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Curing Cut or Ritual Mutilation?

: Some Remarks on the Practice of Female and Male

Circumcision in Graeco-Roman Egypt
Author(s): Mary Knight
Source: Isis, Vol. 92, No. 2 (Jun., 2001), pp. 317-338
Published by: The University of Chicago Press on behalf of The History of Science Society
Stable URL: http://www.jstor.org/stable/3080631 .
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Some Remarkson the Practiceof Female and

Male Circumcisionin Graeco-RomanEgypt
By Mary Knight*


Ancient texts and archaeologicalartifactsprovide the startingpoint for a review of the

surgical aspects of female genital mutilation (FGM) in ancient Egypt. Analysis of the
ancientsurgicalprocedureincorporatesmoder experienceon the subjectas well as ancient
literary and culturalperspectives. Comparisonof FGM with ancient Egyptian male circumcision andconsiderationof motivationsfor the practicecontributeto ourunderstanding
of FGM. In particular,the documentedassociation between male circumcision and generative ability suggests a novel comparison with a naturalprocess in the female-the
breaking of the hymen on first intromission-and ultimately a new hypothesis for the
origin of ancientFGM.

LONG VIEWED AS AN ANCIENT and exotically perplexing land, Egypt frequently

harbored customs, notably those marked by gender, the opposite of Greek and Roman
ones. Thus women were said to run the markets in Egypt while their men did the weaving;
daughters were obliged to maintain their parents in old age while sons were absolved; and
men were dedicated to the gods while women were not. Public, private, and religious
customs were not the only ones identified as "upside down" by classical writers; personal,
physical matters were also affected. Herodotus notes, for example, that Egyptian women
urinated standing up, while their men squatted to perform the same act.' Some of these
claims must surely be viewed with skepticism, particularly in light of archaeological and
philological studies of Egyptian culture; yet one practice continues to be considered an
* AmericanUniversity in Cairo, 113 Shari'a Qasr al-'Aini, P.O. Box 2511, Cairo 11511, Egypt.
I would like to thank the anonymous referees of this essay, who provided valuable suggestions for its improvement.An earlierversion,presentedat the AmericanPhilologicalAssociation's annualmeetingin December
1998, was selected as best oral paper for the year by the Women's Classical Caucus, whose supportand encouragementI would like to acknowledge publicly. Special thanks are also due to Dr. Fayza Haikal for her
advice and encouragement.All translationsare my own, except as indicated.
1Herodotus,Historiae, 2.35. In 2.64 Herodotusremarksthat sometimesEgyptiansand Greekstogetherfollow
certain customs the opposite of those of the rest of the peoples of the world: e.g., Egyptians and Greeks both
abstainfrom having sexual intercoursein temples, whereaseverywhereelse such sexual practicesare a common
featureof temple ritual.
Isis, 2001, 92:317-338
? 2001 by The History of Science Society. All rights reserved.

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aberrantancient Egyptiancustom, in partbecause of its persistencein Egypt to this day.

Thatcustom is excision of the clitoris and otherexternalfemale genitalia,sometimescalled
female circumcision but now usually referredto in Egypt as female genital mutilation
(FGM); the first extant literary mention of it is by the Greek geographerStrabo, who
visited Egypt in about 25 B.C.E.: "This is one of the customs most zealously pursuedby
them [the Egyptians]:to raise every child that is born and to circumcise the males and
excise the females."2
Moder commentatorshave frequentlyconsidered FGM in Egypt an ancient solution
to venery-that is, excessive sexual desire and indulgence of sexual desire. The assumption that the custom was rooted in extinguishingfemale desire has found favor especially
in the West, in partbecause a similarmotivationis occasionally cited in Egypt today.3
Was FGM really practicedin antiquityas a preventativetreatmentfor venery? Since
FGM has long been consideredan operationthat mirrorsmale circumcision,were males
likewise circumcisedto preventexcessive sexual indulgence?This essay will firstexplore
surgical aspects of FGM as revealed in ancient medical sources to determinewho was
operatedon and why. Next, a comparisonwith male circumcision and considerationof
studies of the moder practice of FGM in Egypt will highlight some of the various rationales for such surgical procedures,including the preventionof venery. Finally, a hypothesis for the origin of FGM will be proposed.

Before examining the ancient evidence, such as we have, for FGM, it is prudentto take
into account the problematicnatureof the evidence and interpretationof it as a whole. It
is patentlydifficultto investigateconclusively surgicalproceduresconductedat a distance
of more than two thousand years and in the absence of the living patients themselves.
Significantly,we have no textual sources by women, only by men, although it must be
grantedthat the medical sources as a rule "containprivilegedinformationobtainableonly
from women [and] were directed at a female clientele," since a numberof gynecology
manualsare thoughtto have been writtenfor midwives.4
A related issue is the discrepancybetween how ancient male physicians and surgeons
TxoOo6 Tc&v
Tro zavrtaTpe(petv x
Strabo,Geographika,17.2.5: Kai
kLougg:vcov ntap'abcxolq
In Egypt today the procedure is more
zEptxi;vestvcKai Tr 0f)Xa
y?vvcfueva zat&a icia
thanas a purification(Tahaara),
commonly characterizedas a mutilation(batr, lit. "mutilation"or "amputation")
because there is general agreementthat removal of an organ (as opposed to purely cutaneoustissue) constitutes
a mutilationand that most instancesof khitaanal-binaat ("femalecircumcision")in fact involve removal of the
clitoris-not mere cutaneoustissue.
3 In a 1997 survey of fourteenthousandEgyptianwomen, 9.1 percentof respondentssaid thatFGM preserves
a girl's chastity, yet it is an assumptionthat this preservationresults from a decrease in desire. For the results
see MuhammadFayyad,Al-batr al-tanasuli
li-l-inath (Cairo:Dar al-Shuriiq,1998), p. 146. Popularwriterson
ancient Egypt in particulartend toward simplistic analyses of FGM-see, e.g., Joyce Tyldesley, Daughters of
Isis: Womenof Ancient Egypt (New York: Penguin, 1994), p. 289 and n. 2 (cf. her comments on p. 150); and
Dominic Montserrat,Sex and Society in Graeco-RomanEgypt (New York:Kegan Paul, 1996), pp. 42-44-but
their works, because they are accessible to nonspecialists,are frequentlyconsulted by researchersinterestedin
the modem situation.
4 Leslie Dean-Jones,Women'sBodies in Classical Greek Science (Oxford:Oxford Univ. Press, 1994), p. 27.
See also the discussion of the female medica and midwives in Gillian Clark,Womenin Late Antiquity(Oxford:
Oxford Univ. Press, 1993), pp. 67-70. On the absence of sources by women see ibid., pp. 64-66; and Helen
King, "Boundto Bleed: Artemis and GreekWomen,"in Images of Womenin Antiquity,ed. Avril Cameronand
Am6lie Kuhrt(Detroit,Mich.: Wayne State Univ. Press, 1983), pp. 109-127, esp. pp. 109-110. King explores
the implicationsof this biased recordingof women's bodies and diseases in Hippocrates' Woman:Reading the
Female Body in Ancient Greece (New York: Routledge, 1998).

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viewed the female body and how women viewed theirown bodies-how they understood
the functioning of their own parts, as it were. Yet even if we had clear-cut evidence of
ancient Greek women's understandingof their bodies, we would still be hardpressed to
apply this view wholesale to Graeco-Egyptianfemale groups throughoutthe centuries
during which Greek was the language of the ruling classes. Not only were Greeks and
Egyptiansliving largely separatelives, but Greeksin majorcities such as Alexandriaand
Ptolemais may have differed significantly,both materiallyand culturally,from theircousins in smallercities and in villages.
Equally problematicis the issue of Greek inheritanceof FGM as a custom from the
Egyptians. We note that Strabo considers the practice a distinctively Egyptian one. (He
attributesit to the Jews of Judaeaas well-but, notably, he considers them Egyptians.5)
Did Greeksin Egypt practiceFGM, and, if so, were thereculturalpressuresfor accepting
it either as a surgical procedureor as a custom akin to circumcision?As we shall soon
see, the paucity of evidence, even by male writers,raises more questions than it answers.
Culturalbias-both ancient and modern-is anotherelement that furthercomplicates
ourreadingof the past. This elementcannotbe satisfactorilyevaluatedwithouta reasonable
estimate of the extent to which Greeks embracedthe practice of FGM. The fact that the
extant surgicaldescriptionsdo not appearin any language familiarto Egyptianaudiences
until after the Islamic conquest is telling in this regard,althoughprecisely what it tells us
is similarlyproblematic:assumingthattherewere no surgicaldescriptionsin the Egyptian
literature-a reckless assumption,to be sure-it could be that only the ruling Greek and
Romanclasses engaged surgeonsor othersproperlytrainedto performthe procedure,while
Egyptiansresortedto folk practitionerstrainedorally and by experience or to individuals
invested with the duty of ritualtradition.
More darkly,it is possible that Greekand Romanwriterswere biased againstEgyptians
as pdappacpot
("foreigners");inclusion of FGM in their manualscould thus be construed
as a fetishizingof the colonized, but only if the Greeksin Egypt themselvesdid not embrace
the practice.6There is some evidence that, just as the female was viewed as "different"
from the male, the woman of Egypt may have been considered"different"from her counterpartin Greece or Rome.
Women in Greece were thoughtto be predisposedto hysteria,one cause of which was
a lack of sexual intercourseand of interest in it; treatmentfor the condition frequently
involved fumigations.7By contrast,women in Egypt were renownedfor their sexual proclivities, and, thus, excision and other forms of FGM may have been conceived by male
Greek medical authoritiesas primitiveEgyptian solutions to an Egyptianproblem.8Cers In 16.2.37 Strabo describes circumcisions and excisions as 6ion'tSatgoviat("superstitions")of Jews who
had forgottenthe pious religion of Moses; in 16.2.34 and 17.2.5 he considers the Jews a tribe of Egyptians.His
source for these passages and anotherthat refers to the practice of male circumcision among people bordering
the Red Sea (16.4.17) appearsto be Artemidoros(cf. 16.4.16, 19), who lived in the late second and early first
centuriesB.C.E. Strabodid not visit the Red Sea coast or Judaea,althoughhe spent several years in Egypt.
6 The
hypothesisaboutbias againstforeignersshouldnot be dismissedlightly, given thata numberof Egyptian
and Arab intellectuals today express such opinions when reviewing the ancient testimony. Another opinion
commonly heard is that since the evidence is in Greek and not in Egyptian, only the Greeks were practicing
FGM. The custom is then seen as anotherdegeneratecolonialist import.
7 Hippocrates,Gynaikeia, 1.7. Lesley Dean-Jones, "The Politics of Pleasure:Female Sexual Appetite in the
HippocraticCorpus,"Helios, 1992, 19:72-91, esp. p. 79 f., commentson the practicaland political implications
of the Hippocraticmodel of female sexual appetiteas describedin this passage. See also Helen King's comments
on the ambiguitiessurroundinghysteriain Hippocrates' Woman(cit. n. 4), pp. 212-222.
8 Strabo,17.1.16, refers to the wantonness(kaolupia) of the women and men who engaged in sexual escapades
at Canobusin Egypt. The activity had become proverbial,being dubbedthe "Canobiclife" (Kavop3tayl6g).See
also Montserrat,Sex and Society in Graeco-RomanEgypt (cit. n. 3), pp. 106-135, on the sex industryin Egypt.

