Swedish Study on Circumcision

The Correlation of Genital Mutilation and Infertility

Around the world 6,000 girls are circumcised every day, the majority of them in Africa. Now a Swedish study has found that the practice has a significant impact on fertility. Maja Dreyer reports

photo: dpa
Somali women protesting against genital mutilation - a disputed practice that often causes serious medical injuries

​​Around the world 6000 girls are circumcised every day, the majority of them in Africa. In most countries female circumcision is linked to the belief that it will ensure girls an honorable life, with a husband and many children.

Human rights organizations have been protesting the practice for decades, but the number of circumcised girls remains high. The results of a Swedish study, however, has given them an argument that might change a few minds.

Along with Ethiopia, Somalia, and Egypt, Sudan is one of the countries in which nearly 100 percent of the women have been circumcised. Circumcision means that that the external female genitals have been partly or completely removed – a tradition that is practiced not only on the African continent.

In two hospitals in the Sudanese capital Khartoum the Swedish pediatrician Lars Almroth has conducted the first clinical study about the correlation between female circumcision and infertility. In this study he compared the portion of circumcised women in a group of 180 pregnant women with a group of 100 infertile women. The results are indisputable -- and scientifically sound:

"Such studies naturally take other factors that can cause infertility, such as sexually transmitted diseases, for example, into consideration. But even after allowing for these factors, our results still show that female circumcision increases the risk of infertility, making it five or six times more likely," explains Almroth.

Kitchen knives, razors, shards of glass

Almroth and his colleagues surmise that infections resulting from the circumcision itself cause infertility. Most women were circumcised as young girls – often under extremely primitive conditions. Kitchen knives, razors, or shards of glass are used as instruments.

In the most extreme forms of genital mutilation the circumcisers – usually older, respected women in the village – sew up the edges of the wound with twine or bast fiber until only a small opening remains.

Opponents of female circumcision have long assumed a connection between this practice and infertility. Almroth has now provided the empirical evidence. He now plans to investigate why the direct consequences of female circumcision have not yet been qualitatively proven by physicians:

The need for medical education

"It is necessary to find out why we have not discovered this in hospitals. Do these girls go to the hospital at all, or are we physicians not seeing the problem? There are many unanswered questions.

We know that many girls do not seek medical help when they have problems. And even when they visit a physician, they do not say what the real problem is."

The consequences: infections are not treated, and scars remain that make it impossible for girls to become pregnant later in life. A condition that for many has more serious consequences than other diseases:

Infertility as a real social disaster

"Of course there are other diseases which are much more problematic, if one looks at the figures and statistics," explains Almroth. "But for the women who end up infertile, it is much worse than malaria or childbirth complications. It affects their lives as women, and infertility is also a real social disaster for them in society."

Not only for women does infertility have devastating consequences for their social position. The family is also affected – the husband, parents, and grandparents. Therefore Sudanese and international human rights and health organizations hope that this argument will provide them with a more effective weapon in the fight against genital mutilation.

Up to now they have "only" been able to spread the message that female circumcision is dangerous for women. In response many now have the ritual performed by a physician instead of the traditional circumciser. The risk of infertility, however, calls the entire tradition in question and might move society, as well as men, whose expectations exert tremendous social pressure on women, to see the ritual in a different light.

Circumcision and sexual pleasure

Many of them, however, already have their doubts about female circumcision – but for entirely different reasons, as Lars Almroth discovered:

"According to the traditional concept of female circumcision, men want to marry a woman who is circumcised – for various reasons: Circumcision ensures that she is a good woman, that she has not engaged in premarital sex, and that she will not be unfaithful," Almroth says.

"And then there is the belief in Sudan that a small opening in the vagina provides men with greater sexual pleasure," he goes on to say. "We discovered in our interviews that many men don't think this way at all. Instead they report about their own complications involving female genital mutilation, from sexual dissatisfaction to even impotence. Most young men would rather marry an uncircumcised woman, and this turns the traditional concept of female circumcision in this society upside down."

Maja Dreyer

© DEUTSCHE WELLE/DW-WORLD.DE/Qantara.de 2005

Translation from German: Nancy Joyce

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