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Posted: 10/28/2006 9:07:30 AM EST
[Last Edit: 10/28/2006 9:11:43 AM EST by Hebrew_Battle_Rifle]
Trial Draws Attention to Genital Cutting
By DOUG GROSS (Associated Press Writer)
From Associated Press
October 27, 2006 6:25 PM EDT

LAWRENCEVILLE, Ga. - The trial of an Atlanta-area father accused of circumcising his 2-year-old daughter with scissors is focusing attention on an ancient African practice that experts say is slowly becoming more common in the U.S. as immigrant communities grow.

Khalid Adem, a 30-year-old immigrant from Ethiopia, is charged with aggravated battery and cruelty to children. Human rights observers said they believe this is the first criminal case in the U.S. involving the 5,000-year-old practice.

Prosecutors say Adem used scissors to remove his daughter's clitoris in their apartment in 2001. The child's mother said she did not discover it until more than a year later.

"He said he wanted to preserve her virginity," Fortunate Adem, the girl's mother, testified this week. "He said it was the will of God. I became angry in my mind. I thought he was crazy."

The girl, now 7, also testified, clutching a teddy bear and saying that her father "cut me on my private part." Adem cried loudly as his daughter left the courtroom.

Testifying on his own behalf Friday, Adem said he never circumcised his daughter or asked anyone else to do so. He said he grew up in Addis Ababa, the capital of Ethiopia, and considers the practice more prevalent in rural areas.

Adem, who removed a handkerchief from his pocket and cried at one point during his testimony, was asked what he thought of someone who believes in the practice. He replied: "The word I can say is `mind in the gutter.' He is a moron."

His lawyer, Mark Hill, acknowledged that Adem's daughter had been cut. But he implied that the family of Fortunate Adem, who immigrated from South Africa when she was 6, may have had the procedure done.

The Adems divorced in 2003, and Hill suggested that the couple's daughter was encouraged to testify against her father by her mother, who has full custody.

If convicted, Adem, a clerk at a suburban Atlanta gas station, could get up to 40 years in prison.

The U.S. Department of Health and Human Services, using figures from the 1990 Census, estimated that 168,000 girls and women in the U.S. had undergone the procedure or were at risk of being subjected to it. (if this monsterous behavior crosses "ethnic and religious lines", how would one establish that a certain number of girls are at "risk of being subjected to it?" This sounds like a lie to me)

The State Department estimates that up to 130 million women worldwide had undergone circumcision as of 2001. Knives, razors or even sharp stones are usually used, according to a 2001 department report. The tools often are not sterilized, and often, many girls are circumcised at the same ceremony, leading to infection.

It is unknown how many girls have died from the procedure, either during the cutting or from infections, or years later in childbirth.

Nightmares, depression, shock and feelings of betrayal are common psychological side effects, according to the federal report.

The report estimated that 73 percent of women in Ethiopia had undergone the procedure, based on a 1997 survey.

Taina Bien-Aime, executive director of Equality Now, an international human rights group, said female circumcision is most widely practiced in a 28-country swath of Africa. She said more than 90 percent of women in Ethiopia are believed to have been subjected to the practice, and more in places like Egypt and Somalia.

"It is a preparation for marriage," Bien-Aime said. "If the girl is not circumcised, her chances of being married are very slim."

The practice crosses ethnic and cultural lines and is not tied to a particular religion. ( yeah, sure, unhuh, you bectha. lots of jews, bhuddists, and christians are cuttin their little girls privates up ain't they?! ) Activists say the practice is intended to deny women sexual pleasure. In its most extreme form, the clitoris and parts of the labia are removed and the labia that remain are stitched together.

"I had maybe read about it in Reader's Digest or some other journal, but not really considered it a possibility here," said Dr. Rose Badaruddin, the pediatrician for the Adems' daughter.

Many refugees from Ethiopia and Somalia come to Georgia through a federal refugee resettlement program.