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tainly, the licentiousness of Egypt was a topos contrasted,especially in Augustus's propaganda,with Roman virtue and modesty; the countrywas depicted as morally loose, its
last queen (actually a MacedonianGreek) as an Aphroditewho seduced a drunkenDionysos.9 Yet there is no explicit differentiationof the Greek/Romanwoman from the nonGreek/Romanwoman in the medical literature,and it appearsthatordinaryEgyptiansand
Greeksin Egypt may have valued female modesty as much as theirRomancounterparts.'0
The rhetoricalandfetishizingcharacterof manyof the GreekandLatinworkson foreign
customs is itself filteredby moder interpretersthroughyet anotherlayer of culturalbias.
In the case of FGM, how much of the classical traditiona readermay be willing to reject
out of handas mererhetoricmay correlatewith how willing he or she is to considerancient
Egyptians"different"from their Arabizeddescendants,especially when the topic in question is unpleasant,shameful,or culturallyunacceptableby the reader'sstandards.
There is still anotherproblemposed by the evidence that ties in with culturalbias, and
this problemforces us to focus on the very root of our word "medicine"(the artof healing
or curing). We tend to frame our understandingof the medical proceduresof another
culturewith the medical standardsof our own cultureor society, and this essay will be no
exception: moder Egyptianmedical standardsuniformlyconsiderthe ritualexcision (literally, cutting out) of the clitoris as harmingratherthan healing the patient because the
clitoris is an organ and not superfluoustissue."
Likewise, moder Egyptianmedical standardssuggest the use of variousterms,including "femalegenital mutilation."As background,it may be helpful for readersto note that
FGM, althougha widespreadpracticethroughoutsub-SaharanAfrica and Egypt today, is
not universallythe same operation.(See Figure 1.) Rather,there are severalrecognizable
"degrees"of mutilation, with the preferredchoice depending on local custom.12 Some
authoritiesaccept the mere pricking of the clitoris with a needle as a true circumcision,
9 Plutarch,Antonius,26. The topic has become a standardreferencepoint for understandingthe earlyAugustan
period. See also Peter Green,Alexanderto Actium: The Historical Evolutionof the Hellenistic Age (Berkeley:
Univ. CaliforniaPress, 1990), p. 678 f.; Paul Zanker,The Power of Images in the Age of Augustus(Ann Arbor:
Univ. MichiganPress, 1990), pp. 57-65; and SarahB. Pomeroy,Goddesses,Whores,Wives,and Slaves: Women
in Classical Antiquity(New York: Schocken, 1975), p. 188.
10That young women should remain virgins before marriageseems to have been the rule-see Montserrat,
Sex and Society in Graeco-RomanEgypt (cit. n. 3), p. 87-though less is known about the sex life of native
Egyptian than of Graeco-Egyptianwomen, who are frequentlyrepresentedin the literatureand papyri and on
archaeological artifacts.For references on modesty in Roman life see Elaine Fanthamet al., Women in the
Classical World (Oxford: Oxford Univ. Press, 1994), pp. 295-306; and Paul Zanker,ibid., pp. 156-166. See
also Jody RubinPinault,"TheMedical Case for Virginityin the EarlySecond CenturyC.E.: Soranusof Ephesus,
Gynecology 1.32," Helios, 1992, 19:123-139, on the emergence in the imperialperiod of lifelong virginity as
a healthy goal.
I One survey of doctorsfound that 98.5 percentopposed the circumcisionof girls; the remaining1.5 percent,
althoughthey claimed to accept the practice,would not performthe operationon their own daughters:Fayyad,
Al-batr al-tanasuli li-l-inath (cit. n. 3), p. 152.
12 On the extent of the
practice of FGM see Fran P. Hosken, The Hosken Report, 4th rev. ed. (Lexington,
Mass.: Women's InternationalNetwork News, 1993), p. 13. Classificationschemes vary among authorities;see
the discussion in Mahmoud Karim, Female Genital Mutilation (Circumcision):Historical, Social, Religious,
Sexual, and Legal Aspects (Cairo: National Population Council, 1998), pp. 26-34. See also Nahid Toubia,
"FemaleCircumcisionas a Public Health Issue," New EnglandJournal of Medicine, 1994, 331:712-716; Otto
Meinardus,"Mythological,Historical,and Sociological Aspects of the Practiceof Female Circumcisionamong
the Egyptians,"Acta EthnographicaAcademiae ScientiarumHungaricae, 1969, 16:387-397; and A. Huber,
"Die weibliche Beschneidung,"ZeitschriftfiirTropenmedizinundParasitologie, 1969, 20(1):1-9. Surgicaltechniques and complicationsof the modem procedureare outlined in Karim,Circumcisionsand Mutilations,Male
and Female: MedicalAspects (Cairo:Dar el-Ma'aref, 1995), pp. 45-66; see also Ahmed Abu-el-FutuhShandall,
"Circumcisionand Infibulationof Females:A GeneralConsiderationof the Problemand a Clinical Study of the
Complicationsin SudaneseWomen,"SudaneseMedical Journal, 1967, 5(4):178-212, for a complete review of
FGM, including surgical aspects, in Sudan.

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4r%j- G/


^ L






Figure 1. FGMis stillcommonlypracticedin manyparts of Africaand in the south of the Arabian

Peninsula;significantly,it is not practicedin the Kingdomof SaudiArabia.In Egypt,first-or seconddegree circumcisionsare the normforthose girls who are circumcised;third-degreecircumcisionin
by PatriciaJ. Wynne.)
Egyptis rare.(Illustration

if performedcorrectly;the apdamageor disfigurement

althoughit causesno permanent
genitalia.Leaving type aside,the mildestformof
FGMusuallyrecognizedas suchinvolvesremovalof the hood of the clitorisonly, the
labiaminoraonly,orboththehoodof theclitorisandthelabiaminora.Thesecond-degree
formentailsthe removalof the entireclitorisandusuallyportionsof the labiaminora;it
is theremovalof theclitoristhatcharacterizes
thisseconddegreeas moreradicalthanthe
first,sincethe clitorisis an organandnot merelyskin,like the labiaor the hood of the
the clitoris,labiaminora,
clitoris.In the mostradicalformof FGM,calledinfibulation,
andportionsof thelabiamajoraareall excised;in addition,thegenitalareais suturedshut

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with threador, often, with thorns, leaving only a tiny orifice for urinaryand menstrual
flows. (See Figure 2.) This last type of FGM is relatively rare in Egypt today but not
unknown,being found primarilyin the far south, where it is dubbed "Sudanesecircumcision."13

One question that arises from a review of the modern clinical classificationsof FGM in
Egypt today is whethersimilar distinctionswere apparentin antiquity.Did ancientoperators consciously choose what parts of the anatomy would be excised and were there
distinctive degrees of mutilation?As we shall see, ancient evidence of the surgical procedure in fact demonstratesa clear understandingof certaincomponentsof female anatomy, in particulara distinctionbetween the clitoralorganand nearbytissue. Notably,there
is no extant descriptionof infibulation,the most radicalform of FGM.
One of the earliestextant notices of the procedureis but a rubric,or chaptertitle, Ilpi
unsppey80ou; v6p?qT; ("Onan excessively large clitoris"),from the Gynecologyof Soranus, a second-centuryC.E.physician. It is importantto note that the original Greek text
of this chapter,with Soranus'sown words, has not survived,nor is there any referenceto
excision of the clitoris or any other form of FGM in his extant works. Confusion on this
issue occasionally arises for moderninvestigatorsof FGM because of a certainMuschio
or Mustio, probablyof the sixth century,who translatedSoranus'swork into Latin;Muschio's work apparentlygained currencyat least by the ninth century, and, in addition,a
poor, very late retranslationinto Greekwas made.This work,notwithstandingthe fact that
the words are not Soranus'sown, gives a fair indicationof what his accountactuallywas.
Section 2.25 says:
On the excessively large clitoris, which the Greeks call the "masculinized"[reading"yos"
as a Latinized Yril/Ya;, the god of fertilizing moisture] nymphe [clitoris]. The presenting
feature [a6ow~rxpa]of the deformityis a large masculinizedclitoris. Indeed, some assertthat
its flesh becomes erect just as in men and as if in search of frequentsexual intercourse.You
will remedyit in the following way: With the woman in a supineposition, spreadingthe closed
legs, it is necessaryto hold [the clitoris] with a forceps turnedto the outside so that the excess
can be seen, and to cut off the tip with a scalpel, and finally, with appropriatediligence, to care
for the resultingwound.14
Interestingly,in Sudan infibulationis referredto as "Pharaoniccircumcision":see H. M. Hathout,"Some
Aspects of Female Circumcisionwith Case Reportof a Rare Complication,"Journal of Obstetricsand Gynaecology of the British Commonwealth,1963, 70:505-507; and Shandall,"Circumcisionand Infibulationof Females," (cit. n. 12) p. 179. Shandall's article thoroughly reviews the practice in Sudan, although it is now
somewhatoutdated.See also Allan Worsley, "Infibulationand Female Circumcision:A Study of a Little-Known
Custom,"Journalof Obstetricsand Gynaecologyof the BritishEmpire,1938,45:686-691; andHannyLightfootKlein, Prisoners of Ritual: An Odyssey into Female Genital Circumcisionin Africa (New York: Hanworth,
Soranus, Gynaikeia,4.9 (370), in Sorani Gynaeciorumlibri IV, ed. JohannesIlberg (CorpusMedicorum
Graecorum,4) (Leipzig: Teubner, 1927), p. 147 (chaptertitle). For Muschio's Latin version see Sorani Gynaeciorumvetustranslatiolatina, ed. ValentinRose (Leipzig:Teubner,1882): "De inmoderatalandica,quamGraeci
yos nymphin appellant. (76) Turpitudinissymptoma est grandis yos nymfe. quidam vero adseverantpulpam
ipsam erigi similiter ut viris et quasi usum coitus quaerere.curabis autem eam sic. supinamiactantespedibus
clusis myzo quod foris est et amplius esse videtur, tenere oportet et scalpello praecidere,deinde conpetenti
diligentia vulnus ipsum curare."This Latin translationbecame the most frequentlyused source for translations
of Soranusinto modem languages;see the Bude text of Soranus:Maladie des femmes, trans. and commentary
by Paul Burguiere,Danielle Gourevitch,and Yves Malinas (Paris:Belles Lettres, 1988-1994), Vol. 1, pp. xlix1. For an example of modem confusion regardingSoranus'swork see Hosken, HoskenReport (cit. n. 12), p. 7.

