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In reply—Consider the Personhood of Women Who Experienced Genital Cutting

      We thank Bergstrom and colleagues for their letter in response to our article on female genital cutting (FCG). We are delighted by their thoughtful reading of our article, and we agree with the important points that they make regarding cross-cultural medicine in general and caring for women who have undergone FGC specifically.
      They rightly point out that our review article focused mostly on medical management. As we mentioned in the article, the practice and cultural meaning of FGC varies so much across different ethnicities in Africa and the Middle East that we were not able to fully address the many specific cultural aspects of FGC. We did attempt to emphasize the importance of understanding each woman's experience and her cultural context when meeting and caring for women who have undergone FGC. The goal of Table 2 in our article was to help physicians who may be less familiar with cross-cultural medicine to better understand how women would like the topic of FGC to be approached, if at all. We also stated:In practice, many physicians simply avoid discussion of FGC, which can be frustrating and confusing to the woman with FGC, especially as she anticipates delivery and possible episiotomy. On the other end of the spectrum, women with FGC have expressed concern that their FGC turns them into “specimens” and the presence of the FGC becomes more fascinating to their physician than her presenting health concern or the woman as a whole. Women with FGC have expressed that they want their physicians in America to know that they are circumcised but do not necessarily want to discuss it unless there is a current or anticipated problem.
      • Hearst A.
      • Molnar A.
      Female genital cutting: an evidence-based approach to clinical management for the primary care physician.
      These statements and the information provided in Table 2 of our article were gathered from focus groups and the excellent article by Khaja et al,
      • Khaja K.
      • Lay K.
      • Boys S.
      Female circumcision: toward an inclusive practice of care.
      which Bergstrom et al also cited.
      Female immigrants from countries where FGC is practiced certainly are “more than the condition of their genitals.” We agree that eliciting a narrative and attempting to truly understand these women's experiences is an integral part of providing compassionate and culturally competent care. We chose to focus on clinical aspects of this topic because, as health care professionals, one of our first responsibilities is to also understand the potential health consequences of any patient condition. Women in focus groups have also reported frustration with physicians' lack of knowledge. To communicate effectively with any patient, the clinician must be properly informed. We encourage interested health care professionals to read the article by Khaja et al
      • Khaja K.
      • Lay K.
      • Boys S.
      Female circumcision: toward an inclusive practice of care.
      and for researchers to continue to explore both the medical and communication issues in future research. Certainly excellent patient care cannot take place with just one or the other.

      References

        • Khaja K.
        • Lay K.
        • Boys S.
        Female circumcision: toward an inclusive practice of care.
        Health Care Women Int. 2010; 31: 686-699
        • Hearst A.
        • Molnar A.
        Female genital cutting: an evidence-based approach to clinical management for the primary care physician.
        Mayo Clin Proc. 2013; 88: 618-629

      Linked Article

      • Consider the Personhood of Women Who Experienced Genital Cutting
        Mayo Clinic ProceedingsVol. 88Issue 10
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          In the article published in the June 2013 issue of Mayo Clinic Proceedings, Hearst and Molnar1 reported comprehensive data regarding female genital cutting in African and Middle Eastern women. Although their report was educative and meaningful, they overlooked how the human aspect of these women is affected by the cultural imperatives that dominate their lives. Female immigrants are much more than the condition of their genitals. They have varying needs and levels of acculturation with differing views and experiences.
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