Dr. Edgar Mandeville

The practice known as female genital cutting is recognized as a human rights violation around the world and is a federal crime in the U.S. With the growth of immigrant populations from West Africa, doctors at Harlem Hospital are seeing more and more women and girls who have undergone female circumcision in their native countries. Dr. Edgar Mandeville, Chairman of the Department of Obstetrics and Gynecology, discusses the challenges of caring for affected patients and their families.

Q. What is female genital cutting and why does it happen?

A. Female genital cutting, or female circumcision, is the partial or total removal of the woman’s external genitalia for non-medical reasons. In its most severe form, the procedure involves the cutting and repositioning of the genitalia to seal the vagina except for a very small opening. This is called infibulation.

Female genital cutting is carried out on infants and young girls as a rite of passage in many African countries, including Mali, Nigeria, Ivory Coast and Egypt. It’s usually carried out by traditional circumcisers who have very important roles in the community. But in recent years, some medical providers have started performing the procedure too. It’s often done with little or no anesthesia, and the girls are struggling as they are held down, which affects the outcome of the surgery. It varies from region to region but it is practiced by people at all levels of society.

Q. What are the medical and mental health implications for the women?

A. The long term medical implications include increased bladder and urinary tract infections; scarring; cysts; pain during intercourse; an increased risk of childbirth complications for mother and baby; and a high rate of Caesarian section. If a woman’s vagina has been sealed, it has to be cut open for her to deliver the baby. Some women experience devastating psychological effects from which they take a long time to recover. Often they don’t realize what’s happened until they are adolescents or adults. They feel angry, humiliated, betrayed, and depressed.

Q. How did Harlem Hospital doctors become experts on treating women who have undergone the procedure in their native countries?

A. Here at Harlem Hospital we have one of the largest demographics of West African women in the city. The women come to us for healthcare and bring their children to our pediatricians. The moment we started seeing West African women, we started seeing female genital cutting. We also started working with the Sauti Yetu Center for African Women, a community-based organization, to further educate our professional staff about this practice and the issues surrounding it.

Our doctors are knowledgeable about the medical and mental health consequences of the procedure and culturally sensitive to the women and families we see. We want the women and girls to be comfortable discussing their condition with any medical provider in the hospital – doctor, midwife, physician assistant, nurse – to be able to ask questions and articulate their needs. When families are getting ready to return to the home country for a visit, our pediatricians will talk to the parents about the health implications of female circumcision and urge them to refrain from having their daughters circumcised. We want them to know we are not here to judge them but to provide the medical care and information they seek.

Q. What's next?

A. Our doctors are involved in an ongoing study in which we categorize the type of circumcisions experienced by each patient according to WHO (World Health Organization) guidelines and the countries and regions from which the women come, to try to determine some kind of patterns that will give us more information about female genital cutting. We want to provide all encompassing care to the patients and to continue to learn how to do it better.

June 2011