"With immigration, the immigrants travel with their traditions," Bien-Aime said. "Female genital mutilation is not an exception."

Federal law specifically bans the practice, but many states do not have a law addressing it. Georgia lawmakers, with the support of Fortunate Adem, passed an anti-mutilation law last year. Khalid Adem is not being tried under that law, since it did not exist when his daughter's cutting allegedly happened.
Link Posted: 10/28/2006 9:11:29 AM EST
Thread I posted about the same practice in the UK. ar15.com/forums/topic.html?b=1&f=5&t=510683

Link Posted: 10/28/2006 9:21:22 AM EST

Female circumcision and genital cutting

INTRODUCTION — Female genital cutting (FGC), also known as female circumcision or genital mutilation, is a culturally determined practice, predominantly performed in parts of Africa and Asia and affecting more than 130 million women and girls worldwide [1]. Recent immigration patterns have caused obstetricians and gynecologists throughout the world to increasingly encounter women who have experienced this practice. It is imperative that these providers understand the health and social issues related to FGC so that they can manage the immediate and long-term complications of the procedure.

TYPES — FGC refers to the manipulation or removal of external genital organs in girls and women. The World Health Organization classified FGC into four types of procedures.

* Type I consists of excision of the prepuce, with or without excision of part of all of the clitoris.

* Type II involves clitoridectomy and partial or total excision of the labia minora.

* Type III, or infibulation, includes removing part or all of the external genitalia and reapproximation of the remnant labia majora, leaving a small neointroitus.

* Type IV involves other forms of injuries to the genital region including pricking, piercing, stretching, burning, scraping or any other manipulation of external genitalia [1,2].


They even have their own 'types' like AK receivers.


ORIGINS AND RATIONALE — The origins of FGC are unknown, but theories as to its origins date back to ancient Egypt, pre-Islamic Arabia, ancient Rome, and Tsarist Russia [3-5]. More recently, this practice has come to represent an important rite of passage for girls into womanhood within some cultures. It is thought by some to be a religious custom, but no religion condones it. It is reinforced by customary beliefs that it maintains a girl's chastity, preserves fertility, ensures marriageability, improves hygiene, and enhances sexual pleasure for men.

In Europe and the United States, removal of the clitoris or prepuce was occasionally performed to treat clitoral enlargement, redundancy, hysteria, lesbianism, and erotomania up until the 1930s [6].

Most of the time, circumcision is done out of love. Parents initiate this procedure for their daughters, not to them. Being a wife and a mother is a woman's livelihood in these societies; thus not circumcising one's daughter is equivalent to condemning her to a life of isolation. Infibulation safeguards her virginity, preserves her chastity, and ensures her eligibility for marriage, thereby protecting her future.

Many women who have undergone FGC do not consider themselves to be mutilated. They do not believe that they are being selectively tortured because the majority of women in their community have gone through this ritual. Those who immigrate to the United States from refugee camps may be surprised to learn that most women here are not circumcised. Therefore, these women can be offended if they are referred to as having undergone genital mutilation. Instead, it is better to use the term circumcision, genital cutting, or the exact word they use in their language. Women who have undergone FGC have voiced concern that health care providers are not sensitive when broaching this subject and sometimes must be educated about this practice by the patient herself.

PROCEDURE — Circumcision is performed between the ages of 5 and 12, in some places during a celebration in which the girl receives gifts of money, gold, and clothes. Invited families and friends often bring food and music to the festivities. In other regions, however, girls are abducted in the middle of the night to be circumcised.

Nonmedically trained operators usually perform FGC. Anesthesia and antibiotics are rarely administered. The instruments used are old, rusty knives, razors, scissors, or heated pebbles, which are rarely washed between procedures. Hemostasis is assured by catgut sutures, thorns, or homemade adhesive concoctions such as sugar, egg, or animal excrement. The girl's legs are bound around the ankles and thighs for approximately one week after the procedure, and she is kept in bed. However, the circumcision can be done under more sterile conditions and an anesthetic may be administered when performed in major cities.