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. _. i







Figure2. Intactexternalfemalegenitalia(top)arecontrasted
Thereis no evidencethatthird-degree
of mutilation
J. Wynne.)
by Patricia
Egypt,andeventodaythisformis rare.(Illustration

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A betterperspectiveon Soranus'soriginal accountmay be taken from the Gynaeciaof

Caelius Aurelius, a fifth-centuryC.E.physician from Sicca Veneria (modem el-Kef in
Tunisia) who synthesized much of Soranus's work. In a chapterentitled "De immodica
landica"("On an excessively large clitoris"),he wrote,
A dreadfulsize attendsto certainclitoridesand it upsets the women with the ugliness of the
parts,and, as many relate, when it is affectedby immoderatetumescence,these women acquire
an appetitelike men, and when [the clitoris] is so driven, they come into venery. The woman
is placed in a supine position with her thighs slightly togetherso they do not have recourseto
too much of the space of the female cavity. Then the superfluousamountshould be held with
a forceps and an appropriateamount cut off with the scalpel. For if it is stretchedout to its
greatestlength, ** may follow, and it may cause hurtto the patientwith a very large discharge
from the cuttingoff. But aftersurgery,a remedythatkeeps [the wound]undercontroland [that]
** should be applied.15

Roundingout perspectiveson Soranus'soriginalaccountis a medieval Arabicdescription of the operation,by the eleventh-centuryphysician al-Zahrawi,which is thoughtalso
to derive from Soranus:
The clitoris may grow in size above the order of natureso that it gets a horribledeformed
appearance;in some women it becomes erect like the male organ and attains to coitus. You
must graspthe growthwith your handor a hook and cut it off. Do not cut too deeply, especially
at the root of the growth, lest hemorrhageoccur. Then apply the usual dressing for wounds
until it is healed.16

This excerpt by al-Zahrawiis intriguing not only because it underscoreshow popular

Soranus's work must have been, but also because it is the earliest extant account of the
et feminaspartium
sumantet in
feditateconfunditet, ut pleriquememorant,
ipse adfectetentiginevirorumsimilemappetentiam
veneremcoacteveniunt.suppinadeniquemulierlocandaest conductisfemoribus,ne febresinusdistantiam

sumant. tunc [in] midio est tenenda superfluaatque pro modo alienitatis sue scalpello precidenda. si enim
plurimumextenditurponrectalongitudinesequetur** atqueita inmodicedecissionis largofluoreafficitpatientem.
set post cirurgiamerit adhibendacohercensatque** curatio."The most accessible editionof this work is Caelius
AurelianusGynaecia:Fragmentsof a Latin Versionof Soranus'Gynaeciafroma Thirteenth-Century

Bulletinof theHistoryof Medicine(Suppl.13), 1951(seep. 113).

ed. MiriamF. DrabkinandIsraelE. Drabkin,

Al-Zahrawi(often called Abu al-Qasim or Abucasis in the West), Surgery,2.71:


i L





- C" -eL

IJa a












_,, I


Text and translationin Abucasis On Surgeryand Instruments:A DefinitiveEditionof theArabic TextwithEnglish

Translationand Commentary,ed. and trans. M. S. Spink and G. L. Lewis (Berkeley: Univ. CaliforniaPress,
1973), p. 456 f. For al-Zahrawi'srelianceon Greeksources see Sami KhalafHamarnehand Glenn Sonnedecker,
A PharmaceuticalView ofAbulcasis al-Zahrawiin Moorish Spain (Leiden:Brill, 1963), p. 54.

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procedurein Arabic and the first time a description of the operation would have been
accessible, to one degree or another,to the native populationof Egypt.'7
In the extantwork of Soranusthereis a discussionof cuttingaway a irpijv,or membrane,
that obstructedvaginal flows, but this was not a form of FGM. A close readingclarifies
that the operationhe recommendsis indicatedin girls not involved in exercise who still
do not menstruate."As for those who on accountof some disease do not menstruate,one
must treatthem accordingto the disease thathas caused the suppressionof the menses. In
those who lack a vaginal opening, cut aroundthe membraneor flesh, soften and adjustthe
shapeof the callous overgrowth,relieve the inflammationby gentle means,reduceas much
as possible the scarred-overwound, relieve [undesirable]closures or deviations." The
conditionis caused, most commonly, by an imperforatehymen or labial adhesionsor, less
commonly, by genetic defects that result in the lack of a vaginal opening. In such cases,
as Soranusindicates, one should cut away the obstructingmembrane-Greek 6giIv, not
equivalentto the structureknown in Fnglish as the hymen-and cosmetically repairthe
Paul of Aegina, a seventh-centuryphysician of Alexandria,is known to have borrowed
heavily from Galen and Oribasiusfor his seven-book EpitomElatrikU,of which Book 6
is devoted to more than 120 surgical operations;it is more likely, however, that Soranus
was the source for his discussion of surgeryfor an excessively large clitoris. This conclusion is based on the fact that the descriptionaccords in most of its particularswith those
passages alreadycited whose lineage to Soranusis more firmlyauthenticated.Paul states:
An immenseclitorisoccursin somewomen,becominga shamefulugliness,suchthatthere
arereportsthatsomeof thewomenhaveerectionsof thispartjustlikemenandeagerlydesire
Thus,withthe womanin a supineposition,we takeholdof the excessof
the clitoriswitha smallforcepsandcut it off witha surgeon'sknife,whileguardingagainst
cuttingtoo deeplyso thata rhyadikosstate[urinary
fistula]doesnot developfromit.
The Soranus family of medical reports all highlight the excessively large clitorides of
affected patients as well as the shamefulnessthat resulted from erections and the desire
for sexual indulgencethatattendedsuch physical,but natural,deformities.19
The placement
17 It should be noted that female circumcision is not an Islamic
religious practiceand that it is not practiced
by the Arabsof the Kingdomof SaudiArabia.The primarysupportfor it as Islamic derives from a hadith(report
of the Prophet'ssayings) that was consideredunreliableby the collector, Abu Dawud. It is found in his Kitaab
al-sunan (Jidda:Dar al-Qibla li-l-Thaqaafaal-Islaamiya, 1998), Vol. 5, section on adab, no. 182, no. 5229, p.
456. See also the discussion on the Islamic sources in Fayyad,Al-batral-tandsuli li-l-inath (cit. n. 3), pp. 109117.
18Soranus, Gynae., 3.2b.9 (Ilberg ed. [cit. n. 14]): Tas;6 6tadxt
rdaOogiTlKaOatxpougivaq aKokou60x;
nd0dt Tiiv bcoX'qvT&Yv
v uteva f TxivJapKa
itp4vomv 0epareuxerov, xepiK6xTovra ev b5v
ti Tv raTpfTrov,paXdacovra 8E Kalci eTraaouycp(vovTa
TIV ReptT6X.oxnv icai TOvotpov, xaXZvTa
Tx1voiU5iv, avItvTa i T
ra;U6at5 5Kai
crapeyinap1yoOptK<;qTiv (p.e?'yov'iv, XeInivovra 8e '. CrOTIV
ickoct;. The obstructionof menstrualflows because of the lack of an outlet was noted by other ancientmedical
writers-e.g., Oribasius,latrikon synagogon, 24.32-and by medieval ones as well-al-Zahrawi, Surg., 2.72.
The modem solution is similarto the ancientone describedby Soranus:a simple cruciateincision into the hymen.
See J. RobertWillson et al., Obstetricsand Gynecology (St. Louis: Mosby, 1987), p. 99.
19Paul of Aegina, De re medica, 6.70, ed. I. L. Heiberg(CorpusMedicorumGraecorum,9.2) Heiberg(Leipzig:
Teubner,1924): 'YceppsytOTj; tv(at; yiverat v4u<pt
atiXrv6q; anQavx.*KaOdx8E xtVe;
q Kai eig dtip
ouvouoiav O6pAt&nv.
icrtopoatv, tvtcat Sta TOO)pepoiu; Kca opOtdaouotv iv6pdctv 6ooifo Kral tcpo5;
TbOeptTTOvTf; vu6p5r; cxKTEoa)ev
It6oiep Tixtai;goXaTattopgvT1;xf; yvvatuKcb u5i&pKaTacaXa6vre;
(ppuXaTT6pevot ti c jd0ou; abTiv xKT?ivetv, Iva nh puaSIKucvic Txo6Tou
y:vixrat RdOo;.On Paul
of Aegina see E. F. Rice, "PaulusAegineta," in Catalogus translationumet commentariorum:Mediaeval and
Renaissance Latin Translationsand Commentaries,Vol. 4, ed. F. E. Cranz and P. 0O.Kristeller(Washington,

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of the passage in Paul's text, immediatelyafter a descriptionof surgeriesfor hermaphroditism, may be significant,suggesting that clitoridectomywas a procedurefor intersexed
persons, although this is far from certain;by comparison,the context for the passages
taken from the works of Muschio and Caelius Aurelianusis cancer-like growths in the
Because nymphotomywas known among Greeks as somethingpracticedby the Egyptians, and because Paul of Aegina himself lived in Alexandria,it has been assumed that
he is describingEgyptianpractice,thoughhe does not specifically say so. As an aside, we
might note here that thereis otily one citation from antiquitythat suggests thatFGM may
have been practicedoutside Egypt. Extantfragmentsfrom a fifth-centuryB.C.E.historyof
Lydia by Xanthos of Lydia, a contemporaryof Herodotus,say:
TheLydiansarrivedat sucha stateof delicacythattheywereeventhefirstto "castrate"
women ... ThusXanthossaysin his secondbookon theLydiansthatAdramytes,
thewomen,usedtheminsteadof maleeunuchs.... Inthesecondbook,
he reportsthatGyges,the kingof the Lydians,was the firstwho "castrated"
women,so that
he mightuse themwhiletheywouldremainforeveryouthful.
There is a problem,however, with equatingthe "castration"referredto here with FGM.
The operationis not described,for one thing; and the explicit purposeof the "castration"
was to keep the women youthful,presumablyso that the Lydianking could have frequent
intercoursewithoutfear of causing pregnancy,since the verb Xpdooat (here translatedas
a form of "to use") means "to be intimatewith someone."20FGM does not have any effect
on reproductiveability or on fertility.Althoughthis is mere speculation,it is possible that
the Lydians had invented a means of permanentlysterilizingwomen.

