FGM: is it already here? Part 1: A history


The numbers of Articles (and a few books and book reviews) on Female Genital Mutilation published over the years, as noted in a) Google Scholar based upon queries for separate years, 1600-1899, and b) David M. Westley. (1999).  Female Circumcision and Infibulation in Africa.  EJAB: Electronic Journal of Africana Bibliography, v. 4. Search carried out on 6-4-16.

Female Genital Mutilation: an ethnomedical history


If we consider genital “mutilation” a specific form of genital change or “modification”, the process of changing the form or appearance of this part of the human body has an ancient history.  Along with changing appearance, these changes were also meant to control or modify the sexual activities that are engaged in.  The reasons these modifications might be wished for are numerous.  But they typically focus  on just one behavioral change –to reduce the desire to engage in sexual activity, experienced by a man, or a woman, or both.

Genital mutilation is just of many activities mankind engages in to control and modify the sex drive and activities.  For each culture, there are numerous expectations for when, how, why and what to perform as a part of this behavior that generally requires two or more people.  For much of history, these interpersonal behaviors have engaged a man and a woman, with each playing an assortment of different roles in the rituals expected by a culture.  These ritualistic activities may involve one sex or the other as an aggressor, and so to modify these behaviors when they are not wanted for some reason, the instigator of this change has to decide whether to prevent the aggressor from starting such activities, the respondent from accepting, further supporting and then engaging in these activities, or if it more appropriate, to simply make such activities harder to engage in harder to pursue, harder to complete.


The genital modification process is one method used to control how a person will beginning engaging in, following through, or finishing up with the sexual activities expected by each of the parties involved.   The purpose of genital manipulation or mutilation with regard to this specific interpersonal process is, more often than not, to be sure the possible participants cannot participate in their behavior of choice, for culturally defined reasons related to the initiator and/or instigator or recipient of such events.  Genital changes are made an accepted by a culture and society in order to better ensure the survival of their own type, their own social group.  There are certain expectations that a culture has to help define what these genitalia related events might be.

Culture defines what it is people can do when it comes to sex.  Genital manipulation, change, modification and mutilation are culturally approved procedures that are used to maintain control of this otherwise completely personal, biologically driven phenomenon between two people.  Since the healthcare process is often provided by cultural, societal leaders, with much of its activity and expectations defined by the culture and society’s belief system, be they documented on paper or not, the process of engaging in genitalia changes as a part of the healthcare “practice” is intended to make for a “healthier” more emotionally sound and appropriately active community.  When this process fails to meet cultural requirements and demands, the consequences of such actions can be perceived as more than just a failure by the society involved, but sometimes as a failure of the cultural system itself to be able to survive.  For example . . .


“Monstrosities” 16th C. to 19th C. – Babies born due to poor temperament, heredity, inappropriate sexual encounters, and a host of culturally defined moral causes.

World History of Genital Modification Processes

The global history of GM or genital modification (later genital mutilation) processes did not begin as lopsided or unidirectional in how it targets people genderwise, as it does today.

In some of the oldest tales about this practice by the Ancient writer Seneca, it is said that the purpose of this method of controlling people was targeted most directly at soldiers, so they would retain their male aggression and the strength and agility needed should another war become part of their history.  Seneca’s tales refer to the use of infibulation practices, involving the cutting of flesh from the male genitalia, for the purpose of reducing their desires for engaging in others forms of aggressive and active energy expenditure.

The culturally defined reasons for these changes and their related ethnic reasoning, good or bad, typically bear just a few common elements per generation or few generations period.  A number of related procedures were developed as well to ensure their purpose and activities were justly directed towards the needs of whom they served.  The castration of men was very common, perhaps more than female infibulation practices in some cultural settings.   The development of eunuchs ensured those who were hired met the needs of their employer, instead of the needs of competitors, spies, or enemies.


This eroticus-generated means for protection of the forces was different for the women’s side of politics and the military.  The non-treated males of a given society were like any others in any other societies–meaning the women intended for leaders and royalty to become involved or engaged with were not necessarily “protected” from whatever the other options were in their life experience.  The means for controlling these processes, from the women’s perspective, involved equally aggressive processes focused on manipulating their body form, functionality and desirability, as well as finding the means to still physically control such activities even when the opportunities surfaced for  these behaviors to ensue.

The latter issue was an easier issue to contend with, and involved the well known option of producing a chastity belt in order to deter the potential male (or sometimes female) partner(s).

