|
||||||||
|
OBSTETRICS AND GYNECOLOGY
Clinic Serves Needs of Immigrant Women Who Have Undergone CircumcisionThe African Women's Health Practice at Brigham and Women's Hospital, which opened last summer, sees eight to 10 women each week who have undergone female circumcision. Also called female genital mutilation, the process involves removal of the external genitalia in young girls, usually 5 to 12 years old. The practice is illegal in most countries, including the U.S., but is still common in parts of Africa and Asia, says Nawal Nour, founder and director of the clinic and an HMS instructor in obstetrics, gynecology and reproductive biology.
Nawal Nour (right), talking with interpreter Layla Guled, opened the African Women's Health Practice at the Brigham largely to promote cultural competency. The Immigrant WaveNour says that one of her main purposes in opening the clinic was to promote cultural competency. Massachusetts now has a population of 6,000 to 7,000 immigrant and refugee women who have undergone circumcision. She estimates that this number is increasing by at least 500 per year and says doctors must be prepared to treat these patients in their practices."Female circumcision is a horrible thing, and it needs to be eradicated," Nour explains. But the situation is complex; she says that today the practice is primarily perpetuated by the women themselves, in the assumed interest of their daughters. Strong cultural beliefs hold the ritual as a rite of passage for young girls that protects their virginity. Many women also falsely believe that the traditions of Islam require all women to be circumcised; they think it results in better hygiene, greater beauty, and more sexual pleasure for the husband. Although the practice is less common among educated populations, cultural forces are strong. "This is a tradition perpetuated by parents who love their children and are trying to ensure that their daughters get married," Nour says. Some immigrants choose to circumcise their daughters back in their home countries even though the practice counters both medical advice and the law. The mildest form of female circumcision, Type I, involves removal of the clitoris and the prepuce. The procedure is most commonly practiced in Ethiopia, and the results are often missed by the clinician if not looked for. Type II involves removal of the clitoris and partial removal of the labia minora. Type III is the most severe form, involving removal of the clitoris, labia majora and minora, and infibulation (sewing together of the remnant tissue). This practice is most common in Somalia and the Sudan and causes the most medical complications. Immediate risks include hemorrhage, shock, sepsis, and death. A Health EmphasisNour focuses on these medical concerns when speaking one-on-one with her patients. "It is also a human rights issue," she says, "but my argument is purely medical because human rights ends up being a trickier subject." Nour also never uses the term genital mutilation when discussing the issue with her patients because she finds that most women are offended by it.As a result of altered anatomy, circumcised women often present with particular medical concerns. Cesarean sections may be performed unnecessarily, for example, when a simple procedure like deinfibulation, reopening the incision and restoring normal anatomy, would allow a safe vaginal delivery. Unrelated office visits can also be difficult, Nour says. The shock of discovering abnormal genitalia on a circumcised woman may shake the focus of the medical visit away from the patient's primary complaint. "The most important thing is to talk to the patient holistically," Nour says. "The physician must try to see her for who she is and try to understand her background and not to judge what her culture has forced on her or what she has chosen to perpetuate with her children." —Catherine Chu |