COMPLICATIONS AND OUTCOME — There are both short and long-term complications related to this procedure. However, health care providers should be aware that circumcised women present with a variety of complaints and their circumcision is not necessarily the problem. It is also important to stress that not all women suffer complications.

Periprocedural complications — Surgical precision can be compromised by lack of anesthesia, the struggles of the child held forcibly in the lithotomy position, and the experience of the operator. Success is often dependent upon chance, rather than accuracy. Early post-procedure complications thus include hemorrhage, infection, oliguria, and sepsis (show table 1) [7].

Long-term gynecological issues — Women who have undergone type II or III FGC tend to suffer more long-term complications than those who have undergone type I or IV.

* The most common long-term complications are dysmenorrhea, dyspareunia, and chronic vaginal infections. Other complications are related to voiding (show table 2) . Meatal obstructions and urinary strictures could develop if the urethral meatus was inadvertently injured. Affected women complain of straining, urinary retention, or a slow urinary stream. An infibulated scar can also result in the urine becoming stagnant, thereby facilitating the ascent of bacteria into the urethra. Infibulated women are thus at higher risk for meatitis, urinary stones, and chronic urinary tract infections [9,10].

* Other complications from scarring include fibrosis, keloids, sebaceous cysts, vulvar abscesses, and partial or total fusion of the labia minora or majora. The latter complication can lead to hematometra or hematocolpos. In addition, a small neointroitus may cause vaginismus, chronic vaginal infection, and neuromas [11,12].

* The infertility rate is higher in circumcised women compared to the general population (25 to 30 versus 8 to 14 percent) [13]. The frequency of infertility appears to correlate with the anatomical extent of FGC [14]. Introital and vaginal stenosis create a physical barrier; thus, couples may attempt coitus for months before completing penetration [15]. Failure to succeed and persistent dyspareunia can lead to apareunia [16]. Infertility may also be related to tubal damage from ascending infection related to the procedure.

* Sexual satisfaction has been difficult to ascertain because of the sensitive nature of the topic. One survey that interviewed circumcised women reported they were able to achieve orgasm [17]. However, a study of 1836 circumcised Nigerian women found that the procedure (type 1 and II) did not attenuate sexual feelings or frequency of intercourse and was associated with a higher prevalence of abnormal vaginal discharge and pelvic pain [18]. Another study also showed that those who had undergone type III infibulation were significantly affected in terms of sex drive, arousal and orgasm when compared with those who had undergone a type I procedure [19].

Obstetrical issues

Monitoring labor — Progress of labor is typically monitored using serial cervical examinations. Performing a pelvic exam on an infibulated woman can be challenging. The narrow neointroitus can make a bimanual exam difficult, if not impossible. Obstetricians face the dilemma of either defibulating the woman early in labor or monitoring the labor via rectal exam. Neither of these is an optimum solution: early defibulation would require a very early epidural and irritation of the incision with every cervical assessment, while rectal examination of the cervix is uncomfortable and most obstetricians have no experience using this technique in labor. However, inaccurate cervical assessment is also problematic because latent phase of labor may be falsely diagnosed as active labor and lead to an unnecessary cesarean delivery. Other challenges include difficulties placing a fetal scalp electrode, intrauterine pressure catheter, or Foley catheter and performing fetal scalp pH.

The infibulated scar can prolong only the second stage of labor, probably because the scar may obstruct crowning and delivery [20]. A defibulation procedure during the second trimester is strongly recommended to prevent this problem [21].

Pregnancy outcome — A WHO study group compared obstetrical outcomes of women with and without FGC (n=7171 no FGC, 6856 FGC 1, 7771 FGC II, 6595 FGC III) [22]. Women with FGC II and III, but not FGC I, were at significantly higher risk of cesarean delivery, postpartum hemorrhage, and extended maternal hospital stay, and their infants were at significantly higher risk of requiring resuscitation and of dying in the hospital than women without FGC. The risks were higher in women with FGC III than FGC II. Nulliparous and parous women with FGC I, II, and III had higher rates of episiotomy and perineal tears than women without FGC.

