Might Reinfibulation be Medically Plausible in Carefully Screened Cases?

Polychronis Voultsos


In light of the relational account of autonomy and the modern (holistic and phenomenological) account of health, this paper examines ethical justifications for ‘consensual’ reinfibulation. Significant and constant discomfort in the body following deinfibulation might make a case for reinfibulation (considered as medical treatment in the traditional sense of the term).   In any other case, the following requirements should be met for reinfibulation to be considered medically plausible: a) strong evidence that reinfibulation could help effectively improve woman’s relational well-being, b)  insignificant complications  are expected, c) congruence between first-order and second-order autonomy or -in the context of political liberalism- strong second-order autonomy, d) an “open door” for the woman to exit an oppressive context, e) rigorous scrutiny of woman’s psychology, and f) woman’s practical wisdom to organize her identity-related values, find a balance between her extreme emotions and realize her own goal of meaningful life in accordance with her own conception of the good.  Conclusively, in carefully screened cases and individually judged requests for reinfibulation, it should not be ruled out that, after having been conducted a multi-disciplinary in-depth investigation at social, psychological and medical level may be met conditions that make a case for reinfibulation. (Afr J Reprod Health 2020; 24[1]: 165-181).

Full Text:



Johansen RE. Virility, pleasure and female genital

mutilation/cutting. A qualitative study of perceptions and experiences of medicalized defibulation among Somali and Sudanese migrants in Norway. Reprod Health. 2017 Feb 10;14(1):25.

World Health Organization. Eliminating female genital

mutilation. An interagency statement. Geneva: WHO, 2008.

Earp BD. Between moral relativism and moral

hypocrisy: Reframing the debate on “FGM.” Kennedy Institute of Ethics Journal 2016; 26(2):105-44.

Catania L, Abdulcadir O, Puppo V, Verde JB,

Abdulcadir J and Abdulcadir D. Pleasure and orgasm in women with female genital mutilation/cutting (FGM/C). The Journal of Sexual Medicine 2007; 4(6): 1666-78.

Leye E, Ysebaert I, Deblonde J, Claeys P, Vermeulen G,

Jacquemyn Y and Temmerman M. Female genital mutilation: Knowledge attitudes and practices of Flemish gynaecologists. The European Journal of Contraception and Reproductive Health Care 2008; 13(2):182-90.

Abdulcadir J, Marras S, Catania L, Abdulcadir O and

Petignat P. Defibulation: A Visual Reference and Learning Tool. J Sex Med. 2018;15(4):601-11.

Toubia N. Female Circumcision as a Public Health Issue.

The N Engl J Med 1994; 331 (11): 712-6.

Serour GI. The issue of reinfibulation. International

Journal of Gynaecology and Obstetrics 2010; 109(2): 93-6.

Galeotti AE. Relativism, universalism, and applied

ethics: the case of female circumcision. Constellations 2007;14(1):91-111.

Bello S, Ogugbue M, Chibuzor M, Okomo U and

Meremikwu MM. Counselling for deinfibulation among women with type III female genital mutilation: A systematic review. Int J Gynaecol Obstet. 2017;136 Suppl 1:47-50.

Abdulcadir J, McLaren S, Boulvain M and Irion O.

Health education and clinical care of immigrant women with female genital mutilation/cutting who request postpartum reinfibulation. Int J Gynaecol Obstet. 2016;135(1):69-72.

Vrachnis N, Salakos N, Iavazzo C, Iliodromiti Z,

Bakalianou K, Kouiroukidou P and Creatsas G. Female genital mutilation in Greece. Clin Exp Obstet Gynecol 2012; 39(3): 346-50.

Svenaeus F. Organ transplantation and personal identity:

how does loss and change of organs affect the self? J Med Philos. 2012;37(2):139-58.

Elson J. Hormonal Hierarchy. Hysterectomy and

Stratified Stigma. Gender & Society 2003; 17(5): 750-70.

Shweder RA. The goose and the gander: The genital

wars. Global Discourse 2013; 3(2): 348-66.

Obermeyer C. The consequences of female circumcision

for health and sexuality: an update on the evidence. Culture, Health & Sexuality 2005;7(5): 443-61.

Obermeyer CM. The health consequences of female

circumcision: science, advocacy, and standards of evidence. Medical anthropology quarterly 2003; 17(3): 394-412.

Obermeyer CM. Female genital surgeries: The known,

the unknown, and the unknowable. Medical anthropology quarterly 1999; 13(1): 79-106.

