American physicians are right to condemn the practice of female circumcision, but researchers say that physicians' condemnation of the practice may have the unintended effect of driving circumcised women away from the health care they need.
Carol R. Horowitz, MD, of Mount Sinai Medical Center in New York, and J. Carey Jackson, MD, of the University of Washington, write in the August 1997 Journal of General Internal Medicine that "Although there is ample media and political attention to this volatile issue, there is a relative dearth of practical, clinical information available to providers" on how they should treat circumcised women.
More than 30,000 Africans entered the U.S. during the last decade, 93 percent of them refugees from Ethiopia, Eritrea and Somalia, where more than 80 percent of the women are circumcised.
"There are significant medical sequelae and public health ramifications of female circumcision," the authors write. "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...to treat women knowledgeably and with dignity."
The researchers interviewed 48 immigrants from the three African nations, including five men, in their homes and at a refugee clinic, then developed guidelines for caring for circumcised women, illustrated by case studies. The guidelines include sample questions American physicians should use when examining female patients.
"Blanket condemnation by health workers will not help families decide how to break a long-standing tradition by choosing not to circumcise their daughters," the authors write. "On the contrary, by unwittingly conveying revulsion toward circumcised women and children, providers may drive these families away from the health care they need."
The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care.
Dr. Carol R. Horowitz may be contacted at (212) 241-6868
Contact: : Margo Glen Alderton, managing editor