DEFIBULATION COUNSELING AND PROCEDURE — Women seek defibulation because they are pregnant or planning pregnancy, or because of apareunia/dyspareunia, dysmenorrhea, or difficulty urinating [23].

The optimum time to defibulate a woman is prior to coitus to prevent dyspareunia or prior to pregnancy to prevent obstetric complications. What is medically beneficial to the woman, however, may not necessarily be the best time for her. As discussed above, one of the reasons for female circumcision is to ensure virginity. Therefore, these women may prefer to marry and prove their virginal status prior to defibulation.

Defibulation can be performed during pregnancy. A woman may require multiple prenatal visits before she finally consents to the procedure [21]. Counseling her about the risks of delivery with an infibulated scar is critical; the risks (eg, bleeding, infection, scar formation, preterm labor) and benefits of defibulation must also be reviewed and she should be aware that her urinary stream will feel different (increased).

Surgery during the second trimester under regional anesthesia decreases both obstetrical and fetal risks. General anesthesia is an alternative, but local anesthesia is not a good choice because women sometimes develop flashbacks from their circumcision.

One series of 32 patients who underwent defibulation reported that all of the women and their husbands were satisfied with the results [23].

Technique — The infibulated scar is a flap obstructing the introitus and urethra that must be excised. The steps in the procedure are as follows [23]:

* Place regional or general analgesics and long-acting local anesthesia.

* Insert a Kelly clamp under the scar to delineate its length (show picture 1).

* Palpate anteriorly to assess whether the clitoris is buried under the scar).

* Place two Allis clamps along the infibulated scar

* Make an anterior incision between the two Allis clamps with Mayo scissors, being certain not to cut into a buried clitoris (show picture 2A-2B). The goal is to view the introitus and urethra easily (show picture 3). There is no need to incise too anteriorly towards the clitoral region.

* Place (4.0) subcuticular sutures on each side (show picture 4 and show picture 5).

Postoperatively, instruct the patient to take sitz baths twice each day. Lidocaine cream (2 percent) can be applied after the sitz bath. Opioid analgesics taken as needed for one or two days is usually adequate for postoperative pain control [24].

A treatment technique using carbon dioxide laser surgery has also been described [25].

REINFIBULATION — Some women who have just given birth will request immediate reinfibulation. The procedure may create the long-term complications previously mentioned and should be strongly discouraged. The woman may only feel comfortable being infibulated; her request should be respected. The United States passed a law in March 1997 that made performing any medically unnecessary surgery on the genitalia of a girl younger than 18 years of age a federal crime. However, reinfibulation was not included as a federal crime, so it may be performed with absorbable sutures in a running fashion if a woman strongly insists upon the procedure [26].

SUMMARY AND RECOMMENDATIONS

* There are four types of female genital cutting. (See "Types" above).

* The number of African immigrants and refugees coming into the United States is increasing, bringing renewed interest in unique cultural traditions [27]. The most important aspect of caring for circumcised women is to develop a trusting relationship. Obstetrician-gynecologists should move beyond the scar and address the woman's health needs, such as pregnancy tests, annual Papanicolaou smears, mammograms, and hormone replacement therapy recommendations. Cultural awareness and sensitivity regarding the procedure are crucial. (See "Origins and rationale" above).

* Potential problems after female genital cutting include dysmenorrhea, dyspareunia, chronic vaginal and bladder infections, voiding difficulties, fibrosis, keloids, sebaceous cysts, vulvar abscesses, infertility, and difficulty with pelvic examinations, coitus, and vaginal delivery. (See "Complications and outcome" above).

* We suggest defibulation prior to coitus to prevent dyspareunia or prior to pregnancy to prevent problems with vaginal delivery (Grade 2C). (See "Defibulation counseling and procedure" above).



