Background

In a world with an increasing market for genital plastic surgery in forms such as labiaplasty and vaginoplasty, I was interested in researching the history of such procedures as the subject of this article. Although decorated vulvas for the sake of creative expression are almost always fascinating in their many forms, from tattoos to public hair topiary, I was more interested in the surgically enhanced forms of genital presentation. The readers of this Journal will appreciate how rapidly I came up against the vast wall that separates purely cosmetic surgical procedures on adults and those carried out, often on small children, rooted in ethnic traditions and gender control, which are at the very centre of white hot social and political debate today.

On 21 December 2012, the United Nations General Assembly made a statement that the day before it had passed unanimously a resolution urging countries to ban the practice of female genital mutilation (FGM), calling it an “irreparable and irreversible abuse”. Such mutilation has its origins in many cultures going back century upon century. As much of the information is cloaked in secrecy and in view of the rarity of literate females being able, or willing, to record their own experiences, it is an exceedingly complex area to research. I therefore intend to give readers just a sense of the history of FGM.

History of FGM

Salima Ikram, Professor of Egyptology at the American University in Cairo, has stated that there is no physical evidence of FGM on any known mummies, nor is it to be found within ancient art or literature. Professor Ikram considers that the practice probably originated in sub-Saharan Africa and was subsequently adopted in Egypt. A Greek papyrus dated c.163 BC provides evidence of the procedure being carried out on girls in Egypt at the time when they received their dowries. This is one of the first records of FGM being a rite of passage as a young girl advances to womanhood and marriage.

The Greek academic, Strabo, records one of the earliest mentions of female circumcision in his massive work, Geographica. He visited Eygpt in around 25 BC and wrote of the people that “…they rear every child that is born, and circumcise the males and excise the females”. He also writes that the people of Egypt were zealous in the observation of this custom.

Aetios, a 6th century AD physician, wrote that he believed the Egyptians were right to cut the clitoris if it was unusually large. He considered such a clitoris to be a deformity and that the constant rubbing against clothes would be such a stimulus for sexual activity that it would bring shame on the girl.

The actual reasoning behind many customs associated with the various degrees of FGM seems long forgotten except for the continuation of the ritual simply because it was practised by the forefathers and therefore should be continued.

It would be quite wrong to assume that historically FGM was practised solely in Africa and in certain Middle Eastern and Asian cultures. Some of the more extreme procedures were carried out here in the British Isles in the 19th century.

Cure for hysteria

Surgeon Isaac Baker Brown (1812–1873) was an English gynaecologist who rose through the ranks to become the President of the Medical Society of London. He believed that masturbation of the clitoris was the main cause of hysteria and mania in women and could even lead to epilepsy. He then went on to remove the clitoris of a number of patients and sometimes would remove the inner labia too. In 1866 he published his views in the publication On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy and Hysteria in Females. This work caused a degree of uproar in the medical community, not least because it seems that Dr Baker-Brown performed the operations without consent and his professional colleagues considered the procedure a mutilation. Baker-Brown would go on to be expelled from the Obstetrical Society of London and his name fell into disrepute.

Far from conferring any health benefits as Baker-Brown believed, the consequences of FGM affect the health of women throughout their lives. FGM is now seen for what it is: an abuse of human, women's and children's rights.