Genital mutilation: a continued abuse
Khaled K, Vause S.
Residence Hope Hospital,
Salford, UK.
Br J Obstet Gynaecol. 1996 Jan;103(1):86-7


The practice of circumcision began in antiquity. Female circumcision is common in many African countries, such as Egypt and Sudan. In Egypt, the practice is legal if carried out by a doctor. The Egyptian Organization of Human Rights recently reported that up to 3600 girls were circumcised daily in the country, such that 95% of girls under age 16 years in rural areas and 73% of girls in Cairo had been circumcised. There are three types of female circumcision. The Sunna type involves excising the prepuce of the clitoris. In clitoridectomy, the clitoris is removed with or without the labia minora, while infibulation involves removing the clitoris, labia minora, and the internal faces of the labia majora. Complications are common with all types. Three cases in which women underwent an Aladal operation are described; two of the women died following their operation. The Aladal procedure involves refashioning of the original circumcision with the intent of narrowing the introitus to restore a virgin-like state. In the cases presented, the women were either preparing for marriage or to go on a holy pilgrimage. The Aladal operation is usually performed by a local midwife, under local anesthesia. A fresh incision is made involving the original circumcision area. Both edges are cut longitudinally and extended posteriorly. The edges of the incision are then sutured with any available material. Healing is often poor in such a previously scarred area and depends upon factors such as the involvement of the urethra and the time interval before the resumption of intercourse. Infection is common, and the availability of sterile materials and antibiotics is often limited. Vaginal atrophy in postmenopausal women may also slow the healing process. It is likely that the Aladal operation is as old as circumcision. The author notes that doctors need to be aware of female circumcision and its complications as well as this associated practice of Aladal and the serious sequelae which may result.
Adult circumcision
Neonatal circumcision
Obstetric anaesthesia
Molecular mechanisms
Inhalational techniques
A thalamocortical switch?
Anaesthesia and anaesthetics
Nitrous oxide: adverse effects
Anaesthesia: rivalries and discoveries
Consciousness, anaesthesia and anaesthetics

and further reading
Future Opioids
BLTC Research
Utopian Surgery?
The Good Drug Guide
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World