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First FGM Prosecution

March 29, 2014

What happened?

Female genital mutilation (FGM), the excision all or part of the foreskin/prepuce, clitoris or labia, which causes in some cases labial fusion and narrowing of the vaginal opening, is illegal in the UK.

FGC_Types

Campaigners want people who do it, and parents who allow it, to be prosecuted, and last week the director of public prosecutions, Alison Saunders, announced the first one. It’s an odd story. Here is the DPP statement.

“It was alleged that following a patient giving birth in November 2012, a doctor at the Whittington Hospital, in London, repaired FGM that had previously been performed on the patient, allegedly carrying out FGM himself.

“Having carefully considered all the available evidence, I have determined there is sufficient evidence and it would be in the public interest to prosecute Dr Dhanoun Dharmasena for an offence contrary to S1 (1) of the Female Genital Mutilation Act (2003).

“I have also determined that Hasan Mohamed should face one charge of intentionally encouraging an offence of FGM, contrary to section 44(1) of the Serious Crime Act (2007), and a second charge of aiding, abetting, counselling or procuring Dr Dharmasena to commit an offence contrary to S1 (1) of the Female Genital Mutilation Act (2003).”

The newspapers report that Dr Dharmasena had been an obstetrician at the Whittington in 2012 and that Mr Mohamed was related to the alleged victim.  What could possibly have happened?

The wording “repaired FGM that had previously been performed on the patient, allegedly carrying out FGM himself” suggests that a midline scar joining the labia across the anterior part of the vagina had torn during the delivery. This is a common post FGM injury. The torn edges bleed so obstetricians are obliged to repair them.  They can either place sutures to stop the bleeding but leave the labia separate, i.e return the anatomy more nearly to normal, or they can suture the labia back together across the vaginal opening, i.e. return to the post FGM pre-delivery anatomy.

Although the patient or her partner may request the latter for cultural or sexual reason, it is generally advised against.  The delivery has resolved one of the harmful effects of the FGM, and it could be argued that the doctor harms the woman a second time by rejoining the labia. But it’s a stretch to call such a repair FGM. Of course, if the doctor actually removed part or all of a healthy prepuce, clitoris, or labia, that would be FGM, but the DPP’s statement does not imply that.

I dealt with many such cases in the early 1980s when I worked in Africa.  My practice was to compromise. I sutured the anterior part of the labia across the vagina but left the posterior part open.  I argued that, by leaving a more open vagina, I was making intercourse easier for the woman, but that by repairing the anterior part, I was also respecting the couple’s culture.

It was a more innocent time. I’m glad there were no lawyers looking over my shoulder.

On the face of it this an extraordinary prosecution but perhaps there’s more to it. Ripe-tomato.org will watch the case with interest.

Jim Thornton

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5 Comments leave one →
  1. AAL permalink
    March 29, 2014 11:18 pm

    “I dealt with many such cases in the early 1980s when I worked in Africa. My practice was to compromise. I sutured the anterior part of the labia across the vagina but left the posterior part open.. I argued that, by leaving a more open vagina, I was making intercourse easier for the woman, but that by repairing the anterior part, I was also respecting the couple’s culture.” What a LOAD OF RUBBISH. Shoud a doctor respect the “culture” of the Nazis if he/she worked in Nazi Germany?

    • March 30, 2014 11:29 am

      Perhaps my wording “respecting the couple’s culture” was badly chosen. But my point that repairing a circumcision scar is not so clearly wrong as doing a primary FGM in the first place remains. An FGM victim might have become so accustomed to her new anatomy that she now prefers it that way. She may have developed techniques to achieve orgasm that depend on the FGM anatomy. After all, unmutilated women often report that they need to alter their ways of achieving orgasm after childbirth.

      I’m not saying any of these speculations are true or valid. I support guidelines for circumcision repair after childbirth that recommend not rejoining the labia. My objection is to prosecuting an obstetrician, who allegedly makes an error in this area, as if he was the primary FGM perpetrator.

  2. voxinfantorum permalink
    March 31, 2014 8:23 am

    “Of course, if the doctor actually removed part or all of a healthy prepuce, clitoris, or labia, that would be FGM, but the DPP’s statement does not imply that.” What, like a rich white woman’s “fanny tuck” labioplasty or vaginal tightening to make her more like se was 18 again? Bad, white, panic law written and repeated all over the white world without discrimination. “Mutilation” is what brown people do; WE do “cosmetic surgery”. And “Of course, if the doctor actually removed part or all of a healthy prepuce” – what if doctor removed the WHOLE of a healthy prepuce – of a boy? Go straight to medical or religious heaven. And collect $200. Answer: protect all children identically wihtout sex discrimination and let grown women and men chop and stitch away at themselves with abandon. And pay for it.

  3. January 19, 2015 10:15 pm

    My interpretation was correct. http://www.theguardian.com/uk-news/2015/jan/19/fgm-genital-mutilation-trial-uk-dharmasena “It is the stitching back together by Dr Dharmasena which the prosecution says is an offence under the act,”

    What he did was unwise. It is not current recommended practice. But is it FGM? Is this prosecution really a good use of public resources?

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