By the dawn of the eighteenth century, with the scientific revolution well underway, the knowledge of anatomy and physiology helped scholars, and sometimes physicians, develop useful theories for understanding the interplay of human consciousness, thought processes, emotions, and the desire for sex.  Astrologers had a long history of trying to define this unique interplay of supposed natural “forces” between two different beings or objects.   During the 17th century, astrologers’ ideas were still circulating about the medical and early human psychology fields, but were often intertwined with the similar ideologies posed to scholars by alternative cultures and their own unique philosophies.

The mid 17th century was when science had to explain the role of the nerves aligning the spine, which they defined as the source for sympathetic activities in the body that take place to modify and controls its reactions to everything internal and external to the corpus in general–they named it the sympathetic nerve.  Over the next few decades, the sympathetic nerve was related to the energy of heat, the element of fire in the body, and these could be likened to the oriental philosophy of chi (a term they did not use in their writings), which in turn many felt reconfirmed much older hippocratic teachings.


Daniel Turner, donated a set of his books to the Yale Medical Library when it opened.  Author of books on the mother and her influences on the health and formation fo the child in utero, such as The Force of the Mother’s Imagination upon her Foetus in Utero, Still Farther Considered (1730)

From these insights came other theories about the body’s energy, its animated powers, its emotions and metaphysical responses.  By 1700, the notion of a life energy in the human egg and sperm was known, and the notion of seminal power in the production of life a popular metaphysical construct used by physicians to explain the inexplicable nature of humans to engage in certain behaviors as if they were out of their conscious control.  The “sperm” of the egg, its energy, could be born by either man or women, but the nature of science often led its followers to believe that the “sperma” produced by man gave the ova of women the life force it needed. Thus, when it came sexual activity, performance, and physical events produced by way of these activities, the male was the producer of life, but woman the vessel.  This further detailed and separated the roles that each gender had in sex and reproduction, the production of the life force, by merging the metaphysics of one with that of the other, only in a different form.

Between 1720 and 1750, this dominated some of the mental concepts continuously being shared between physicians and philosophers.  During the late 1600s, the remaining philosophies of alchemists were transposed into more related religious and philosophical concepts, by chemists Robert Boyle and Johannes von Helmont, and chemist-physician Herman Boerhaave, personified in their metaphysical value by Paracelsus and Jakob Boehme (entia), and transformed into a very much God-given Christian philosophy by the Harvard natural philosopher (to us a scientific “medium”) Charles Starkey (ens veneris).  This made mankind seem uncontrollable due to his/her “passions”, and the nature by which their energies wished to flow freely, without physical restraints.


When we look at the popular writings for this time of a “scientific”, scholarly, and philosophical nature, we find their mention of sexual desire and activity to be much along these same philosophies of the then past and present.  But when it came to controlling these behaviors, the physical procedures needed to change or modify the human behavior were important.  These dictionaries commonly explained to their readers the purpose of the castration, clitorectomy and infibulation. Treating this as a fair non-preferential human sexual topic, men’s need for these processes were explained almost as fairly as the women’s need for their equivalents.

The more historical nature of the need to control male in Western societies led this particular philosophy along a different route than the same for a woman’s “lack of control.”   The religious influences now prevail, and the notion of prostitution and infidelity become important concepts by the 1770s, as the philosophy of controlling sexual vigor finally reached at state that was desperately in need of change.

In the late 1760s and 1770s, two common themes prevailed for writings pertaining to women–circumcision and infibulation.  For men, these two terms could also relate, but the main means for controlling masculinity was castration, a practice by then atypical of western societies, except when the dire need for it exists, or when it becomes the result of an “accident”.  By this time as well, the published notes about the practice of the same purportedly by Native Americans were in the public press.  These behaviors reminded some of the nearly identical medical practices engaged in by African and some “Oriental” (including Middle Eastern or Muslim) communities.

During the 1780s and 1790s, this transition of infibulation into a mostly female related process continued to develop.  Reminiscences of the ancient Greek and Roman practices of male infibulation are noted in the historical writings here and there, but as for the contemporary practice of this process, it was slowly becoming intended mostly if not only for women.

The male circumcision process now had its culturally defined places for being practiced, as well as infibulation, castration, “generation” or “degeneration”, and  “skoptziism”.  Their causes were different for the infibulation and clitorectomy procedures performed on women.



The Skoptzy are an unmentioned culture that thrived in certain parts of Eastern Europe.  Yet they are the equivalent to the women of African engaged in the ritual process of clitorectomy and infibulation.  They voluntarily undergo a ritual castration of external sexual organs, thus removing their ‘semenic’ power and reducing the “pleasure” sensing parts of their body, which otherwise might distract them from their cause and purpose.

