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Female “circumcision” African women confront American medicine

The practice of female “circumcision,” or traditional female genital surgery, is simultaneously complex and controversial. Although some consider it a human rights infringement, others view it as an integral part of cultures in which it remained unchallenged for centuries. With more than 30,000 Africans entering the United States in the last decade, American clinicians are challenged with meeting African women’s health needs, as they are barraged with a debate about the ethics and politics of circumcision. 
 
There are significant medical sequelae and public health ramifications of female circumcision; therefore most U.S. physicians probably would agree that programs to abolish it should continue. However, although there is ample media and political attention to this volatile issue, there is a relative dearth of practical, clinical information available to providers who care for circumcised women and their families. As African communities and advocates grapple with how to stop this practice, circumcised women need clinicians familiar with these surgeries, who will move beyond negative feelings they may have about the practice in order to treat women knowledgeably and with dignity. It is important to distinguish respect from unreflective acceptance. However, blanket condemnation by health workers will not help families decide how to break a long-standing tradition by choosing not to circumcise their daughters. On the contrary, by unwittingly conveying revulsion toward circumcised women and children, providers may drive these families away from the health care they need. 
 
Our objective is to understand and address the conflicts that occur when clinicians provide care to patients whose beliefs and practices differ from their own. We review the practice, cultural significance and medical complications of female circumcision, and offer sensitive clinical guidelines, illustrated by case examples, for caring for currently circumcised women.