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Female “circumcision”: African women confront American medicine.

J Gen Intern Med. 1997 Aug;12(8):491-9.

Female “circumcision”: African women confront American medicine.

Horowitz CR, Jackson JC.

Department of Health Policy, Mount Sinai Medical Center, New York, NY 10029, USA.

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…

Comment in J Gen Intern Med. 1997 Aug;12(8):513-5.

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Irreversible error: the power and prejudice of female genital mutilation.

J Contemp Health Law Policy. 1996 Spring;12(2):325-53.

Irreversible error: the power and prejudice of female genital mutilation.

Annas CL.

Catholic University of America, Columbus School of Law, USA.

There is no abstract available for this article.

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Female genital mutilation. Council on Scientific Affairs, American Medical Association.

JAMA. 1995 Dec 6;274(21):1714-6.

Female genital mutilation. Council on Scientific Affairs, American Medical Association

[No authors listed]

Female genital mutilation is the medically unnecessary modification of female genitalia. Female genital mutilation typically occurs at about 7 years of age, but mutilated women suffer severe medical complications throughout their adult lives. Female genital mutilation most frequently occurs in Africa, the Middle East, and Muslim parts of Indonesia and Malaysia, and it is generally part of a ceremonial induction into adult society. Recent political and economic problems in these regions, however, have increased the numbers of students and refugees to the United States. Consequently, US physicians are treating an increasing number  of mutilated patients. The Council on Scientific Affairs recommends that US physicians join the World Health Organization, the World Medical Association, and other major health care organizations in opposing all forms of medically unnecessary surgical modification of the female genitalia.

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Female circumcision: a report of four adolescents.

J Adolesc Health. 1995 Aug;17(2):128-32.

Female circumcision: a report of four adolescents.

Walker LR, Morgan MC.

University of California, San Diego 94143, USA.

PIP: Although female circumcision is not traditionally performed in the US, health professionals must consider the possibility when seeing a female patient from central Africa that she may have been circumcised. A genital examination
should therefore be part of such women’s routine health maintenance. Pertinent genitourinary symptoms which may be secondary to the circumcision should be elicited. When pelvic exam is difficult or impossible in a patient, pelvic sonography can supplement rectal exam when pelvic pathology is suspected. Some adolescents may desire reconstructive surgery, while others will want only symptomatic treatment if complications arise. It is also important to create a comfortable environment in which relevant psychosocial issues may be discussed as the young women become acculturated into Western society. Four cases of recently immigrated, circumcised adolescent females from Somalia are reported. It is not illegal to perform female circumcision in the US, but efforts are being made to create and implement such legislation. When parents present requesting a circumcision for their daughter, they must be given information about the risks and complications of the procedure and its outcome. Culturally sensitive counseling should be offered to help the family make its decision.

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Female genital mutilation: what every American dermatologist needs to know.

Dermatol Clin. 2011 Jan;29(1):103-9.

Female genital mutilation: what every American dermatologist needs to know.

Dave AJ, Sethi A, Morrone A.

Department of Medicine, Stanford University School of Medicine, CA 94305-5109,
USA. AJDave6@uchicago.edu

Female genital mutilation (FGM) has become more common in the United States with  increased immigration to the United States of individuals from areas where the practice is endemic. Although the root causes of FGM may be multiple, the practice is banned in the United States on all women under age 18 and is increasingly being outlawed by individual state legislatures. American dermatologists should expect to see a growing number of patients having undergone FGM who may present with complications ranging from keloids and epidermal cysts to clitoral neuromas and abscess formation. While treatment of such complications is often elusive and unsuccessful, recognition of the practice may prevent future patient abuse and death. The eradication of FGM will require the concerted efforts of many individuals, both within and outside of the health care field, with dermatologists poised to play a crucial role in diagnosis and management in  the near future.

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The culture of female circumcision.

ANS Adv Nurs Sci. 1996 Dec;19(2):43-53.

The culture of female circumcision.   

Morris R.

School of Nursing, San Diego State University, California, USA.