More remarkablethan the Soranus family of descriptionsof the surgical procedureare

two accounts that definitively place the practicein Egypt. The first is a brief mention of
the operationin a work (Eiaaycoyi i] ia'p6o; ["Introduction;or, Physician"])that has
been ascribed to Galen (fl. mid-second century C.E.) but whose authenticityis suspect:
"Betweenthese [labiamajora],a small bit of flesh, the clitoris, grows out at the split.When
it sticks out to a great extent in their young women, Egyptiansconsider it appropriateto
cut it out."21(Galen may have describedthe operationin detail, but such an accounthas
not survived.)
D.C.: CatholicUniv. AmericaPress, 1980), pp. 145-191; andLawrenceJ. Bliquez, "TwoLists of GreekSurgical
Instrumentsand the State of Surgery in Byzantine Times," in Symposiumon Byzantine Medicine, ed. John
Scarborough(DumbartonOaks Papers, 38) (Washington,D.C.: DumbartonOaks, 1984), pp. 187-204. See
BernadetteJ. Brooten, Love between Women:Early ChristianResponses to Female Homoeroticism(Chicago:
Univ. Chicago Press, 1996), pp. 162-168, for a probing,well-researchedanalysis of the Soranusfamily of texts
and the "culturallyproblematicsexual behavior"that is at the root of these texts.
20Die Fragmente der griechischen Historiker, ed. Felix Jacoby (1923-1958; Leiden: Brill, 1993), 3C
765.F.B4: Au6oi 8' si; xoforov4~uov Tpixpfq;, x Ica!
tpaixroit yuvatCaq;euvouxrat ... 6 8' oUv Xdv0oo
?v Tft SsuTcpat t6bvAuStaic&v 'ASp t'Tq,v(P1oai amkoa ipo&ov yuvaiKaq s6vouXiaavra Xpf0Oat
It sEoT'pcot
6 AuS&6v paaTe'6
To0UT'viCaopel, bx;ipro; rF6Xa;q
auTactt;avxi av6p&v s6voU%ov.... Ev
usvo6Xtasv, 6oto a6atq; xp6tro aei vsacou6aatq. On the verb see Henry George Liddell
and RobertScott, comps., A Greek-EnglishLexicon, rev. by Henry StuartJones with RoderickMcKenzie (Oxford: Oxford Univ. Press, 1996), Xpadotat,IV.b.
21 Karl Gottlob Kiihn, ed., Medicorumgraecorum opera
quae extant (Leipzig: Cnoblock, 1921-1933), Vol.
KaTa rTivStaacXia KlCs(puKO;g
6 Kcai8aa6 TppOKURTEtv
14, p. 706: Tr be jA.oov TOUTcoV
aapKislov, vU.pqnI,
iti nokU ?KTOcfA;
4ato&rat nap' Aiyuxifot; tid TVv nap09vov. On the ascriptionto Galen and its questionable authenticitysee ibid., Vol. 1, p. cxlviii.

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The second passage that places the practice in Egypt is by Aetios, a Greek physician
and comes obsequii (official attendantphysician) of the emperorJustinianI (ruled 527565 C.E.).Aetios was born in Amida (now Diyarbakirin Turkey)and studiedmedicine in
Alexandriain Egypt. He compiled a sixteen-book encyclopedic medical treatise ptikia
iaTpucta cKKaiSi,a, also known as the Tetrabiblon,that drew on more ancient authors'
works that in many cases are no longer extant. These earlier medical writers,including
Oribasius,Soranos, Galen, and many others, are listed as his sources in the 7civat (index
list) of each book. Aetios's descriptionof FGM appearsin book 16, which was devoted
to obstetricsand gynecology; he cites Philomenes, a Greekphysician at Rome thoughtto
be eithera contemporaryof Galenor to have lived a little later,as his source.22The nymphe,
or clitoris, was the primaryfocus of Aetios's operation,which was indicatedin girls whose
excessively large clitorides were viewed both as a deformity and as a source of sexual
stimulusthat would predispose"victims"to venery.
Aetios's account of the procedureis the fullest that is extant from antiquity.The girl is
seated in a chairwhile a strongyoung man restrainsher legs and the rest of her body from
behind. The operator,positioned in front of the girl, grasps the v6cpTr,or clitoris, with a
forceps held in his left hand, pulling it toward him. Then he cuts it off just above the
pincers of the forceps. Aetios warns that the base of the organ should not be removed,
since there is a risk of cutting into the urinaryoutlet. The surgeon next wipes the wound
with wine or cold water, and a sponge soaked in vinegar can be bandaged in place to
staunchthe bleeding. He then discusses postoperativeointmentsand powders for a recuperativeperiod lasting about a week.
The so-called nymphe[clitoris]is a sort of muscularor skinlike structurethat lies above the
junctureof the labia minora;below it the urinaryoutlet is positioned. [This structure]grows in
size and is increasedto excess in certainwomen, becoming a deformityand a source of shame.
Furthermore,its continualrubbingagainstthe clothes irritatesit, andthatstimulatesthe appetite
for sexual intercourse.On this account, it seemed properto the Egyptiansto remove it before
it became greatlyenlarged,especially at thattime when the girls were aboutto be married.The
surgery is performedin this way: Have the girl sit on a chair while a muscled young man
standingbehind her places his armsbelow the girl's thighs. Have him separateand steady her
legs and whole body. Standingin front and taking hold of the clitoris with a broad-mouthed
forceps in his left hand, the surgeon stretchesit outward,while with the right hand, he cuts it
off at the point next to the pincers of the forceps. It is properto let a length remainfrom that
cut off, about the size of the membranethat's between the nostrils,23so as to take away the
excess materialonly; as I have said, the partto be removedis at thatpointjust above the pincers
22 See the discussion of Aetios in James V. Ricci, Aetios Amida: The
Gynecologyand Obstetricsof the VIth
Century,A.D., Translatedfrom Cornarius' Text of 1542 (Philadelphia:Blakiston, 1950), pp. 5-9; and MarieHelene Marganne,La chirurgiedans l'Egyptegreco-romained'apres les papyrus litterairesgrecs (Leiden:Brill,
1998), pp. xx-xxi. The Greek edition of his work-Gynaekologie des Aetios, sive sermo sextus decimus et
ultimus, zum erstenmale aus Handschriftenveroffentlicht,ed. Skevos Zervos (Leipzig: Fock, 1901)-gives
Philomenes as the source in the vt'vat,or index list; no source is cited in the sixteenth-centuryLatintranslation
of Comarius.We have one extant treatise by Philomenes in Greek-Philumeni De Venenatisanimalibuseorumqueremediis,ed. MaximilianWellmann(CorpusMedicorumGraecorum,10.1.1) (Berlin:Teubner,1908)on animalpoisons and their remedies, which was used as a source for Aetios's book 13, chs. 1-44. In addition,
a numberof fragments and several translationsthat were made into Latin are extant. See Wellmann, "Philumenos," Hermes, 1908, 43:373-404.
23 Cf. the 1549 translationinto Latin
by Johannes Comarius, Aetii Medici graeci contractae ex veteribus
medicinae Tetrabiblos,hoc est quaternio, id est libri universales quatuor, singuli quatuorsermones complectentes, ut sint in summa quatuor sermonumquaterniones,id est sermones XVI (Basel: Froben, 1549), p. 902:
"Mensuraaiuntresectioniseandemquamin columellae sectione servareoportet,ut ne funditusipsamresecemus."
['"hey assert that it is necessary to preservethe same measureof the partcut off as that in the resection of the
uvula, so that we do not cut it off completely."]

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of the forceps. Because the clitoris is a skinlike structureand stretchesout excessively, do not
cut off too much, as a urinaryfistula [poti;q] may result from cutting such large growths too
deeply. After the surgery,it is recommendedto treatthe wound with wine or cold water, and
wiping it clean with a sponge to sprinklefrankincensepowder on it. Absorbentlinen bandages
dipped in vinegar should be secured in place, and a sponge in turn dipped in vinegar placed
above. After the seventh day, spreadthe finest calamine on it. With it, either rose petals or a
genital powder made from baked clay can be applied. This [RX] is especially good:24Roast
and grinddate pits and spreadthe powderon [the wound]; [this compound]also works against
sores on the genitals.25

Apartfrom its being both detailed and derivedfrom a traditionseparatefrom the Soranus
family of manuscripts,Aetios's account is remarkablefor two furtherreasons. First, he
identifiesprecisely a physical mechanismthatpromotesclitoralstimulation-namely, the
rubbingof the organ against the clothing, a feature that highlights the excessive size of
this organ in affected patients-and notes that this irregularstimulationis an indication
for surgery.Second, he states categoricallythat Egyptiansperformthis clitoralreduction
surgery on their girls before they are marriedto prevent excessive enlargementof the

Thus, Aetios's account appearsstronglyto corroborateStrabo's statementthatEgyptians

excise their females, but with the furthersuggestion that the proceduremay have been
performedin preparationfor marriage.Yet equally remarkableis the highly developed
characterof Aetios's surgicaloperationand its assignmentto the realm of male operators,
which suggests that excision may not have been the exclusive provenanceof midwives,
at least not in Egypt (Muschio's work, cited earlier, was a handbookfor midwives, but
Aetios is describing a clearly Egyptianpractice where the customaryoperatormay have
24Cf. ibid.: "linimentumposca madefactumindatur.Et spongia ex posca expressa superdeligetur.Post septimam vero, cadmiamminutissimetritamper se, aut cum rosarumfloribusinsperge.Aut sic cum ex lapide phrygia
paratum,et ad pudendorumfissurasdescriptum.Aut cineremossium palmularuminsperge."["A linimentmoistened with posca (a mix of egg, vinegar, and water) is put on, and a sponge squeezed out of posca is fastened
above. Moreover,afterthe seventhday, sprinklefinely groundcalamineby itself or with rose powder,or likewise
a powderpreparedfrom Phrygianstone (modernidentificationnot known;Pliny, Historia Naturalis, 36.36.143,
mentionedits use in dyeing), describedat fissures of the pudendum.Or sprinkleon ashes of date pits."]
25Aetios, 16.105 (Zervos ed. [cit. n. 22]): 'H ayop&:vrI
ioTi ouycpt&
Pdattov Ktp?Lvov

KaraT XV dvo)eV Tv

xv tepuycoldstov


KaO' 6vTr6ov

q otpi'p0pa TxtaKTxa

a6ffl'atv %atjpavov, KaQii5a
Si TIatV Wli
te; peettavKai aiaXUv6tv
To&Vi uaTriov ipeOiet, icai TilV cp6o; uvouiav 6pnilv
yivsrat. ak&ka
Kai tcaparpt6pOtvov ovvex;,
0 X? 6OT a~taoa,6O6OT
o504e ToiqAiyuxTiotq;
apatpeTv auTb6
S6Ioep 7pO Tfq; 0oys0oo0tq0caox;
cp6; yd4aov
lAv I1nap0gvoq Cri 8i(ppou,xapeCaTo; 8 6oaOEv veaviaicog UTovoq;u6opdXXcovToru iSioug;xcic;tq
Xn KalTO
8 vVavTiov
C&oa'- oTdx5q
6 Lvspy(bv
Kal: uSi(p
TaT;eK:eivi; iyvuatq,
'SSei4ta roxTe?vETxw
prIv Sta Tfqqstuvutou XsipbOaCOTEIstvE
tcXaTUxTO6p au).Xapdv
TObU66vtaQ; ToO gu?iou. eT:pov SextpooqKce KaTcXatvoxgi
aTxOTeaVOg?VTi;KltOVtiO0,va TO6
nap8a S Tob; 66vTag TOtO
IPuSou TiV 4KpaipcaivetiTov y?vgoOati,sta T6
6Xoevat Tliv vt5pnTPvKai x0apeKTviCoveoaltlApt tXesfCTTo. 6drT?e ihimKTfl; RepITTOTtEpa;
cb CK
pota; 7EaK:oXou0eTv.MeTa Se
Tf5; pa60VTpa;TC&V?yK:av0iStov
cKaa&iouatavTa; (rM6yyqpadvvav wrtnaxxsv, cat
TiIv 'licotv iq VuXp iSzaTt,
OtVqwtpocrKEcst rtxTqEstv
3pp xovTag E;iTI0OvEat,
dvo)Ov cx6TTyov6Kpcptq p3ppeyt vov ixdXtvsi:t0Ovat?
8tl ppUyo00q06ou
tTa i'sTiV ep6giv
XeioTd0Trv bticaCoetv. 1oiUvatfl P6. ov
avOOq, fiT'OSa
TOTO- 6oaaq(oitviov
Kait edavaq; crinttaasE Ttv
Cxno6V, xotIe
,Tlpov aiSoticbv. icakov 8Kaical
Ical ppO6q

V aiSotqot eKi.

