Lucrezia Catania

Seven Things to Know about Female Genital Surgeries in Africa

HASTINGS CENTER REPORT 19 Starting in the early 1980s, media coverage of customary African genital surgeries for females has been problematic and overly reliant on sources from within a global activist and advocacy movement opposed to the practice, variously described as female genital mutilation, female genital cutting, or female circumcision. Here, we use the more neutral expression female genital surgery. In their passion to end the practice, antimutilation advocacy organizations often make claims about female genital surgeries in Africa that are inaccurate or overgeneralized or that don’t apply to most cases. The aim of this article—which we offer as a public policy advisory statement from a group of concerned research scholars, physicians, and policy experts—is not to take a collective stance on the practice of genital surgeries for either females or males. Our main aim is to express our concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of littleknown others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates. In effect, the statement is an invitation to actually have that debate, with all sides of the story fairly represented. Some of the signatories of this policy statement support efforts to promote voluntary abandonment of all practices of genital surgery on children. Other signatories wish to allow parents to continue to circumcise males, but not females. Still other signatories seek to preserve the right of parents to carry forward their religious and cultural traditions and Seven Things to Know about Female Genital Surgeries in Africa

Female Genital Mutilation: A Visual Reference and Learning Tool for Health Care Professionals

Female genital mutilation comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs for nonmedical reasons. Health care providers for women and girls living with female genital mutilation have reported difficulties in recognizing, classifying, and recording female genital mutilation, which can adversely affect treatment of complications and discussions of the prevention of the practice in future generations. According to the World Health Organization, female genital mutilation is classified into four types, subdivided into subtypes. An agreed-upon classification of female genital mutilation is important for clinical practice, management, recording, and reporting, as well as for research on prevalence, trends, and consequences of female genital mutilation. We provide a visual reference and learning tool for health care professionals. The tool can be consulted by caregivers when unsure on the type of female genital mutilation diagnosed and used for training and surveys for monitoring the prevalence of female genital mutilation types and subtypes.

Preliminary Research Into the Psycho-Sexual Aspects of the Operation of Defibulation

Infibulation is the excision of part or all the external genitalia followed by stitching closed the vaginal opening (WHO, 2000). All types of female genital mutilation (FGM) have immediate and long-term complications (Cook, Dickens, and Fathalla, 2002), but long-term complications are more often associated with infibulation than with the lesser excision or sunna. Wheelwright (1989) states that genital mutilation results in significant reduction of sexual desire, El-Defrawi, et al. (2001), report that mutilated women have greater loss of desire and difficulty in reaching orgasm than intact women. Morrone (2001) describes loss of orgasm due to the amputation of the clitoris, and Rymer (2003) reports that, even if FGM has resulted in minimal physical damage, the sexual response is often decreased or absent. In the same way, Thabet and Thabet (2003) report that sexuality is markedly affected in mutilated women. Nevertheless, Ahmadu (2000) suggests that infibulation may not always have a negative impact on women’s psychosexual life. Lightfoot-Klein (1989) reports that circumcised women have sexual

The First Survey on Genital Stretching in Italy

In 2006 and 2007, the first survey of genital stretching (GS) in Italy was implemented in order to evaluate the degree of knowledge of professionals involved in immigration issues who may be faced with such ritual modifications in the future. During the survey, some obstetrician/gynecologists pointed out that they had also encountered the same morphology in Italian non-manipulated patients. We recorded these cases as physiological stretching. In the survey, the data collection was done by means of a questionnaire, administrated to 272 professionals, consisting of items to measure the knowledge about these expansive modifications; moreover, among the latter 272 professionals, 14 specialists were subjected to a detailed interview, and they described 21 cases of stretching, both ritual and physiological. On the whole, the phenomenon of GS is poorly known by Italian health operators: 93% of the interviewees declared they knew little or nothing about it. The women with labial hypertrophy identified in the survey included 20 Africans with ritual stretching and about forty Western women with physiological stretching. The incidence in the latter sample is hypothesized from 8 to 20%. In conclusion: physiological GS is ignored by health professionals, even when it is stressed by the patients bearing this trait with concomitant psychological discomfort, which may develop into real anxiety, especially in teenagers. Ritually “modified” immigrant women, forced to cope with a Western society of intact women, consider themselves “different” also because of this morphological trait, with a consequent worsening of their feelings of discrimination and marginalization in diaspora, although they seldom ask for surgical reduction of the elongated labia. Thus, labial hypertrophy has a different semantic connotation in Africa and in Italy.

