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Consider the Personhood of Women Who Experienced Genital Cutting

      To the Editor:
      In the article published in the June 2013 issue of Mayo Clinic Proceedings, Hearst and Molnar
      • Hearst A.A.
      • Molnar A.M.
      Female genital cutting: an evidence-based approach to clinical management for the primary care physician.
      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.
      Focus group research reveals that these women are frustrated and often feel disrespected when physicians' questions quickly switch from the presenting problem to female genital cutting. One 65-year-old woman asked, “Why do you ask me so much about this?,…My back hurts, I need a job and my family to be together again. These are my problems.”
      • Horowitz C.R.
      • Jackson J.C.
      Female “circumcision”: African women confront American medicine.
      Raising Kleinman's questions
      • Kleinman A.
      Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry.
      may give these women the sense that a clinician respects them and their viewpoints: (1) What do you call the problem? (2)What do you think has caused the problem? (3) Why do you think it started when it did?
      When caring for African women, we remind clinicians that African cultures are typically based on an oral tradition. If clinicians build rapport and trust by listening to patients' stories, they may hear of deep love toward children and extended family, respect for elders, and actions weighed on the basis of impact on community. They may hear about trauma experienced in leaving a war-torn country or difficulties raising children in a new culture without family and community support as experienced back home.
      We recommend a stance of respectful curiosity to sensitively partner with these immigrant families. Carl Rogers said, “If I can be genuinely understanding, listen not only to the words but to the meaning, that is helpful.…If I really care about this person in an unconditional way, that's helpful. If I can really be myself in the relationship, not a professional expert, not a psychoanalyst, not a psychotherapist, just me in that relationship, that is helpful.”

      Rogers C, Rogers N. Carl Rogers on Person-Centered Therapy [DVD]. Psychotherapy.net website. http://www.psychotherapy.net/video/person-centered-therapy-carl-rogers.

      Instead of condemning traditional practices and leading women to be defensive, a Somali woman requested, “Educate the family [considering circumcising their daughter]...You can explain the consequences, what is going to happen. She may have psychological trauma, bleeding, she may get infection, it may affect fertility…They will understand. The Somalian people understand when you explain to them and make them understand.”
      • Khaja K.
      • Lay K.
      • Boys S.
      Female circumcision: toward an inclusive practice of care.

      References

        • Hearst A.A.
        • Molnar A.M.
        Female genital cutting: an evidence-based approach to clinical management for the primary care physician.
        Mayo Clin Proc. 2013; 88: 618-629
        • Horowitz C.R.
        • Jackson J.C.
        Female “circumcision”: African women confront American medicine.
        J Gen Intern Med. 1997; 12: 491-499
        • Kleinman A.
        Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry.
        University of California Press, Berkley, CA1980 (Comparative Studies of Health Systems and Medical Care, No. 3)
      1. Rogers C, Rogers N. Carl Rogers on Person-Centered Therapy [DVD]. Psychotherapy.net website. http://www.psychotherapy.net/video/person-centered-therapy-carl-rogers.

        • Khaja K.
        • Lay K.
        • Boys S.
        Female circumcision: toward an inclusive practice of care.
        Health Care Women Int. 2010; 31: 686-699

      Linked Article

      • Female Genital Cutting: An Evidence-Based Approach to Clinical Management for the Primary Care Physician
        Mayo Clinic ProceedingsVol. 88Issue 6
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          The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician.
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      • In reply—Consider the Personhood of Women Who Experienced Genital Cutting
        Mayo Clinic ProceedingsVol. 88Issue 10
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          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.
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