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differed). In Egypt today FGM is frequentlyperformedby males, either medical professionals or-more commonly, since it is now illegal-barbers and butchers.26
The male gender of the operatormay be significantin that it suggests that the proceBoth genderdure-at least in Graeco-RomanEgypt-was surgical,and not obstetrical.27
specific tasking and the surgicalcharacterof the procedurecould theoreticallyhave strong
implicationsfor understandingFGM in ancientEgypt. Surgicaltools similarto those used
in the operationdescribed by Aetios-the forceps, surgeon's knife, and bandages-are
present in a panel from the rear wall of the Temple of Sobek and Horns at Kom Ombo.
It is thought that such surgical tools were not available to Egyptian physicians until the
arrivalof the Greeks and Romans;the Kom Ombo panel dates to the second centuryC.E.
and appearsto depict typical Roman tools. Most Egyptian surgical procedureswere very
simple, and, by one accounting,some "30,000 mummieshad been investigatedwithouta
single surgical scar being reported."28
Depictions of only three surgical proceduressurvive from pre-HellenisticEgypt. One
such procedureis male circumcision,representedby a scene from the Old Kingdom (ca.

B.C.E.) and another from the New Kingdom (ca. 1567-1085

B.C.E.). In the

first of these, from the tomb of Ankh-ma-hor,the implement employed may be a stone
knife or a razor, according to various authorities.And although the words of the panel
have led to a debateover whethera priest is circumcisingor being circumcised,some sort
of ritual initiation seems to be taking place.29That is, the proceduredepicted may not be
strictlysurgical, exclusively for medical indications.
Given that surgical (medical) proceduresmay have been relatively rare in pre-Greek
Egypt and that Aetios suggests that FGM was performedbefore any clear medical indication necessitatedthe surgery,it is certainlypossible that, if FGM was practicedbefore
the arrivalof the Greeks, it was viewed not as a medical procedureper se, but perhapsas
a religious rite associatedwith temple life.30It is thenplausiblethatthe GreeksandRomans
shifted the custom into the realm of physician-surgeons;conceivably, two types of operators may have coexisted, one traditionaland the other informedby Graeco-Romanscientific theory and practice.
A papyrusnow in the British Museum suggests that this may have been the case, since
its subject, an Egyptiangirl named Tathemis,was authorizedby the Temple of Sarapisof
Memphis to collect alms. The letter concerns money earmarkedfor Tathemis's circumcision, for which she needed a dowry and a suitable dress, all indicationsof her entering
into womanhood:
26In the mid 1990s, male medical doctors and surgeons as well as barbersand others who work at mulids
(festivals honoring Muslim popular"saints")accountedfor 64 percent of operators,while midwives accounted
for 36 percent:Fayyad,Al-batral-tandsuli li-l-inath (cit. n. 3), pp. 140-141. Gender-specifictaskingis common
in many areas where FGM is practiced;see Worsley, "Infibulationand Female Circumcision"(cit. n. 13), p.
687, which describes the situationin Sudan.
27Cf. Hdt., 2.84: il 5e
iTxptKi: KaTa Td5a CqPt6:acrxatftqf; vo6aou hicxacrogirqtp6o; ot Kclai o
Xos6vcov. dvTat 8' ibrTpCov catt rnkca


yap o6pa6(IXaiI)v
irlTpol Katcaoeaca,

oi S KC(plaf;qq,oi &e

6oovtov, oi S6 TcOVIKaravr6v, oi U8 T6)V&qpavio)vvouoaov.["Medicineis dividedaccordingto the following

way: Each doctor specializes in a single illness and no more. (Egypt) is full for doctors for everything.So there
are doctors for the eyes, doctors for the head, doctors for the teeth, doctors for the belly, doctors for diseases
that are not apparent."]
28John F. Nunn, Ancient EgyptianMedicine (Norman:Univ. OklahomaPress, 1996), p. 164 f., describes the
panel in detail and provides the relevantbibliography;for the quotationsee p. 165.
29Ann Macy Roth, Egyptian Phyles in the Old Kingdom:The Evolution of a Systemof Social Organization
(SAOC, 38) (Chicago: OrientalInstitute,1991), pp. 66-68.
30See Montserrat,Sex and Society in Graeco-RomanEgypt (cit. n. 3), p. 43. Some scholars favor a strictly
medical interpretationeven for the pre-Greekperiod;see Roth, EgyptianPhyles in the Old Kingdom,p. 68.

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Sometime afterthis, Nephoris defraudedme, being anxious that it was time for Tathemisto be
circumcised,as is the custom among the Egyptians.She asked that I give her 1,300 drachmae
from what [Tathemis]had paid me ... to clothe her ... and to provide her a marriagedowry,
and [she promisedthat] if she didn't do each of these or if she did not circumciseTathemisin
the month of Mecheir,year 18 [163 B.C.E.],she would repay me 2,400 drachmaeon the spot.31
It may be helpful to bear in mind that marriage did not disqualify priests and others
affiliated with the temples from continuing their service.
Archaeologically, there may be confirmations that FGM existed even during the preGreek period. One tantalizing text is found on the sarcophagus of Sit-hedj-hotep, dating
to the Middle Kingdom (12th dynasty, ca. 1991-1786 B.C.E.) and now preserved in the
Egyptian Museum. The passage details a magical spell that is effected by the anointment
of the spellcaster with certain body substances (b3d; exact meaning unknown) of an uncircumcised girl and an uncircumcised bald man.
As for any man who knows it while it is sealed, he is more glorious thereby than Osiris: He
has passed every tribunalin which Thoth is, but Thoth will be in the tribunalof Osiris. If a
man, a great one, who is on his lake of death,going to the BeautifulWest, should recite it four
times as a purification,then on the fourth day, he will go (die). [This] is correct more than
anything.But if a man wants to know how to live, he should recite it every day, afterhis flesh
has been rubbed with the b3d of an uncircumcisedgirl and the flakes of skin [Fnft]of an
uncircumcisedbald man.32
The presence of the word for uncircumcised male ('m') supports the translation of the
word relating to the female, 'm't, as "uncircumcised," as most scholars have done.33 This
reading makes sense and is reasonable, although some Egyptologists are uncomfortable
31PLond (= Greek Papyri in the British Museum,ed. F. G. Kenyon [London:British Museum, 1893]), 1.24
SCTtva Xp6vov Tfi; N8(p6ptToq;apaXoy7tao vi5; pe ai xpoesveyic?acvlq
11.9-18 (164/163 B.C.E.):PETCa
90oq;oTi rTO;AiTyuwnot;xeptTplVCa0 at tadoi
ipatetsi acTrjv cKat.... s .... Gcrata5tinv avSpi pepvietv, ?av S6 ph
Taq;drT?qp Torto OctTeXs,crara
ot5rcovef Trilph espe It Tipv TdirtOUtv tn&pesfp
l oi rapagrlvito6 tqL atroxTei(st
iotfit Kicac0 TOUTv
Xplpua < PIu,Karl Sudhoff, "Beschneidung,"in Arztliches aus friechischen Papyrus-UrkundenBausteine zu
einer medizinischenKulturgeschichtedes Hellenismus (Leipzig: Barth, 1909), p. 178 f., sees an association
between female circumcisionand temple service. This view is not universal.PaulWendland,"Die hellenistischen
Zeugnisse iiber die 'gyptische Beschneidung,"Archivfar Papyrusforschung.1903, 2:22-31, finds no ground
for assumingthatTathemis'sassociationwith a temple was connectedwith her excision, since the letterindicates
thatthe rite was an Egyptiancustom preparatoryto marriage(dxq S0oq;ari TOr;AiyutMiotq-"as is the custom
among the Egyptians").
32Egyptian Museum sarcophaguscat. no. 28085. The passage reads, "[448d]" ir s nb rh(t) sy sd3ti [448e]
3h sw im r Wsir [449a] iw sw3-n-f d3d3t nb(t) wnnt Dhwty im-s wnn swt Dhwty [449b] m d3d3t nt Wsir
[449c] ir wnn s wr ht s-f n hpt r imnt nfrt [449d] sd sy ? s4m-f w'bt nt tp hrw 4 [449e] hpp-f m fdn-nw-f [450a]
mty r hp nbt. [450b] ir swt mrr-frh s'nh [450c] sdd-f sy r' nb [450d] sin-n-f 'wf-f m b3d [lacuna] [idyt] 'm't
hn' snfw nt i3s 'm'." The hieroglyphictext is in Pierre Lacau, Sarcophages extirieurs au nouvel empire (no.
28001-29086 (Cairo:IFAO, 1904), sarcophagusno. 28085 (innercoffin), Vol. 1, p. 217. It is CoffinText spell
1117, 448d-450d; see the variorumedition by Adriaande Buck and Alan H. Gardiner,The Egyptian Coffin
Texts (Chicago:Univ. Chicago Press, 1961), Vol. 7, pp. 448-450.
33 Adolf Erman and Hermann
Grapow, comps., Worterbuchder aegyptischen Sprach (Berlin: Akademie,
1982), Vol. 1, p. 185; Dimitri Meeks, Annie lexigographique.Vol. 2 (Paris:Favard, 1978), p. 70; Alexandre
Piankoff, The Wanderingof the Soul (Princeton,N.J.: PrincetonUniv. Press, 1974), p. 32; and HermannKees,
Totenglaubenund Jenseitsvorstellungender alten Agypter(Berlin:Akademie, 1956), p. 300 f. Eugen Strouhal,
Life of the Ancient Egyptians(Norman:Univ. OklahomaPress, 1992), p. 29, likewise concludes on the basis of
this text that FGM was practiced.See also the commentsby Emmanuelde Rouge, "Inscriptionhistoriquedu roi
Pianchi-Meriamoun,"BibliothaqueEgyptologique, 1911, 24:263-307, on p. 281 n 1; Frans Jonckheere, "La
circoncisiondes anciens egyptiens,"Centaurus:InternationalMagazineof the Historyof Science and Medicine,
1950-1951, 1:212-234, esp. p. 216 f.; and Constant de Wit, "La circoncision chez les anciens 6gyptiens,"
Zeitschriftfir AgyptischeSprache und Altertumskunde(ZAS), 1972, 99:41-48, esp. p. 43.