The issue of female circumcision takes on special significance as more women migrate to the United States from countries where the practice has religious and  traditional underpinnings. Female circumcision is a problem unfamiliar to most Western health care practitioners. This article describes an ethnographic study of the types of female circumcision, the reasons for and against the practice, the health implications of this practice, and cultural attitudes of circumcised women both in Western Africa and as migrant refugees living in the United States. Ethical dilemmas in dealing with this practice and implications for nurses and health care providers are discussed.  PIP: In San Diego, California, health-care providers to a rapidly growing community of 3000-4000 Somali refugees have been confronted with female genital mutilation (FGM) for the first time. In order to help Western practitioners devise ways to deal with this phenomenon, this article describes the history of FGM, the various types of mutilation, attitudes towards the procedure, early attempts to abolish it, reasons why the practice is continued, and reasons why it should be ended. The article then describes the results of an ethnographic study  of the procedure using data gathered in Liberia and Kenya and the results of a needs assessment among Somali refugees in San Diego. In Kenya, the Kpelle tribe conducts the Sande Bush School every few years. This school removes all the young girls from the villages for 6-12 weeks’ training, which includes the secret ritual of FGM. Not all of the girls survive this ordeal. In order to reduce the incidence of mortality, a local hospital sent physicians and nurses into the bush to perform the least destructive type of mutilation in a mobile van. In Kenya, respondents favored the least destructive type of circumcision and adamantly supported the practice. The Somali refugees in the US are undergoing stress adjusting to economic difficulties that make it necessary for women to work outside of the home and make large families prohibitively expensive. All of the interviewed women had the most severe type of infibulation performed, with many of the mutilations taking place in hospitals when they were 5-10 years old. Most  of the women believed the practice was mandated by Islam and were distressed by the refusal of US medical personnel to perform FGM. While health care providers need to understand the cultural forces that support FGM, there is no doubt that it would be unethical as well as illegal to perform the procedure. Cultural diversity must be accepted while cultural change is promoted.

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Perspectives of Somali Bantu refugee women living with circumcision in the United States: a focus group approach.

Int J Nurs Stud. 2009 Mar;46(3):360-8. Epub 2008 Jun 11.

Perspectives of Somali Bantu refugee women living with circumcision in the United States: a focus group approach. 

Upvall MJ, Mohammed K, Dodge PD.

Eta Epsilon Chapter, Carlow University, School of Nursing, 3333 Fifth Avenue, Pittsburgh, PA 15213, USA. upvallmj@carlow.edu

BACKGROUND: The purpose of this study was to explore healthcare perspectives of Somali Bantu refugees in relation to their status as women who have been circumcised and recently resettled in the United States. These women and their families were already uprooted from Somalia to Kenya for over 10 years, increasing their vulnerability and marginal status beyond that of women who have  been circumcised.

METHODS AND PARTICIPANTS: A purposive, inclusive sample of 23 resettled Somali women in southwestern Pennsylvania of the United States participated in focus group sessions for data collection. A supplemental interview with a physician who provided care to the women was also conducted. Verbatim audio taped transcripts from the focus groups and physician interview were coded into primary and secondary levels.

RESULTS: Implications for development of culturally competent healthcare providers include attention to providing explanations for routine clinic procedures and accepting the Somali women regardless of anatomical difference, not focusing on the circumcision. Healthcare providers must also develop their skills in working with interpreters and facilitate trust to minimize suspicion of the health care system.

CONCLUSION: Circumcision is considered a normal part of everyday life for the Somali Bantu refugee woman. Communication skills are fundamental to providing culturally competent care for these women. Finally, healthcare providers must take responsibility for acquiring knowledge of the Somali women’s challenges as refugees living with circumcision and as immigrants in need of healthcare services.

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Female genital mutilation: cultural awareness and clinical considerations

J Midwifery Womens Health. 2007 Mar-Apr;52(2):158-63.

Female genital mutilation: cultural awareness and clinical considerations.

Braddy CMFiles JA.

Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA.

ABSTRACT

Clinicians in the United States are increasingly encountering girls and women who have undergone female genital mutilation. To foster a more trusting relationship with such patients, health care providers must have an accurate understanding of the cultural background surrounding this practice, a working knowledge of the different types of female genital mutilation procedures that may be encountered, and an awareness of both the acute and long-term complications. Some of these complications are potentially fatal, and the correct clinical diagnosis can be lifesaving

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