Male perspectives on FGM among communities of African heritage in Italy

Purpose – The purpose of this paper is to investigate the attitudes, knowledge and beliefs regarding female genital mutilation/cutting (FGM/C) of six groups of immigrant men from countries where FGM/C is practiced and to identify their role in the decision-making process of circumcising their daughters. Design/methodology/approach – The study took the form of qualitative action research with seven focus groups of 50 men coming from Somalia, Eritrea, Ethiopia, Benin, Egypt and Nigeria, living in Florence, Italy. Findings – Different conceptions, cultures and attitudes about FGM/C exist among men coming from different countries, but also within the same community. The participants expressed positions both in favor and against the maintenance of the practice. There were opposite beliefs about the religious motivations invoked. Research limitations/implications – The study is qualitative and the non-probability sample and the small number of participants are important limitations. Practical implications – The...

Female Genital Mutilations

WHO defines Female Genital Mutilation (FGM) as all procedures that involve the partial or total removal of external genitalia or other injury to the female genital organs for non-medical reasons (Eliminating female genital mutilation: an interagency statement. World Health Organization, Geneva, 2008). The practice is still being reported in 30 countries in Africa and in some countries in Asia and the Middle East (Eliminating female genital mutilation: an interagency statement. World Health Organization, Geneva, 2008. Female genital mutilation/cutting: a global concern, UNICEF, Geneva, 2016).

Knowledge and Opinions of North Italian Health Operators About Female Genital Mutilation

Since its creation, the Working Group on Female Genital Mutilation (FGM) has looked at large-scale epidemiologic investigation as the best way to monitor the evolution of FGM in Italy. Obstetricians and gynecologists have been considered the most qualified subjects to be interviewed because they have the first contact with the excised women of Africa. The first investigation, which was made in 1993, found that 50% of professionals had at least one experience with FGM patients (Grassivaro Gallo and Viviani, 1995, Female Genital Mutilation: A Public Health Issue Also in Italy. Padua: Unipress); with the second investigation, dated 1999, it was discovered that female gynecologists were more professionally involved with this problem than their male colleagues (Grassivaro Gallo and Cortesi, 1999, Linee guida per il personale medico di fronte a casi di Mutilazione Genitale Femminile (MGF), Quaderni di Ricerca, n. 5, Osservatorio Regionale Regione Veneto (ORIV), Assessorato Politiche Flussi Migratori, Venice). We now introduce the results of the third investigation. The national congresses of specific associations have been the most valuable scientific occasions to collect the opinions of professionals, coming from all parts of the country; the most recent investigation is limited to Northern Italy, but is strictly connected to a similar one in Tuscany. For this reason, the results of the two investigations give us information about the operators working in the North Italian regions. The focus of the present investigation is to evaluate the knowledge and opinions on FGM of the socio-health workers of Northern Italy (Zanotti et al., 2007, Conoscenza e Opinioni degli operatori socio-sanitari del Nord-Italia sulle Mutilazioni Genitali Femminili (MGF) (Rapporto Preliminare). Relazione all’83° Congresso Nazionale SIGO, Naples).

