This page recognizes the
many ways the genital integrity of females is compromised in our
society. Statistics show that women who are cut are more likely to allow
their babies to be cut. FGM has many forms: Sunna (amputation of the
clitoral hood, also called the prepuce); clitoridectomy (amputation of
the clitoris itself); infibulation (amputation of the inner labia and
clitoris and some of the outer labia and stitching the vagina almost
shut); most episiotomies (cutting the perineum to enlarge the vagina
during birth--especially when birth is attempted in positions that do
not use gravity and don't allow full vaginal and pelvic opening); many
hysterectomies (the operation that cuts out a woman's uterus and
often her overies-- so-named because it supposedly removed a woman's
hysteria, an operation that is life-saving when needed but done done far
too often according to many authorities). Such unnecessary operations on
minors has been illegal since 1996 according to North Dakota and Federal
May Raise, Not Lower, Incontinence Risk
out on Unacknowledged FGM
Genital Mutilation in Western Obstetrics.
Journal of Family Practice, Neonatal circumcision: associated
factors [including episiotomy].
Email from a Woman
Who Was Cut.
To Cut or Not to Cut
Episiotomies May Raise, Not Lower,
By Shawna Vogel
B O S
T O N, Jan. 7 — A
minor surgical procedure often performed on women just before childbirth
may cause trouble rather than preventing it, according to new research.
A new study in the British Medical
Journal suggests that women who receive episiotomies, a procedure to
enlarge the opening from which the baby emerges, run a higher risk of
losing their bowel control, which the procedure is supposed to help
More Harm than Good?
Experts say this research adds to the ongoing debate over whether this
often routine procedure — performed on nearly one-third of the
three-million-plus U.S. women who give birth each year — does a woman
more harm than good.
Episiotomy involves a quick cut of the
perineum, which is between the vagina and rectum, as a mother is pushing
out her baby. It was once thought to protect a woman from damage to the
anal sphincter. Such damage is believed to be the main cause of the anal
incontinence — loss of bowel control — that affects up to 10 percent
of women who have given birth.
is a procedure to enlarge the opening from which the baby
But in the past decade, evidence has
mounted that episiotomy may be inflicting the damage. “One of the
questions with these studies,” says Amanda Clark, chief of the
division of urogynecology and reconstructive pelvic surgery at Oregon
Health Sciences University, “has been, is it episiotomy that causes
the problem or is it the forceps and the larger babies” — two
aspects of birth that often go hand in hand with the procedure.
To study the issue, Lisa Signorello and her
colleagues at Harvard Medical School asked 626 women who delivered their
first infant vaginally to report any anal incontinence they experienced
in the months after giving birth. They were divided into three
almost-equal groups: women who received episiotomies, women whose
perineums tore “naturally” during delivery, and women who had
Higher Risk After Episiotomies
“About 10 percent of women with episiotomies were experiencing fecal
incontinence three months after giving birth,” Signorello writes. “Women
in the “tear” group and the intact group had less than half that
risk.” Women in all the groups reported less incontinence at six
months, but it was still two times more common for the episiotomy
recipients than for the other two groups.
Signorello found that the extra risk for bowel
problems had nothing to do with the mother’s age, the baby’s weight,
labor length, use of forceps or vacuum extractor, or other complications
“This would argue against routine use of
episiotomy to protect the pelvic floor during birth,” Clark says.
Ben Sachs, chief of OB/GYN at Boston’s Beth
Israel Deaconess Medical Center and co-director of the Harvard Center of
Excellence in Women’s Health, isn’t ready to agree. He says the
study would have been more meaningful if the researchers had looked at
He also pointed out that the women in the
episiotomy group were generally older than those in the other groups.
“And the condition of the perineum is going to be somewhat reflective
of age,” he said.
Not Recommended Routinely
Nevertheless, he says, “I personally think that there is no evidence
that routine episiotomy does any good.”
He and Clark point out, however, that there may
still be circumstances in which episiotomy is recommended — in cases
in which the child’s health is threatened, for example, Clark says it
can shorten delivery time by up to half an hour.