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with it. As with the English word "uncircumcised,"the word 'm't obviously does not tell
us anythingaboutthe circumcisedstate-the degree of circumcisionpracticedat thattime.
To resolve this conundrum,Saphinaz-AmalNaguib analyzedthis text and,with herreading
of a hieroglyphthat shows the position of the ancientEgyptianwoman in labor,concluded
thatinfibulation,or third-degreeFGM, was not practicedin Egyptin antiquity,a hypothesis
that accords well with the Greek descriptionsof the clinical procedurealreadynoted.34
This conclusion was supportedby physical examinationof female mummies. G. Elliot
Smith, an Australianpathologistin the early decades of the twentiethcenturywho visually
inspected hundredsof mummies, observed that infibulationhad not been performed.In
his remarkson the techniqueof mummificationduringthe 21st dynasty, he statedthat in
most cases the skin of the labia majora,"while still soft and flexible, was pushedbackward
towardthe anus so as to form an aproncovering the rima pudenda"that gave the appearance of infibulation.We might speculatethatthis curiousprocedurewas designedto ensure
thatthe deceasedwas not violated, a hazardcited by Herodotus.3Smithdid not specifically
address the question of first- or second-degreecircumcision, at least not in print;he recorded that soft tissues frequentlywere removed by the embalmers,either accidentallyor
deliberately,or deterioratedto a point where it was impossible to determinewhether a
lighter circumcisionhad been made.36In light of the fact that only rarely have scientific
researchersautopsyingmummies specifically looked for the presenceor absence of FGM,
conclusive remarksabout the prevalence of the practice must await a detailed study of a
large cohort of female mummies. (For scientific purposes, it is necessary for researchers
to state negative findingsas well as positive ones; the absence of remarksregardingFGM
cannot be held as proof that it was not practiced,since we have no indicationthat most
investigatorseven looked for signs of it.)

A parallel surgical procedure,male circumcision,may help us understandthe practicein

females, especially if motivation for it can be satisfactorilyidentified.Certainly,it must
be grantedthat several of the earliest male mummies yet found prove that male circumcision was alreadya familiarprocedurein the Old Kingdom.Investigationof latermummies links the practicewith priestsandroyalty.37This positive verificationof the procedure
contrasts with the situation with female mummies. As already noted, however, several
factors may account for the lack of evidence in females: the manipulationof female external genitalia during the process of mummificationaltered the appearanceto such a
34Saphinaz-AmalNaguib, "L'excision
pharaonique-une appelationerronee?" Bulletinde la Societe d' Egyptologie, Geneve, 1982, no. 7, pp. 79-82. So-called pharaoniccircumcision is thus a gross misnomer, since it
appearsnot to have been practicedat any time in ancient Egypt.
35G. Elliot Smith, A Contributionto the Studyof Mummificationin Egypt. (Mtmoires PrMsent6sa l'Institut
Egyptienet Publies sous les Auspices de A. A. Abbas II, Khedived'Egypte, 5[1]) (Cairo, 1906), p. 30; and Hdt.,
36This opinion was echoed by anotherearly pathologist,who commentedthat "the bodies are in such a state
that it would often be difficult to state with certaintywhethersuch an operationhad been done":Marc Armand
Ruffer, Studies in the Paleopathologyof Egypt (Chicago:Univ. Chicago Press, 1921), p. 171.
37Reportsof uncircumcisedmales are not unusual,especially among nonroyalnonpriestlypersons. See, e.g.,
GeraldD. Hartet al., "Autopsyof an EgyptianMummy(Nakht-ROM),"CanadianMedicalAssociationJournal,
1977, 117:461-476; and Aidan Cockbum et al., "Autopsyof an EgyptianMummy,"Science, 1975, 197:11551160, who reporton a mummy (Pum n) from ca. 700 B.C.E. More thaneight thousandmummieswere autopsied
in the early part of the twentieth century (ibid., p. 1155), but the autopsies were often conductedcarelessly or
in such haste that we do not have a reliable estimate of the percentageof males that were circumcised.

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degree thatno determinationcan be made regardinglighterforms of FGM;female corpses

may have been delivered for mummificationin a relatively putrefiedstate, as Herodotus
notes; and, finally, researchershave not been specifically looking for the presence or
absence of signs of FGM. Furthermore,it can be hypothesizedthat if circumcisionwere
primarilyritualisticor associatedwith temple activities, given thatfewer roles are attested
for women thanfor men, then relativelyfewer women may have undergonethe procedure.
Two male circumcisionscenes are attestediconographically;the first, as alreadymentioned, is from the tomb of Ankh-ma-horin Saqqarathat dates to the Old Kingdom. A
second panel portrayingthe operation, from the Temple of Amenhotep III beside the
Temple of Mut at Karnak,dates to the New Kingdom. This latter scene is interestingin
that the mummy presumedto be AmenhotepIII, the man who dedicatedthe panel, was
found to be circumcised.Although the mummy thoughtto be that of this pharaoh'spredecessor,AmenhotepII, likewise shows thatcircumcisionhadbeen performed,the practice
does not appearto have been universaleven amongroyal title holders,since the mummies
held to be Amenhotep II and Ill's dynastic predecessors,Amenhotep I and Ahmose I,
were not circumcised.38
Identificationof mummiescannotusually be verifiedwith 100 percentcertainty,yet the
overall trend-some apparentlyroyal corpses show circumcision while others from the
same period do not-calls into doubt any historicallycomprehensivestatement,such as
The popularity
Herodotus'sAtiylCTtot8e CS ptTatvovtat ("theEgyptianscircumcise").39
of circumcisionmay well have varied,but it nonetheless seems likely that priests,temple
attendants,and royal and other high-rankingpersonagesadheredfairly rigidly to the custom.40

Apartfrom the ritualnatureof male circumcision,otherobservationstangentialto FGM

may be broached.First, it must be conceded thatthe apparentlypublic and open character
of the operationin males, as depicted in the two wall panels, contrastsstrikinglywith the
lack of public works celebratinga female's circumcision.It is worthnoting, however, that
in Egypt today there is a clear-cutdistinctionin the circumstancessurroundingmale and
female circumcisions:the boy's event is public and widely celebratedwith great cheer,
whereasthe girl's event is private,carriedout with little fanfareor ostentation.In the case
38On the scene from the tomb of Ankh-ma-horsee Bertha Porterand Rosalind L. B. Moss, Topographical
Bibliographyof AncientEgyptianHieroglyphicTexts,Reliefs, and Paintings (Oxford:OxfordUniv. Press, 19271951), Vol. 3, p. 514. A thoroughdiscussion with bibliographyis in Roth, EgyptianPhyles in the Old Kingdom
(cit. n. 29), pp. 62-68. On the panel from the Temple of Amenhotep see F. Chabas, "De la circoncision chez
les 6gyptiens,"Revue Archeologique,N.S., 1861, 3:298-300; and MauricePillet, "Les scenes de naissance et
de circoncision dans le temple nord-estde Mout, AKamak,"Annales du Service des Antiquitesd'Egypte, 1952,
52:93-104. AmenhotepIH's mummywas very badly damaged,with most of the flesh of the head missing, along
with much of the other soft tissues: Salima Ikramand Aidan Dodson, The Mummyin Ancient Egypt (London:
Thames & Hudson, 1998), p. 324; it has been presumedthat he was circumcised since he was the dedicantof
the circumcisionscene at Karnak.On AmenhotepII see G. Elliot Smith, Royal Mummies(Cairo:IFAO, 1912),
p. 37. X-ray imaging has demonstratedthat AmenhotepI and Ahmose I were not circumcised,althoughearlier
investigatorshad presumedthat they were. See James E. Harrisand Kent R. Weeks, X-raying the Pharaohs
(New York: Scribner's, 1973), pp. 126, 130.
39Hdt., 2.36.3; cf. Meinardus,"Mythological,Historical,and Sociological Aspects of Female Circumcision"
(cit. n. 12), p. 389 f. I am remindedof a modem reverse parallel:when interviewedby Westernresearchers,a
numberof upper-classEgyptian women firmly denied that they had been circumcised, yet an Egyptiangynecologist who examined them found that in fact about 90 percent of them were circumcised (MahmoudKarim,
40See, e.g., de Wit, "Circoncisionchez les anciens egyptiens" (cit. n. 33), p. 43; Jonckheere,"Circoncision
des anciens 6gyptiens" (cit. n. 33), p. 231 f.; Sudhoff, "Beschneidung"(cit. n. 31), pp. 177-180; and Ulrich
Arch. Papyrusforschung,1903, 2:9-12. Most scholars
Wilcken, "Die agyptischen Beschneidungsurkunden,"
agree that the practicewas more obligatoryfor the priestly class than for the common people.

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of boys, the extendedfamily and neighborsof both sexes freelyjoin in a publiccelebration;

the girl, by contrast,usually receives only immediatefamily members,and often only the
females, at home. (This was the case even before female circumcision was made illegal
and even when the practicewas supportedby the government.)41
It is notable that circumcisionwas practicedon boys at aboutthe same age as FGM in
girls. The boys depicted in the two circumcisionscenes I have discussed arejust entering
puberty;certainlythey are not infants. Two ancient authors,Philo Judaeusand Ambrose,
indicate that the operationwas done when children entered adulthood,for girls at about
fourteenyears of age. Philo, commentingon Genesis 17:10, says, "Whydoes He command
thatonly the males be circumcised?In the firstplace, the Egyptiansby the custom of their
countrycircumcise the marriageableyouth and maid in the fourteenth(year) of their age,
when the male begins to get seed, and the female to have a menstrualflow." Ambrose,
bishop of Milan (d. 397 C.E.),largely echoes Philo's words: 'The Egyptians circumcise
their males in the fourteenthyear and the females among them are broughtto be circumcised in the same year, because certainly from that year, the passion of manly sensation
begins to burn and the monthly courses of women begin."42Ambrose, however, seems to
suggest a moral purpose in circumcising males, in that they begin to experience sexual
desire at aroundthe age of fourteen. This leads to the question of motivation:What was
the likeliest motivatingfactor for FGM in ancientEgypt?

Given that the evidence suggests two generaltheatersof operationfor FGM, one medical
and curativeand the other ritualin nature,it is likely that more than a single motivating
factor accounts for the practice in antiquity. Aetios, Galen, and the Soranus family of
sources provide a strictly clinical indication for excision, namely, an excessively large
clitoris. It should be noted that the clitoris appearsrelatively larger in the prepubescent
girl than in the adultwoman: as she maturesthe organdoes not grow substantially,in fact
often becoming slightly smaller.43Yet Aetios is not referringto a child's normalclitoris,
since he gives the instructionthata muscled young man shouldrestrainthe girl undergoing
surgery.Even today, a greatly enlarged clitoris-say, about 1.5 inches in length-is an
41 Hamed
Ammar,Growing Up in an EgyptianVillage, Silwa, Province of Aswan (London:Routledge, 1954),
p. 116; and John G. Kennedy, "Circumcisionand Excision in Ancient Nubia,"Man, 1970, 5:175-191, on p.
42Philo Judaeus, Quaestiones et solutiones in Genesim, 3.47, in Philo: Questions and Answers on Genesis,
Translatedfrom the AncientArmenianVersionof the Original Greek,trans.Ralph Marcus(Cambridge,Mass.:
HarvardUniv. Press, 1953). The Greek version of this work is now lost. Ambrose, De Abrahamo2, 11.78
(348A-B), in Sancti Ambrossiopera, pars prima, ed. Karl Schenkl (CorpusScriptorumEcclesiasticorumLatinorum, 32) (Vienna: Tempsky, 1897): "deniqueAegyptii quartodecimo anno circumciduntmares et feminae
apud eos eodem anno circumcidi feruntur,quod ab eo videlicet anno incipiat flagrarepassio motus virilis et
43 The clitoris at birthis
very nearto its adult size, althoughit does grow throughoutlife, especially at puberty:
Kumud Sane and Ora Hirsch Pescovitz, "The Clitoral Index: A Determinationof ClitoralSize in Normal Girls
and in Girls with AbnormalSexual Development,"Journal of Pediatrics, 1992, 120:264-266. Thus the clitoris
frequentlyappearslargerin girls thanin women because of the relativelysmallersize of girls andyoung children.
A second growth spurtin the organ is associated with childbirth,with parous women having slightly, but still
significantly, larger clitorides than nulliparouswomen: Barry S. Verkauf, James von Thron, and William F.
O'Brien, "ClitoralSize in NormalWomen," Obstetricsand Gynecology, 1992, 80:41-44. Occasionally,growth
is found in elderly women-John W. Huffman,"Some Facts aboutthe Clitoris,"PostgraduateMedicine, 1976,
60:245-247-presumably because of the relative increase in male to female hormonesafter menopause.

