book on the history of female circumcision and clitoridectomy in America, many Americans who condemn the practice of FGM/C elsewhere in the world don’t realize that some physicians used clitoridectomy and female circumcision as therapies here in the United States, since at least the mid-19th century. The procedures were used until at least the 1960s as medical treatments for masturbation in infants, girls, and women. In addition, female circumcision has been used continually since at least the 1890s as a therapy to enable an adult woman to orgasm during penetrative, heterosexual sex. The therapeutic use of female circumcision and clitoridectomy were based within a medical understanding of the clitoris as a, if not the, principal sexual organ for women. But the surgeries were also based within a cultural understanding of what constituted normative and healthy female sexual behavior for white, middle class women: heterosexual and penetrative (and more often than not, married). If a 10-year-old girl masturbated or a 22-year-old woman failed to orgasm with her husband, some believed the basis of this “abnormal” behavior lay in an “abnormal” condition of the clitoris. Some physicians thus corrected the condition by circumcising or removing the organ.
The medical understanding of women’s bodies existed within a cultural context that posited a narrow definition of healthy sexual behavior for females. Female circumcision and clitoridectomy in the United States were, to paraphrase Rosenberg, therapies “defined and framed in ways appropriate to both the clinical” (an understanding of the clitoris as a sexual organ) and “the more general contours and needs of the culture” (a narrow understanding of normative female sexual behavior). The medical reasons for the use of female circumcision and clitoridectomy were embedded within American cultural ideas regarding “appropriate” female sexuality. To put it simply: these medical procedures were part of American culture.
Dr. Rosenberg, if you are reading this, I hope you are not uncomfortable by my use of your work on cholera as a point of reference to illustrate how female circumcision and clitoridectomy were framed by medical ideas of the female body and cultural ideas of acceptable female sexual behavior. That said, I hope that knowing the American history of these medical practices leads to some productive, if possibly uncomfortable, discussions among Americans generally, and more specifically among those at organizations such as USAID and the WHO, as they consider the labeling of FGM/C as cultural practices done for non-medical reasons.
Sarah Rodriguez is a lecturer in Medical Humanities and Bioethics in the Feinberg School of Medicine and a lecturer in Global Health Studies in the Weinberg College of Arts and Sciences at Northwestern University. Sarah’s area of research is women’s reproductive and sexual health. You can find out more about her at: http://www.sarahbrodriguez.com
 USAID, “Female Genital Mutilation/Cutting: United States Government’s Response,” updated July 21, 2014.
 Charles Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: The University of Chicago Press, 1987): 235.
Feature image: The Hospital (Spyros Papaspyropoulos/Flickr CC BY-NC-ND)
Kirsten Bell, “Genital Cutting and Western Discourses on Sexuality,” Medical Anthropology Quarterly 19 (2005): 125-148.
Ylva Herlund and Bettina Shell-Duncan, eds. Transcultural Bodies: Female Genital Cutting in Global Context (Rutgers University Press, 2007).
Birgitta Essen and Sara Johnsdotter, “Female Genital Mutilation in the West: Traditional Circumcision versus Genital Cosmetic Surgery,” Acta Obstetrica et Gynecologica Scandinavica 83 (2004): 611-613.
Marge Berer, “Labia Reduction for Non-Therapeutic Reasons vs. Female Genital Mutilation: Contradictions in Law and Practice in Britain,” Reproductive Health Matters 18 (2010): 106-110.