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Curing
Cut
or
Ritual
Mutilation?
ABSTRACT
318
CURINGCUT OR RITUALMUTILATION?
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
patdA-ra
kLougg:vcov ntap'abcxolq
To
In Egypt today the procedure is more
9taKreiveiv.
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).
2
MARY KNIGHT
319
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.
320
CURINGCUT OR RITUALMUTILATION?
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.
321
MARY KNIGHT
I-Xh
4r%j- G/
cza
^ L
%~?
a
O
O
0o
PRACTICE
OF FGM
AFRICA
THROUGHOUT
ANDSAUDIPENINSULA
-I
DEGREE
THIRD
FIRST
ORSECOND
DEGREE
322
CURINGCUT OR RITUALMUTILATION?
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
THE MEDICAL SOURCES: THE SORANUS "FAMILY"
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
13
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,
1989).
14
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.
323
MARYKNIGHT
EXTERNALFEMALEGENITALIA
CLITORIS
URETHRAL
ORIFICE
LABIA
MINORA
VAGINAL
ORIFICE.
OF MUTILATION
DEGREES
DEGREE
FIRST
DEGREE
SECOND
THIRDDEGREE
,q'y"t
5?
u''
~'.
. _. i
.I~.~
.r.
HOODOFCLITORIS
REMOVED
CLITORIS
REMOVED
REMOVED
LABIA
MAJORA
REMOVED
MINORA
LABIA
MINORA
REMOVED
LABIA
CLTORISREMOVED
withthethreemostcommondegrees
Figure2. Intactexternalfemalegenitalia(top)arecontrasted
inancient
circumcisions
werepracticed
Thereis no evidencethatthird-degree
of mutilation
(bottom).
J. Wynne.)
by Patricia
Egypt,andeventodaythisformis rare.(Illustration
CURINGCUT OR RITUALMUTILATION?
324
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
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
Manuscript,
p-o^u^!
14
_...
i L
LF~L~ JIJ
>1
jjJJI
_
ILX,
_
u...~I..L..L,J
J
- C" -eL
L.
I *LL
IJa a
Jjl^~'
^*
c,,~,
J-L
.j,f
J
,
S J
,i
..J
c
J.
S"
jLLJ
..L
_,, I
jI
MARY KNIGHT
325
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
area.18
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
sexualintercourse.
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;
Tx(nCicotil6KOTi
nd0dt Tiiv bcoX'qvT&Yv
v uteva f TxivJapKa
itp4vomv 0epareuxerov, xepiK6xTovra ev b5v
ti Tv raTpfTrov,paXdacovra 8E Kalci eTraaouycp(vovTa
8e
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:
:iesav
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;
aif.I
(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,
326
CURINGCUT OR RITUALMUTILATION?
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
uterus.
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"
their
women ... ThusXanthossaysin his secondbookon theLydiansthatAdramytes,
thekingof
theLydians,castrating
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.
THE ANCIENT MEDICAL SOURCES: GALEN AND AETIOS
MARY KNIGHT
327
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
of
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."]
328
CURINGCUT OR RITUALMUTILATION?
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
organ.
MEDICAL PROCEDURE OR TEMPLE RITE?
KaraT XV dvo)eV Tv
xv tepuycoldstov
ruglpoXiiv.
KaO' 6vTr6ov
q otpi'p0pa TxtaKTxa
xkov
TCOV
yuvaLIKIcv
a6ffl'atv %atjpavov, KaQii5a
Si TIatV Wli
te; peettavKai aiaXUv6tv
yYE?06verTai
n6O
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;
rCysdipst,
XXotsv
I
fS
TbOV
Tp6Oov
ai
0aXp0evoI.
:IEtteXstTalt
TOOTOV.
kSpac4Tx
y6yeoal
q?X&tpoupy(a
cp6; yd4aov
lAv I1nap0gvoq Cri 8i(ppou,xapeCaTo; 8 6oaOEv veaviaicog UTovoq;u6opdXXcovToru iSioug;xcic;tq
Xn KalTO
cai
8 vVavTiov
Ta
6Xov
C&oa'- oTdx5q
6 Lvspy(bv
Kal: uSi(p
S8tKpaTsiTco
TaT;eK:eivi; iyvuatq,
t,
vT
Tv
'SSei4ta roxTe?vETxw
prIv Sta Tfqqstuvutou XsipbOaCOTEIstvE
tcXaTUxTO6p au).Xapdv
apa
TObU66vtaQ; ToO gu?iou. eT:pov SextpooqKce KaTcXatvoxgi
tf|;
aTxOTeaVOg?VTi;KltOVtiO0,va TO6
nap8a S Tob; 66vTag TOtO
IPuSou TiV 4KpaipcaivetiTov y?vgoOati,sta T6
&qV
IEptTTOoV
govov
tpaef*
6Xoevat Tliv vt5pnTPvKai x0apeKTviCoveoaltlApt tXesfCTTo. 6drT?e ihimKTfl; RepITTOTtEpa;
8spgaT6MSI'
cb CK
xTivXetpoupytav
pota; 7EaK:oXou0eTv.MeTa Se
Tf5; pa60VTpa;TC&V?yK:av0iStov
iKTOtfqg;
KO07cf;
cKaa&iouatavTa; (rM6yyqpadvvav wrtnaxxsv, cat
TiIv 'licotv iq VuXp iSzaTt,
OtVqwtpocrKEcst rtxTqEstv
3pp xovTag E;iTI0OvEat,
dvo)Ov cx6TTyov6Kpcptq p3ppeyt vov ixdXtvsi:t0Ovat?
0oTov6ui)paTxqp
Kaltcc
8tl ppUyo00q06ou
c8Ka6Liav
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
Ka6aaq
?
Ta
Ical ppO6q
V aiSotqot eKi.
329
MARY KNIGHT
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.
2613-2181
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
oSv
oi
yap o6pa6(IXaiI)v
irlTpol Katcaoeaca,
oi S KC(plaf;qq,oi &e
330
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
T'i
5ou6vataurfit
TTivTdOrlZtv
6pav
d)q
;X&tv
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.
MARY KNIGHT
331
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.)
CIRCUMCISION OF MALES
332
MARY KNIGHT
333
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.
180.
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
feminarummenstruasumantexordia."
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.
334
CURINGCUT OR RITUALMUTILATION?
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
there
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
44
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.
Genital
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.
p.
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
MARY KNIGHT
335
336
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
AspovU;*
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.
MARYKNIGHT
DIFFERENT
FORMSOF THE HYMEN
ANNULAR
SEPTATE
337
PAROUS
INTROITUS
CRIBRIFORM
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,
55Thehumanhymensillustrated
in types;see
in Figure3 areintendedto showsomeof thegeneralvariation
andMutilations
Karim,Circumcisions
(cit. n. 12), p. 21 f. See also the followingarticleson hymenvariation
of the Prein normal(i.e., nonsexuallyabused)girls:SusanFerrellPokomy,"Configuration
andterminology
andGynecology,1987,157:950-956;AbbeyB. Berensonet
American
Journalof Obstetrics
Hymen,"
pubertal
of the Hymenin Prepubertal
al., "Appearance
Girls,"Pediatrics,1992, 89:387-394; andJ. JaneGardner,
in Healthy,Nonabused
Premenarchal
Girls,"J. Pediatr.,1992,120:251Studyof GenitalVariation
"Descriptive
257.
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
Pediatrics,1987,80:399-400;andPokomy,"Configuration
Hymen,"p. 954.
338
CURINGCUT OR RITUALMUTILATION?
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)
fertility.
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.