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indicationin both Egypt and the United States for a proceduresimilarto the one described
by Aetios and Paul of Aegina.44
These two surgeonsremarkon one of the complicationsof such a large clitoris:tactile
contact with clothing stimulatesthe organ, making the patient subjectto excessive desire
for coitus. It seems significantthat the descriptionmentions a physical deformity;45
is no indication that excessive desire in females with normal clitorides can be corrected
or even preventedby excision. It may be remarkedhere that there is a common misconception that FGM removes sexual desire; in fact, modem studies have found that women
whose clitorides were excised at puberty or before experience a pronounced(normal)
increase in desire in adulthoodbut that it is not matchedby correspondingsexual satisfaction.6 Physiologically, FGM does not treat venery, and the ancient Graeco-Roman
surgical testimony does not indicate it as a surgical solution for a woman who is overly
licentious or as a measureto preventsuch licentiousness from developing.
Nevertheless, chastity may have entered into the traditionssurroundingthe procedure
even at an early period, especially since Aetios suggests that it was performedto prevent
a physical deformity from developing. Here, a comparisonwith modem experience in
Egypt, where both curativeand ritual theatersexist, may be enlightening.When queried
about their motivationfor circumcisingtheir girls, modem Egyptianinformantshave offered primaryexplanationsthat vary widely over large blocks of time (say, from decade
to decade); but if all given explanationsare trackedover time, a menu limited to a few
motivationsemerges.47Some reasonswax and wane in popularity,whereasothersarecited
for a shorttime andthen disappear.Althoughmodem motivationscannotserve as evidence
for ancientcounterparts,the modem situationsuggeststhe most satisfactorycomprehensive
statement:as the traditionof FGM became embedded within the culture, new reasons
mixed with old ones to favor continuationof a practice whose original motivationmost
likely had long been forgotten.Medical, clinical, and curativemotivationsprobablymixed
with ritual, social, and moral reasons to favor the continuationand spread of a practice
that initially may have been narrowlyperformed.
We may nonetheless be able to identify a menu of ancient motivations,apartfrom the
strictly medical, curativemotivationsdescribedin Aetios, Galen, and the Soranusfamily
of manuscripts,especially if we makereferenceto male circumcision.Most commentators,
such as Herodotus,refer to cleanliness or hygiene as the principalreason why Egyptians
practicedthe custom. Complementaryto this is the idea of perfection-that is, the circumcised were free not only of transitoryfilth and pollution but also of inherentblemishes or
flaws.48These qualities were very importantto the priests and other temple personnel,in

See, e.g., the reductionmethod describedin J. Engert, "SurgicalCorrectionof Virilised Female External
Genitalia,"Progress in Pediatric Surgery, 1989, 23:151-164, esp. pp. 161-163. Like the ancient surgeons,
Engertstronglyunderscoresthe need to maintainsensitivity in the organ:"Fora woman, preservationof clitoral
sensitivity is essential to a satisfying sexual life. All techniquesinvolving total clitoridectomy.. .must therefore
be discarded"(p. 151).
45 An
excessively large clitoris was recognized by laypersons even in Rome, although they tended to treat
women so afflictedwith derision.E.g., an inscription(Corpusinscriptionumlatinarum,4.10004 [Berlin:Reimer,
1892-]) describes one such woman: "Euplialaxa landicosa."["Eupliahas a clitoris that's big and loose."] Cf.
Martial,Epigrammata,1.90,1.8; and Priapea, 12.14.
46 Shandall, "Circumcisionand Infibulationof Females" (cit. n. 12), p. 193 f.; and Karim, Female
Mutilation(cit. n. 12), p. 113. Shandall(p. 195) furthernoted that circumcision,and especially infibulation,did
not deter young women from seeking multiple sexual partners;see the discussion by Karim(p. 128 f.).
47Karim,Female Genital Mutilation, 66.
48Regardingcleanliness see Hdt., 2.37.2:
Ta re ai6ota icepxdgvovrai KaOapet6iTroqei've?cV, i7potgladvTeq;KaOapot etVactIf sunpeirxeTSpot. ['They circumcise the genitals for cleanliness, preferringto be clean

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whom, it has alreadybeen noted, circumcisionwas primarilypracticed.49In this vein, we

might add that the priests may have valued the procedurefor its ritual character,which
would have contributedto its propagationand continuation.
The widest menu of motivations for circumcision is provided by Philo Judaeus,who
cites four reasons in his work De specialibus legibus ("On the special laws") for the
practice among the ancients, including the Egyptians. One, of course, was hygiene, but
anotherwas that circumcisionprevents what was called in Greek divOpa4,equivalentto
moder phimosis.50Modem clinical studies have found that, contitay to Philo's assertion,
circumcisiondoes not significantlyreducethe occurrenceof this disease, providedordinary
hygienic practices, such as washing, are observed.5 In any case, this reason cannot find a
parallelin FGM.52
Philo then states thatcircumcisionmakes the generativeorgansimilarto the heart.Both
heartand sex organswere designed by the deity for generation:the heartfor new spiritual
life through the divine and the sex organs for new materiallife blessed by the divine.
ratherthan very good looking."] Cf. Plutarch,On Isis and Osiris, 4-5 (= Moralia, 352 c-f). With respect to
perfection see AgyptischeUrkundenaus den kiniglichen [Staatliche] Museen zu Berlin (Berlin: StaatlicheMuseen PreussuscherKulturbesitz,1895-), 13.2216, 11.25-28: 'Aya9orqg; m5Oexro,d xiva -crnpFla EXounv
ei CiO
esio6vtxo ao'plou; aooibS eivat, KXau6to;
'Ilpo6oou icpoypagaxrrx;
ti x&v?v Aiylwrq)
ipp6bv napanslae(osdevo; T OvnmtarooXv
'Aya9olcKXj6 apXtepEi Kicat
Escev. s6vavrat Kca' &tatotS oi uioi cou 'AplayadOlg icai 'AvxbcptSlcai
c;TOTrof4tI 7eptTrlfqivat
T6 S0o;. ["Agathoklesasked whetherthe boys had any birthmarksor other blemishes on theirbodies; when the
hierogrammateussaid they were withoutany, ClaudiusAgathokles,the high priestandthe overseerof the temples
in Egypt, putting his seal on the letter, said, 'Your sons, Harpagathesand Anchophis, and Stotoetis, at your
request, are able to be circumcisedaccordingto custom."']
49Inscriptionalevidence indicates that women in priestly families were expected to serve as priestesses; see
Adolf Erman,Life in Ancient Egypt (New York: Dover, 1971), p. 291 n 13.
50For the four reasons in their entirety see Philo, De specialibus legibus, 1.1 (pp. 210-211M), in Philonis
Alexandriniopera quae supersunt,ed. Leopold Cohn and Paul Wendland(1896-1930; Berlin: Reimer, 19621963). On cleanliness see ibid., 1.1.5: 8s6Tepov 8e TiV 1t' 6Xou ToOadsa'co; Ica0apt6';rxa npo;qT ap6'oxTovTated itapo:evi, napo Kai aupovratxc onpacatppoc)sneppUovxre; oi ?v AiyxrcTp-T&Vitsp&ov
yap KcaiuxocrurXet KaltOpt4i Kai iaoaiaat; vlaTa&V opesto6vcov Ka0aipeaO0a. ["(Circumcision provides), secondly, cleanliness of the whole body in accordancewith what is fitting for the priestly
class. As a result, carrying it to an extreme, some of the priests in Egypt also shave the body, since certain
substances(e.g., smegma) that must be removed graduallycollect and even drawback both hair and foreskin."]
On ivepa4 see ibid., 1.1.4: Ev ggv XaXkerxqv6aou icai urtadou, xoaivrTj;, d&akXayiv, fiv dvOpaKa
KakoOrtv,alcio ToOKaietv eVTrWixp6vov, OKoijat, xau6Mg;
Tf; pocniyopiaq uXo6vra,6rep?UiKoXdrepov
toSI a&KponrocOia;XouCtv Eyytivras. ["(Circumcisionprovides), first, a way of avoiding a difficult and
incurabledisease, thatof the prepuce,which they call anthrax('charcoal,'equivalentto modernphimosis),taking
its name, I believe, from its smolderingbum. It occurs more readily in those who have a foreskin."]
51Results of one study demonstratedthat "regularhygiene with retractionof the foreskin significantly decreased the incidence of phimosis, adhesions, smegma accumulation,and inflammation":HeatherKruegerand
Lucy Osborn,"Effectsof Hygiene among the Uncircumcised,"Journal of Family Practice, 1986, 22:353-355,
on p. 355. Patients who did not retractthe foreskin in washing had significantlyhigher rates of phimosis and
other associated conditions (p. 354). Educationon what constitutesproperhygiene appearsto be crucial, since
anotherstudy that did not include patient instructionin hygiene as a variablefound that penile problems were
significantlyhigher in a groupof uncircumcisedboys than in a circumcisedgroup:Lynn W. Herzog and Susana
R. Alvarez, "The Frequencyof ForeskinProblemsin UncircumcisedChildren,"AmericanJournal of Diseases
of Children, 1986, 140:254-256. The American Academy of PediatricsTask Force on Circumcisionhas recognized the importanceof appropriategenital hygiene, advising that it "be emphasized as a preventive health
topic throughouta patient's lifetime":"CircumcisionPolicy Statement,"Pediatrics, 1999, 103:687.
s2 A search of the literaturerevealed a single case study of female phimosis: D. G. McLintock,"Phimosisof
the Prepuceof the Clitoris:Indicationfor Female Circumcision,"Journalof the Royal Societyof Medicine, 1985,
78:257-258. It is noteworthy that the patient had type 1 diabetes, since certain conditions associated with
diabetes, such as polycystic ovarian syndrome, are linked with clitoral hypertrophy:Jan Hofejsf, "Acquired
ClitoralEnlargement:Diagnosis and Treatment,"Annals of the New YorkAcademyof Sciences, 1997, 816:362369. In addition,removalof the hood of the clitoris alone, while it is theoreticallypossible, has not been reported
in the literature;see Toubia, "FemaleCircumcision"(cit. n. 12), p. 712.

