In the last 30 years, female genital mutilation has become the topic of worldwide discussion and debate both as a health issue and a human rights violation (1-5). In 1996, the World Health Organization estimated that approximately 100 million women undergo different forms of genital alterations in over 60 developing countries (6). Three types of such alterations are recognized widely by authorities as constituting genital mutilation. The first type, called Sunna circumcision, involves the removal of the prepuce with or without the excision of part or all of the clitoris. The second type of mutilation involves partial or total removal of the clitoris as well as scraping off the labia majora and minora. The third type, the most extreme form, consists of infibulation or pharaonic circumcision, which removes the clitoris, adjacent labia, and then sews the scraped sides of the vulva leaving a small opening for urine and menstrual blood (6).

Calling these forms of alteration "mutilation" has become a political issue. Some researchers have argued that using the term mutilation to refer to the traditional forms of female cuttings is a value-laden approach that condemns the cultural context of these practices. They also question the appropriateness of the use of the term "female circumcision" on the grounds that the severity of the harm done to women is underplayed by such comparison to male circumcision

(5,7). Thus, this chapter avoids using these value-laden terms and uses the neutral phrase "female genital alterations" (8). This terminology permits the exploration of practices of genital alteration regardless of country, rationale, or even degree of technological sophistication. In addition, because of the political connotations of "female genital mutilation," the sociological and medical literature on the topic has focused on practices in Africa and Asia and almost entirely overlooked the history and current prevalence of female genital alterations in the West.

Female genital alterations began in the Western countries around the 1820s and were mainly justified as a cure for the "diseases" caused by excessive masturbation and nymphomania. The advent of such surgical alterations was linked to a transformation of masturbation from a sin, condemned by the Church for centuries, into a medical condition. This chapter discusses the distinct forces that converged to create a new illness called "postmasturbatory disease," which comprised such different manifestations as epilepsy, syphilis, fatigue, and dementia thought to be caused by masturbation. The extraordinary obsession with masturbation during the 19th century that led to female genital surgeries cannot be understood without considering the strange confluence of economic, cultural, religious, and medical ideas.

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