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The BMJ news summary errs. (1) Close reading of the American Academy
of Paediatrics (AAP) Bioethics Committee statement (2) shows that, despite
sensitively explaining the cultural meanings, procedures, consequences and
illegality, the 1998 stance (3) has been modified; proposing legal change
in the USA to enable paediatricians to “reach out to families by offering
a ritual nick as a possible compromise”. FGC is not a treatment in the
child’s best medical interests. (4) Cultural rituals, rites of passage,
adult female sexual pleasure and marriageability are not within the scope
of appropriate, expert paediatric practice. A girl without a problem is
not a patient; the doctor becomes a stranger with no indication to expose,
touch or cut the genitalia. Different approaches, including moratoriums
on non-medically indicated genital alteration, have been suggested until
adolescents or adults can make the decision themselves, e.g. in children
with disorders of sex development (5,6) and circumcised boys. (7) Girls
could accuse the AAP of disregarding unconsented damage to their sexual
lives and betraying the trust vested in the medical profession. If parents
or associates perform the “nick” they take responsibility for any
consequences. If doctors charge a fee-for-service, they have an interest
in creating a veneer of ‘medical respectability’. The coy presentation of
laceration as harm limitation condones FGC and will have worldwide
repercussions. The AAP must be condemned for giving ideological succour to
medical involvement in ritual FGC. However minor, assaults on children
should be named and requests met with a gentle but firm ‘no’.
Susan Bewley MD FRCOG MA
Consultant Obstetrician, Kings Health Partners, London
Janice Rymer MD FRCOG FRANZCOG FHEA
Professor of Obstetrics and Gynaecology, Kings College London
Sarah Creighton MD FRCOG
Consultant Gynaecologist, University College Hospital, London
(1) In brief. US paediatricians condemn ritual female genital
cutting. BMJ 2010;240:942
American paediatricians give support to medicalised female genital cutting (FGC)
The BMJ news summary errs. (1) Close reading of the American Academy
of Paediatrics (AAP) Bioethics Committee statement (2) shows that, despite
sensitively explaining the cultural meanings, procedures, consequences and
illegality, the 1998 stance (3) has been modified; proposing legal change
in the USA to enable paediatricians to “reach out to families by offering
a ritual nick as a possible compromise”. FGC is not a treatment in the
child’s best medical interests. (4) Cultural rituals, rites of passage,
adult female sexual pleasure and marriageability are not within the scope
of appropriate, expert paediatric practice. A girl without a problem is
not a patient; the doctor becomes a stranger with no indication to expose,
touch or cut the genitalia. Different approaches, including moratoriums
on non-medically indicated genital alteration, have been suggested until
adolescents or adults can make the decision themselves, e.g. in children
with disorders of sex development (5,6) and circumcised boys. (7) Girls
could accuse the AAP of disregarding unconsented damage to their sexual
lives and betraying the trust vested in the medical profession. If parents
or associates perform the “nick” they take responsibility for any
consequences. If doctors charge a fee-for-service, they have an interest
in creating a veneer of ‘medical respectability’. The coy presentation of
laceration as harm limitation condones FGC and will have worldwide
repercussions. The AAP must be condemned for giving ideological succour to
medical involvement in ritual FGC. However minor, assaults on children
should be named and requests met with a gentle but firm ‘no’.
Susan Bewley MD FRCOG MA
Consultant Obstetrician, Kings Health Partners, London
Janice Rymer MD FRCOG FRANZCOG FHEA
Professor of Obstetrics and Gynaecology, Kings College London
Sarah Creighton MD FRCOG
Consultant Gynaecologist, University College Hospital, London
(1) In brief. US paediatricians condemn ritual female genital
cutting. BMJ 2010;240:942
(2) American Academy of Pediatrics. Policy statement – ritual genital
cutting of female minors. Pediatrics
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-
0187v1 published online April 26, 2010 accessed 2/5/2010
(3) American Academy of Pediatrics. Committee on Bioethics. Female
Genital Mutilation. Pediatrics 1998;102;153-156
(4) World Health Organisation. Female genital mutilation.
http://www.who.int/mediacentre/factsheets/fs241/en/ accessed 2/5/2010
(5) Creighton SM, Liao L-M. Changing attitudes to sex assignment in
intersex. BJU International. 2004;93:659-664
(6) Kipnis, K. & Diamond, M: Pediatric Ethics and the Surgical
Assignment of Sex. J. Clin. Ethics 1998;9 (4) 398–410
(7) Circumcision information and resource pages
http://www.cirp.org/library/statements/ accessed 2/5/2010
Competing interests:
None declared
Competing interests: No competing interests