T09-P-13 The importance of the Kegel exercises for the erection of the male and female erectile organs (male and female penis)

The erection of the male and female erectile organs (male and female penis) consists of three phases: a) latent, b) turgid, c) rigid or muscular. Ischiocavernosum muscles (muscles of erection) are much more developed in male than in female. These muscles are innervated by branches of the pudendal nerve, that originates from Onufs nucleus located in the sacral spinal cord. The androgens are responsible of the sexual dimorphism of this nucleus. The tonic contraction of ischiocavernosum muscles during erection is necessary for the rigidity of penis. These muscles, as also the bulbocavernosum muscle (muscle of ejaculation and orgasm), though histologically striated, have a semiautomatic function: ischiocavernosum muscles, together with bulbocavernosum muscle, introduce a continuous involuntary reflected hypertonic contraction during erection. This is necessary not only for the rigidity of the penis, but also for the maintenance of erection. The Kegel exercises allow the contraction of the pubovaginalis (elevator of the prostate in male) and the puborectalis muscles, and of all the perineal muscles and especially of the superficial ones (the most important in sexology): only with these exercises it is possible to train the ischiocavernosum and bulbocavernosum muscles. This training could reduce the post-ejaculatory refractory period that increases in every man with age and could facilitate the erection after a first ejaculation. In elderly men the ejaculation takes place with less strength or without squirting. The Kegel exercises, training bulbocavernosum muscle, are important to prevent and postpose the physiologic reduction of the strength of ejection of the seminal liquid.

T05-P-12 Embryology and anatomy of the female erectile organs

Introduction In sexology textbooks, the embryology and the anatomy of the female erectile organs are neglected. A correct knowledge of female sexual anatomy and functioning is very important in sexual education and therapy. Embryological development of the female genital organs Only the body of the uterus and the uterine tubas are formed by the Mullerian ducts; the vagina develops from the urogenital sinus. The female external genital organs develop, as in the male, from the phallus, from the urogenital folds and from the labioscrotal swellings. Anatomy of the female erectile organs Vulva is constituted by the labia majora and the vaginal vestibule, with an erectile apparatus: clitoris, bulbs and corpus spongiosum, labia minora, corpus spongiosum of the female urethra. Corpus spongiosum of the female urethra is present in every woman and the female urethral sensibility has not been well investigated until now. The correct term to indicate the whole female erectile organs should be female penis from embryological and anatomical points of view. Conclusion The erectile structures are the same in female and in male. The clitoris is only a part of the male penis. The vagina is mainly a reproductive organ; the vaginal orgasm and G-spot are not based on scientific evidence. In sexology textbooks the female genital anatomy should include all the erectile structures responsible for the female orgasm. Every woman has the right to have a sexual health and sexual pleasure: the female orgasm is possible in every woman because it is caused by female erectile organs.

Researches about sexual pleasure and orgasm in Female Genital Mutilation (FGM/C)

Introduction FGM/C violates human rights. FGM/C womens sexuality is not well known and often it is neglected. Physicians caring for women with FGM/C have little understanding of the customs, culture, and tradition, and the roles they play in womens sexual experiences. Sexuality must be considered in the context of the environment in which a woman and her partner live. In addition in mutilated women, some fundamental structures for the orgasm have not been excised. Aim The aim of this report is to describe and analyze the results of five investigations on sexual functioning in different groups of cut women. Instruments Semistructured interviews; Female Sexual Function Index (FSFI). Sample. 5 Groups of women affected by different types of FGM/C, living in the West. A control group of intact women. Results Every group of study reported orgasm, the group investigated with FSFI showed significant differences comparing with an equivalent group of control in Desire, Arousal, Orgasm, Satisfaction with mean scores higher in the group of mutilated women. Conclusion Embryology, anatomy, and physiology of female erectile organs are neglected in specialist textbooks. Cultural influence can change the perception of the pleasure, as well as social acceptance. Every woman has the right to have sexual health and to feel sexual pleasure for full psychophysical well-being. In accordance with other researches, the present study reports that FGM/C women can have the possibility to reach an orgasm. Therefore, FGM/C women with sexual dysfunctions can and must be cured; they have the right to have an appropriate sexual therapy.