Gruenbaum E. The cultural debate over female

circumcision: the Sudanese are arguing this one out for themselves. Med Anthropol Q. 1996;10(4):455-75.

Public Policy Advisory Network on Female Genital

Surgeries in Africa. Collaborators: Abdulcadir J, Ahmadu FS, Catania L, Essen B, Gruenbaum E, Johnsdotter S, Johnson MC, Johnson-Agbakwu C, Kratz C, Sulkin CL, McKinley M, Njambi W, Rogers J, Shell-Duncan B, and Shweder RA. Seven things to know about female genital surgeries in Africa. The Hastings Center Report 2012; 42(6): 19-27.

Mackie G and LeJeune J. Social dynamics of

abandonment of harmful practices: a new look at the theory. Special Series on Social Norms and Harmful Practices, Innocentim Working Paper No. 2009-06, UNICED Innocenti Research Centre, Florence, 2009.

Johnsdotter S. Discourses on sexual pleasure after

genital modifications: the fallacy of genital determinism (a response to J. Steven Svoboda). Global Discourse 2013; 3(2): 256-65.

Nordenfelt L. On the nature of health: an action-theoretic

approach. 2nd revised & enlarged edn. Dordrecht: Kluwer Academic. 1995.

Venkatapuram S. Health, vital goals, and central human

capabilities. Bioethics. 2013; 27(5):271-9.

Nussbaum MC. Frontiers of justice: disability,

nationality, species membership. Cambridge, MA: The Belknap Press of Harvard University Press. 2006.

Sen A. The Idea of Justice. London: Allen Lane. 2009.

Richman KA. Ethics and the Metaphysics of Medicine.

Reflections on Health and Beneficence. Cambridge, MA: The MIT Press, 2004.

Moxey JM and Jones LL. A qualitative study exploring

how Somali women exposed to female genital mutilation experience and perceive antenatal and intrapartum care in England. BMJ Open. 2016; 6(1):e009846. doi: 10.1136/bmjopen-2015-009846

Savulescu J and Sandberg A. Neuroenhancement of love

and marriage: The chemicals between us. Neuroethics 2008;1(1):31–44.

Svenaeus F. Illness as unhomelike being-in-the-world:

Heidegger and the phenomenology of medicine. Med Health Care Philos. 2011; 14(3):333─43.

Pellegrino ED and Thomasma DC. A philosophical basis

of medical practice. New York: Oxford University Press. 1981: pp: 69, 73-4, 80, 147.

Pellegrino ED and Thomasma DC. The Virtues in

Medical Practice. New York, Oxford: Oxford University Press. 1993: pp. 73-4.

Johnsdotter S and Essén B. Cultural change after

migration: Circumcision of girls in Western migrant communities. Best Pract Res Clin Obstet Gynaecol. 2015 Oct 24. pii: S1521-6934(15)00195-9.

Knipscheer J, Vloeberghs E, van der Kwaak A and van

den Muijsenbergh M. Mental health problems associated with female genital mutilation. BJPsych Bull. 2015;39(6):273-7.

Creighton SM and Hodes D. Female genital mutilation:

what every paediatrician should know. Arch Dis Child. 2016;101(3):267-71

Kimani S, Esho T, Kimani V, Muniu S, Kamau J,

Kigondu C, Karanja J and Guyo J. Female Genital Mutilation/Cutting: Innovative Training Approach for Nurse-Midwives in High Prevalent Settings. Obstet Gynecol Int. 2018 Mar 15;2018:5043512.

Brown K, Beecham D and Barrett H. The Applicability

of Behaviour Change in Intervention Programmes Targeted at Ending Female Genital Mutilation in the EU: Integrating Social Cognitive and Community Level Approaches. Obstetrics and Gynecology International Article ID 324362, 12 pages, 2013. doi:10.1155/ 2013/324362

Heiman JR. Orgasmic disorders in women. In:

Leiblum SR, ed. Principles and Practice of Sex Therapy. New York: Guilford, 2007: 84

MacKenzie C and Stoljar N. (Ed.). Relational

Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. New York: Oxford University Press. 2000. pp: 4.

Nedelsky J. Law’s Relations: A Relational Theory of

Self, Autonomy, and Law. New York: Oxford University Press. 2011.

Veltman A and Piper M. (Ed.). Autonomy, Oppression

and Gender. New York: Oxford University Press. 2014. pp: 15-41, 118.