I'd post pics but it would violate the CoC.
Link Posted: 10/28/2006 9:29:17 AM EST
Kill him with fire.
Link Posted: 10/28/2006 9:47:04 AM EST

The practice crosses ethnic and cultural lines and is not tied to a particular religion. ( yeah, sure, unhuh, you bectha. lots of jews, bhuddists, and christians are cuttin their little girls privates up ain't they?! )


No, not really. It is, however, most commonly practiced among people belonging to smaller, more localized religions which are generally lumped together under the term "animism," or religions that generally believe that everything is alive and has a soul ("animism" comes from "animus," meaning "mind" or "soul"). Whether or not the practice is done or permitted in Muslim groups depends on the group. The Shafi'i school of Islam at one time ordered a slight trimming of the clitoral hood that was thought to enhance sexual pleasure. The Shias practice something similar. It is not, however, mandatory (although like male circumcision, the one being circumcised usually doesn't have any say in the matter, and it's rather the parents who choose). Many Arab Muslims reject the practice entirely, saying it's un-Islamic.


Originally Posted By Tim84K10:
Kill him with fire.


Has he been found guilty? It sounds like he's still under trial. You know, that thing that we all have a right to, and an impartial one at that, according to the Constitution?
Link Posted: 10/28/2006 10:07:47 AM EST

Originally Posted By MagKnightX:

The practice crosses ethnic and cultural lines and is not tied to a particular religion. ( yeah, sure, unhuh, you bectha. lots of jews, bhuddists, and christians are cuttin their little girls privates up ain't they?! )


No, not really. It is, however, most commonly practiced among people belonging to smaller, more localized religions which are generally lumped together under the term "animism," or religions that generally believe that everything is alive and has a soul ("animism" comes from "animus," meaning "mind" or "soul"). Whether or not the practice is done or permitted in Muslim groups depends on the group. The Shafi'i school of Islam at one time ordered a slight trimming of the clitoral hood that was thought to enhance sexual pleasure. The Shias practice something similar. It is not, however, mandatory (although like male circumcision, the one being circumcised usually doesn't have any say in the matter, and it's rather the parents who choose). Many Arab Muslims reject the practice entirely, saying it's un-Islamic.


Originally Posted By Tim84K10:
Kill him with fire.


Has he been found guilty? It sounds like he's still under trial. You know, that thing that we all have a right to, and an impartial one at that, according to the Constitution?

Uh, no, that is bullshit. ALthough some tribes practice circumcision that are not Muslims the practice is MOST prevalent among Muslims and not just Africans. It is practised from Saudi Arabia and that area all the way to Morocco. Most of the Others that do practice it are "part" of the Islamic world and the habit just crosses religious lines. Very few "animist tribes" practise this ritual. And NO they do not do it for some kind of pleasure for the women AT ALL. The whole entire purpose of it to deny women sexual pleasure so that they will remin "chaste" till they get married. Same with the veils and locking them up in the house 24/7 and of course marrying them as young as possable to avoid "temptation" and making the society an essentially Sexually segregated one. It is NOT really a problem in Africa south of the Sahara, and although it does predate Islam so did slavery, but unlike other cultures that did away with this abhorrent practice Islam has kept it up and nutured it. Ethiopians DO NOT practise this unless they are Muslims, most are christian and do not.
Link Posted: 10/28/2006 10:17:56 AM EST

Originally Posted By MagKnightX:

Originally Posted By Tim84K10:
Kill him with fire.


Has he been found guilty? It sounds like he's still under trial. You know, that thing that we all have a right to, and an impartial one at that, according to the Constitution?


You're right. Wait until he's convicted, then kill him with fire. We still have some rights left in this country, and due process of law is one of them.
Link Posted: 10/28/2006 10:23:34 AM EST
Female circumcision is a comom African Muslim practice. An example of piety by virtue of the blade.
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