To demonstrate their faith and their willing to adhere to its teaching about fidelity only to one, they undergo a ritualistic physical castration of both phallus, most of the scrotum, and its testicular contents.  In modern societies, such as practice is rare, if it indeed still exists.  Many modern “castrations” that are performed are engaged in medically, and for medical reason, using unusual chemical and pharmaceutical castration processes.



From a missionary pamphlet, for education of travelling missions students. (The small two-pointed spot is the belly button, beneath which is the belly and then pubic area (hair possibly included); the left and right lower parts are right and left thigh, respectively, with the skin creases and joints between these parts.)

In most of western European post-renaissance history, nearly every generation had one or a few reasons for considering a faith-proving intervention.  The first and by far the broadest reason shared by cultures stems from the adolescent desire for promiscuity and sex, involving both genders.  The second reason for genital modification, in terms of cultural beliefs, is the focus on the desire to control the mind and emotions, most often privately expressed in the form of “onanism”, as they termed it during the 19th century, or masturbation, as it is referred to today.  Like the concerns for uncontrollable desire and promiscuity, the fear of “onanism” also pertained to both genders.

Whereas the above two sexual desires pertain to both genders, the third reason often given focuses on just the nature of the female body.  It is considered the receptacle and instigator of the opposite sex.  The desire to control it was important to the minds of community leaders.

To control this problem, in the physical sense, two different preventive measures could be taken.  The first was to prevent the sex acts from occurring, by closing up the orifice.  The second involved producing a physical defense against potential perpetrators.

Such logic of course pertains mostly to the traditional western philosophy pertaining to chaste and virginity.  Whereas a simple physical device served this purpose in many cultures, the means for protecting the body from unwanted advances without such a device required extensive modification of the body/reservoir of such unwanted people.  Due to cultural beliefs, this practice makes the infibulation and circumcision process unique in that is is mostly a practice argued for a defined by cultural beliefs, as held by the family, parents and/or individual willing to engage in this activity.

This need to control the attractive feature, if performed on an adult, may have the mental health required for it to be allowed by its recipient.  But in most traditional settings where this practice is engaged in, the lack of sufficient reasoning for the need of infibulation and/or clitorectomy practices makes this unwarranted by most outside cultures.  The lack of understanding that children have about this procedure, and the level of maturity that they are at,  turn them into passive, forced recipients of this medical procedure.

This cultural split in the ideology of this procedures has been evident since the late 18th and early 19th century.  However, during those decades, we see several transitions in Western philosophy take place that temporarily support one of more reasons why these practices might be allowed.


In Western Europe, much of the Christian interpretation of onanism was in full control of these activities; with few exceptions, we find this reasoning prevail over others in the writings published during this time.  But around the end of the 18th century, Malthusianism was having an influence upon much of what society was thinking about population growth and crowding.  This led a number of leaders and governing heads to consider the role of infibulation and even castration or the promotion of “eunuchism” as methods for prevent the Malthusian predictions of the future.

And not that surprisingly, this belief system did perpetuate for several decades, almost to the mid-19th century, but it is infrequently mentioned.  When it is argued, the emphases are placed once again on maintaining family integrity, the control of human emotions control, preventing onanist behaviors from fostering sick and unhealthy children.  By this the mid to late 1800s, we find the practice of infibulation has become a mostly female-targeted procedure, and a major moral issue for western, non-Islamic societies, around the world.

The development of this practice in Africa and parts of the Middle East since the early to mid-1800s helped to stabilize its cultural meaning, resulting even in its ability to exist because it is a culturally specific behavioral practice with belief systems different from western traditions, that enabled these practices to continue.  For political and financial reasons, it enabled the woman to become more powerful through attractivity, but less powerful in terms of position within society.  The idea that prostitution and lust were to be prevented gave medical professionals even more reasons to promote the female genital modification procedures like clitorectomy and infibulation.  It was also during this time that the definitions of three types of procedures became well known and published, and their inventors or instigators well defined and targeted by the anti-gender discrimination groups developing in the western world.

From about 1850 to 1875, the first versions of the modern interpretation of genital “modification” or “mutilation” were published, referred to by their previous names for the time, without the cultural inferences linked to a term like “mutilation”.