Chambers C. Are breast implants better than female

genital mutilation? Autonomy, gender equality and Nussbaum's political liberalism. Critical Review of International Social and Political Philosophy 2004; 7(3): 1-33.

Nelius T, Armstrong ML, Rinard K, Young C, Hogan L

and Angel E. Genital piercings: diagnostic and therapeutic implications for Urologists. Urology 2011;78:998–1008.

Johannsdottir NK. Patriarchy and the subordination of

women from a radical feminist point of view. Universitatis Islandiae Sigillum. Hugvísindasvið. 2009. p. 20. Available from: https://skemman.is/bitstream/1946/3017/1/Nina_Katrin_Johannasdottir_fixed.pdf (Last accessed: 15 June 2018).

Johnsdotter S and Essen B. Genitals and ethnicity: the

politics of genital modifications, Reproductive Health Matters 2010; 18(35): 29-37.

Abdulcadir J, Alexander S, Dubuc E, Pallitto C, Petignat

P and Say L. Female genital mutilation/cutting: sharing data and experiences to accelerate eradication and improve care. Reprod Health. 2017 Sep 15;14(Suppl 1):96.

McGill-Rutherford E. Feminism, Liberalism, and

Relational Autonomy. Dissertation Submitted to the Faculty of the Graduate School of Vanderbilt University. In partial fulfillment of the requirement for the degree of Doctor of Philosophy. In Philosophy August, 2015 Nashville, Tennessee. Available from: https://etd.library.vanderbilt.edu/available/etd-06052015-104052/unrestricted/McGill-Rutherford.pdf (Last accessed: 15 June 2018).

Jecker NS and Ko AL. Is that the Same Person? The

Problem of Identity Following Neurosurgical Interventions. AJOB Neuroscience 2017 [Ahead of Print].

Stanford Encyclopedia of Philosophy. Feminist

Perspectives on Autonomy. (First published Thu May 2, 2013). Available from: http://plato.stanford.edu/entries/feminism-autonomy/ (Last accessed: 15 June 2018).

Fischer JM. Responsibility and autonomy: The problem

of mission creep. Philosophical Issues 2012a; 22: 165–84.

Christman J. Relational Autonomy, Liberal

Individualism, and the Social Constitution of Selves. Philosophical Studies, 2004; 117: 143–64 (152).

Westlund A. Rethinking Relational Autonomy. Hypatia

; 24: 26–49 (29).

Meyers DT. Feminism and Women's Autonomy: The

Challenge of Female Genital Cutting, Metaphilosophy, 2000a; 31: 469–91 (479).

Benson P. Feminist Intuitions and the Normative

Substance of Autonomy. In: Taylor JS (Ed.). Personal Autonomy. Cambridge, UK: Cambridge University Press, 2005, 128–30, 136.

Stoljar N. Autonomy and the Feminist Intuition. In:

Mackenzie C and Stoljar N (Ed.). Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. New York: Oxford University Press, 2000, 95.

Bruckner DW. In defense of adaptive preferences.

Philosophical Studies 2009; 142 (3):307 – 24.

Colburn B. Autonomy and Adaptive Preferences.

Utilitas 2011; 23(1): 52-71 (57).

Elster J. Sour Grapes - Utilitarianism and the Genesis of

Wants. In: Sen AK and Williams BAO (Ed.). Utilitarianism and Beyond. New York: Cambridge University Press, 1982, 219—38 (225).

Frankfurt, HG. Reply to Gary Watson. In: Buss S and

Overton L (Ed.). Contours of Agency: Essays on Themes from Harry Frankfurt. Cambridge, Massachusetts: MIT Press, 2002, 160-64.

Rawls J. Justice as Fairness: A Restatement. Cambridge,

MA: Harvard University Press. 2001.p: 19.

Ubel PA, Scherr KA and Fagerlin A.. Empowerment

Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy. Am J Bioeth. 2017;17(11):31-9.

Blumenthal-Barby JS and Ubel P. In Defense of

“Denial”: Difficulty Knowing When Beliefs Are

Unrealistic and Whether Unrealistic Beliefs Are Bad. Am J Bioeth 2018 [Ahead of Print].

Widdershoven GAM, Ruissen A, van Balkom AJLM and

Meynen G. Competence in chronic mental illness: the relevance of practical wisdom. J Med Ethics. 2017 Jun;43(6):374-78.


  • There are currently no refbacks.