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Circumcisioneffectively removes the seal on the physical generative organ, permitting

reproductionto take place, just as an uncircumcisedheart cannot produce good, moral
thoughts.Almost as a corollaryto this idea, Philo stateshis fourthreason:thatcircumcision
makes the man more fertile because the path of the semen is not obstructed.53
The association between circumcision and generative ability is likewise reflected in
Egyptian textual evidence, as in the Book of the Dead, chapter 17, which glorifies and
praises the creatorRa and all his creation:"Whatis this? It is the blood that fell from the
phallus of Ra when he mutilated himself. It became the gods Hu (Authority) and Sa
(Wisdom), who follow Ra and who accompanyAtum daily and every day." This chapter
is one of the oldest and most fundamentalamong the Book of the Dead texts. Ra's selfmutilationis understoodby most commentatorsas a referenceto circumcision.The visible
sign of blood from circumcisingbecomes the physical sign of generativepower. Furthermore, returningto the text found on the sarcophagusof Sit-hedj-hotep,there may be an
association between sealing and ritual magic involving uncircumcisedpersons. The spell
detailed in the text was partof a longer series, now called The Book of Two Ways(Coffin
Texts spells 1029-1185), intended to guide the deceased past the hazardson the trip to
the realm of the afterlife.54One key station was judgmentby the gods, especially Thoth,
and spell 1117 appearsto guaranteethe deceased the ability to pass this tribunalwith ease.
There may be some sympatheticmagic in using partsof persons-whether young or old,
male or female-whose generative organs are still sealed as an aid in knowing what is
sealed or perhapseven knowing how to hide somethingfrom the scrutinyof the wise judge

The perceived causal link between circumcisionand generative ability, whetheror not it
is physiologically accurate,is certainlypowerful validationfor the practicefrom the point
of view of ritual.I would also like to suggest that it may be a clue to the origin of FGM,
although my analysis is merely hypothetical. Given that male circumcision is attested
iconographically,textually, and physically from a very early date and that evidence for
female circumcision does not appearuntil the Middle Kingdom at the earliest, scholars
53Philo, Spec. Leg., 1.1.6: Trpiov 6e TTIvzp6; KcapSiavo6oot6TrTaToO pcpitgP09vTO(q
ipqO ytp
y:vectv QdAupo7tapsEDaCCaTait, T'O tV yicdp6tov zve?0pavoqTidxtCv,TO6S yOvtJov opyavovv(qxov 6tiKcaixocavyap oi rtp(Rxot
tCp&paveTKai picpElTovt,?t' ou Ta voqTtaoauvfoTaTaat,TO ugpavhgKai 6parov,
4) Ta aia0xTa yevvaal
7gUpKcev,tolooitbaat. ["Third,(circumcisionprovides) resemblanceto the heart,
since both are designed for creation,the spirit in the heartfor (producing)thoughtand the generativeorganfor
(producing) living beings. The first people rightly claimed that the material and visible element, by which
perceptiblethings come into being, should be assimilatedto the unseen and the betterelement, by which thought
exists."] On the uncircumcisedheartsee Ezekiel 44.7; Romans2.29; and Quran,2.88. For the fourthreason see
Philo, Spec. Leg., 1.1.7: T&rapTov6? Kai avayicatOTatovTTIV
xipO;so3XuyoviavnapaowsKUcv- 3Xyetat yap
(x); suo6et T6 oxTgpa AqTe IcKtSvadtvovjT?TstSptpp&ov si5 ToUI;Tqg; too9ia; KOctXou;-O60evK:ai tZE
rsptTcsv6OesvaTOV 90ve)viroXuyoviraTa Kai noXuav0poTnrtaraeival SOKsI.["(Circumcisionprovides),
fourth and most necessary, the preparationfor fecundity, since it is said that the sperm thus has a free course,
neither scatteringnor slipping away into the folds of the foreskin. As a result those of the peoples who are
circumcisedseem to be the most fecund and the most populous."]
54Book of the Dead, 17.60-63. The passage reads "pftrirf sw. snf pw pr(w) m hnnw n R' mbtw3-f r irt s'd
im-f ds-f. 'h'-n-w bpr m ntrw imyw-bt R', Hw hn' Si3, wnn-sn m-tt 'Itmw m bit hrw nt hr'w nb." On Ra's act
as circumcision see Chabas, "Circoncisionchez les 6gyptiens"(cit. n. 38), p. 300; Jonckheere,"Circoncision
des anciens 6gyptiens"(cit. n. 33), p. 215; and de Wit, "Circoncisionchez les anciens dgyptiens"(cit. n. 33), p.
42. Cf. Ursula Verhoeven, Das saitische Totenbuchder Iahtesnacht(Bonn: Habelt, 1993), p. 100 n 1. On the
spell see Piankoff, Wanderingof the Soul (cit. n. 33), pp. 7-11; and LeonardH. Lesko, The Ancient Egyptian
Book of Two Ways(Berkeley:Univ. CaliforniaPress, 1972), pp. 2-7.

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reveal the diversityin this

Figure 3. Threeformsof intacthymen (annular,septate, and cribriform)
membranoustissue. Nevertheless,in spite of the individualvariation,the contrastwiththe same area
in a womanwho has given birth(farright,parous introitus)is clear,pronounced,and readily
perceived. (Illustration
by PatriciaJ. Wynne.)

have long assumedthatthe practicein females was inventedto mirrorthatin males. Taking
the oldest recordedmotivation we have for Egyptian male circumcision-that circumcision unsealed the generativeorgan-as a startingpoint, I would like to propose thatmale
circumcisionoriginally was invented to mirrora naturalprocess in females. Indeed, this
process usually is marked with a sign of blood, and it effectively opens the womb to
production of new life: it is the breaking of the hymen that normally occurs on first
intercourse,especially if the female is fairly young. (See Figure 3.)55
The hymen in young female humans is a unique sexual feature not found in other
primates. It has been speculated that sexual selection accounts for its evolution, on the
theory that girls with hymens were preferredover those without them because the former
could "prove"their virginal status. A more plausible theory is that the hymen is an embryonic structureretainedthroughoutinfancy and childhood as a means of protectinggirls
from infection, a barrieragainstorganismsthatmight be introducedinto the vaginathrough
inadequatehygiene. The protectivebarrierbecomes less importantas the girl maturesand
is able to clean herself appropriately,and the loss of the hymen can serve as a biologic
markerof a female's adult status.More pointedly stated,the hymen has been found in all
normalfemale infants, althoughit is recognized that the vaginal orifice and surrounding
tissue become distensible with adult levels of circulating female hormones, a fact that
makesthe hymen unreliablefor virginitytests in oldergirls.56In prepubertalgirls, however,
in types;see
in Figure3 areintendedto showsomeof thegeneralvariation
(cit. n. 12), p. 21 f. See also the followingarticleson hymenvariation
of the Prein normal(i.e., nonsexuallyabused)girls:SusanFerrellPokomy,"Configuration
andGynecology,1987,157:950-956;AbbeyB. Berensonet
Journalof Obstetrics
of the Hymenin Prepubertal
al., "Appearance
Girls,"Pediatrics,1992, 89:387-394; andJ. JaneGardner,
in Healthy,Nonabused
Girls,"J. Pediatr.,1992,120:251Studyof GenitalVariation
56A. J. Hobday,L. Haury,andP. K. Dayton,"Function
of the HumanHymen,"MedicalHypotheses,1997,
49:171-173;CaroleJenny,MaryL. D. Kuhns,andFukikoArakawa,"Hymensin NewbornFemaleInfants,"
of thePrepubertal
Hymen,"p. 954.

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the presence and the appearanceof the hymen are useful indicators,althoughphysicians
and other health-careprofessionals in the United States today are trainedto assess appearanceprimarilyin cases of suspectedsexual abuse.
The most strikingpoints to be takenfrom modem researchon the hymen are these. The
hymen is not directly related to virginity; this is a false construct.But it is always conversely relatedto fertility, in that absolutely no female humanbeing who has given birth
(proof of fertility) has an intact hymen. From that perspective, an ancient theoristcould
indeed have assertedthat the breakingof the hymen "unseals"a young woman's genital
organs, since this breaking,with its characteristicblood sign, is a precursorof (potential)
Although the hymen structurewas apparentlynot known to Greek or Roman medical
specialists until a fairly late period, it is not unknown among many so-called primitive
peoples.7 It is possible thatancientEgyptiansbeforerecordedhistorynotedthe association
between the broken hymen and a subsequentpregnancy and created circumcision as a
symmetricsign to celebratethe adult capabilitiesand responsibilitiesof young men; such
an association could account for the motivation for male circumcision,noted earlier,of
making a man more fertile. We know in fact that a significantnumberof Old Kingdom
rituals were lost, misconstrued,or adaptedby the Middle Kingdom and later regimes.58
Stretchingthe analysis farther,it is possible that the original symmetryof brokenhymen
and circumcisedprepucewas forgottenand that a new ritual-FGM-was developed to
maintainthe appearanceof symmetry.
57The existence of a hymen was denied by Soranus (1.17); see comments in Giulia Sissa, Greek Virginity
(Cambridge,Mass.: HarvardUniv. Press, 1990), p. 113 f., which also explores the idea of hymenless virginity
in ancient Greece (pp. 168-173). On knowledge of the hymen among "primitive"peoples see HerantA. Katchadorianand Donald T. Lunde,Biological Aspects of HumanSexuality(New York:Holt, 1975), p. 19. See also
Elisha P. Renne, "VirginityCloths and Vaginal Coverings in Ekiti, Nigeria," in Clothingand Difference: EmbodiedIdentitiesin Colonial and Post-ColonialAfrica, ed. Hildi Hendrickson(Durham,N.C.: Duke Univ. Press,
1996), pp. 19-33, for a discussion of how the physical hymen has been conflatedwith a materialobject (cloth)
in a traditionalsociety undergoingtransitionto a more Westernizedpattern.The intellectualrecognitionof an
associationbetween the physical hymen and virginityis not lost, however. Even in more developed cultures,the
hymen remains the focus for determiningvirginity. For example, GuillermoUribe Cualla, a Colombianlegal
expert,concluded that only complete ruptureof the hymen, not injuryor incompleterupture,should be takenas
the medicolegal standardfor defining deflorationin his country:Uribe Cualla, "Cual debe ser la base para el
diagn6stico mddico-legal de la desfloraci6n,"Zacchia, 1971, 46:1-6, esp. p. 4. Another remarkablesituation
exists in Egypt today, where surgeons have discoveredhow lucrativehymen repaircan be for less-than-perfect
brides-to-be;see Peter Kandela,"Egypt'sTradein Hymen Repair,"Lancet, 1996, 347:1615. Recently, religious
authoritiesat al-Azharhave wisely affirmedthatthe presenceof a hymen is not a valid preconditionfor marriage;
see Nevene M. Shawki, "Hymenor No Hymen, MarriageRuled Valid,"EgyptianGazette, 19 Sept. 2000, p. 7.
58 See A. Rosalie David, TheAncientEgyptians(New York:Routledge, 1982), Ch. 3, esp. pp. 92 f., 105-112;
and Klaus Koch, Geschichteder dgyptischenReligion von den Pyramidenbis zu den Mysteriender Isis (Stuttgart:
Kohlhammer,1993), pp. 209-240.

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