The first US Medical Journal article on infibulation.  This complete article may be reviewed at https://brianaltonenmph.com/6-history-of-medicine-and-pharmacy/hudson-valley-medical-history/carribean-and-african-medicine-in-the-valley/a-disease-peculiar-to-the-children-of-negro-slaves-1810/

United States History

The first detailed description in United States medical literature of what we today refer to as female genital mutilation (FGM) is found in the Medical Repository, one of two of the earliest medical journals published in the newly formed United States during the late 18th century.  This article was penned by a physician, in the form of a retrospective case study drawn up from memory by a physician who was hired by a plantation owner in the mid-Atlantic region to manage the health of local slaves (see my full page on this, with the article, at https://brianaltonenmph.com/6-history-of-medicine-and-pharmacy/hudson-valley-medical-history/carribean-and-african-medicine-in-the-valley/a-disease-peculiar-to-the-children-of-negro-slaves-1810/ ).


Title, figure 1, “Infibulation” and dedication page, from the 60 page tome entitled (as per rough translation) “The Hidden Truths of Ethnography: on the circumcision of women, virginity, infibulation, aging, eunichs, skopticism, padlocks and belts.”   In the figure, a mature lady is presented, possibly with a “hottentot apron”, but also alluding to preparation for infibulation.

A number of accounts of this practice were noted in the journals kept by travelers of Africa during the late 18th and 19th century.  One of the first fairly explicit ethnomedical essays on this procedure and several related cultural medical practices is French Navy Commandant Émile Duhousset’s  Les huis-clos de l’ethnographie : de la circoncision des filles, Virginite, Infibulation, Generation, Eunuches, Skopizis, Cadenas, Ceintures. (Londres, 1878.  Accessed at http://gallica.bnf.fr/ark:/12148/bpt6k5719939q/f4.image.r= ), published under the penname “E. Ilex” (see also Google version at https://books.google.cat/books?id=4qMvQwAACAAJ ).

Prior to 1960 (1900-1960, perhaps as early as 1865), many of the items published on infibulation were primarily anthropological in nature and provided the medical anthropologist’s perspective.  Medical cases came to be reported by the 1950s, resulting in a shift in philosophy about moral and ethical issues regarding this practice.  This cultural perspective however, being western based, had little if any influence on the actual practice of these rituals.  Until the 1960s, very little was known within the medical profession about this process, and with few if any patients presenting with these conditions, the understanding of this condition and its health consequences remained unlearned material for nearly all physicians, except foreign trained attending physicians.

As an example of this dilemma in health care, in a fairly early publication on this process in the British Medical Journal dated 1964, a brief description of the procedure was given along with the following two black and white images of the affected parts.  Its purpose was to detail what to nearly all physicians in the United States was a new and unessential therapeutic process capable of causing numerous health risks and repercussions.  Over the next few years, this now primarily female targeted diagnosis or state became of global interest.  (Dewhurst, C. J., & Michelson, A. (1964).



In 1962, 1966, and 1967,  pivotal articles for the African medical ethnomedicine field were published on this topic, the most influential British Journal of Obstetrics and Gynaecology (Mustafa, 1966), and by the Sudan Medical Journal (Shandall, 1967).  The first was a general overview of this practice, the second a more thorough clinical review in which three consequences of this process were mentioned: urinary retention, hemorrhaging and the post-procedural/post-surgical shock induced by pain and infection-related physical, emotional and/or mental consequences (Shandall, 1967).  About the same time of this review, a presentation was made on the history of these procedures on local sociocultural and economic stability and their influence upon future international relations (Modawi, 1967).


Dewhurst, C. J., & Michelson, A. (1964). Infibulation complicating pregnancy. British Medical Journal, 2(5422), 1442. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1817445/?page=1 )

Modawi, S. (1967). The impact of social and economic changes in female circumcision. [Unpublished Presentation].

Mustafa, A. Z. (1966), FEMALE CIRCUMCISION AND INFIBULATION IN THE SUDAN. BJOG: An International Journal of Obstetrics & Gynaecology, 73: 302–306. doi:10.1111/j.1471-0528.1966.tb05163.x

Shandall, A. A. (1967).  Circumcision and infibulation of females: a general consideration of the problem and a clinical study of the complications in Sudanese women. Sudan Medical Journal, 5(4), 178-212. Accessed at http://www.popline.org/node/510718#sthash.v3u2Jiju.dpuf ).

Published Bibliography

Westley, David M.  (1999).  Female Circumcision and Infibulation in Africa.  Accessed at EJAB: Electronic Journal of African Bibliography.  Vol. 4. Accessed at http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1009&context=ejab




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