Activist Speaks Out on an FGM Unacknowledged
[Comments by Pat]:
I have been collecting research about American ritualized
sexual mutilation for over 20 years. Episiotomy is America's most common
surgery and most common form of FGM. There is NO medical research
showing value for episiotomy. Instead, it causes the severe tearing we
have been led to believe that it will prevent. The website mentioned
below is similar to CIRP. It is a collection of research studies and
current writings about episiotomy.
I couldn't bring myself to have a homebirth the first
time because of all the surgeries I had when I was a teenager. I feared
that my body might fail again. (I have recently discovered that all of
these surgeries were unnecessary.) When I was a childbirth teacher I
worked with several women who were adult survivors of childhood sexual
abuse and two whose mothers had died during their childhood. All of
these women were particularly vulnerable to excessive intervention and
surgery during birth, no matter how physically healthy they were. Toward
the end of my teaching, I could accurately predict who would end up cut.
I was increasingly unable to help these moms make changes in their care
that would make them safer. Instead, I found that my classes were
helping some women feel safe when they should not. They wielded their
birth plans like magic talismans, but guess what? Scissors still cut
paper. I don't teach anymore.
The OB at my first birth had agreed not to do an
episiotomy. He cut me anyway. The cut extended into a third degree tear,
a complication associated almost exclusively with episiotomy. When the
doctor saw what was happening, he tried unsuccessfully to stop the tear
by cutting a mediolateral episiotomy (see website for definitions). I
was in severe pain for a long time. I noted in a journal that I kept
that six weeks later I was still not able to sit for long. At my six
week appointment, this doctor claimed that my perineum was
"abnormally strong" which required him to cut me without my
consent. He derided me for not resuming intercourse, and suggested that
I was frigid. Another doctor I consulted at that time was not able to
insert two fingers to examine me. He advised reconstructive surgery or
gradual stretching. It was two years before I no longer bled with
I have permanent sexual damage. I am not alone. See
Sheila Kitzinger's "Episiotomy" and "Some Women's
Experience of Episiotomy" for similar stories.
Research shows that birth attendant skill is the key
factor in avoiding perineal harm during birth. However, attendant skill
is not a factor in preventing severe harm caused by extended episiotomy.
There is no way to predict who will have a catastrophic tear or to
prevent one once an episiotomy has created the opportunity. The only way
to avoid this harm is to not allow anyone with cutting implements near
you while giving birth.
Plain and simple:
Hire a birth attendant who is not a surgeon for starters. Birth tubs are
great because they provide a physical barrier. Don't give birth in a
place that makes money from cutting up women.
I knew how harmful episiotomy was before I gave birth. I
had files of studies proving harm. (One study of maternal deaths showed
that 20% occurred in otherwise healthy women who death resulted from an
infected episiotomy.) I had even written about it. I thought that I had
done what I needed to protect myself. Van is right! I am proud that I
was able to protect my son, but will always regret that I didn't protect
Episiotomy, cesarean section, and circumcision didn't
become common in this country until birth was moved to hospitals. Read
"The Five Standards of Safe Childbirth" by David Stewart (of
NAPSAC) for research proving the superior safety of homebirth for most
women. There are lots more eloquent books with this viewpoint, but this
one and Henci Goer's "Obstetric Myth versus Research Reality"
document the research.
Empowering women to give birth without mutilation will
empower them to protect their babies, also according to research! Read
the conclusions of the abstract of "Neonatal circumcision:
associated factors and length of hospital stay" at the bottom of
this page. This study is available on >CIRP.
Every woman who has a cesarean section or an episiotomy
experiences sexual harm, not just those who have extensions. I will send
one more message on this topic, a study showing that clitoral tissue is
far more extensive than previously thought. It appears that almost any
surgery in the genital area will cut into clitoral nerve endings.
The uterus is a sex organ, too. Uterine muscles contract
during orgasm. Some women who have had cesareans complain of inability
to have orgasms or loss of intensity, but no one has ever studied sexual
function after cesarean section. There is research available documenting
this loss of sexual pleasure after hysterectomy.
I'll close what has become my essay with a revision of
Imagine that you are an expectant mom, happy and excited
to be in labor. Now imagine that a person (just as likely to be a woman
as a man) takes your clothes, straps you to a bed, sticks a needle in
your arm and your lower back--warning you not to move--and drugs you.
Now imagine this person cutting your baby out with a knife--either
through your uterus or your perineum. Your baby is taken away while you
are sewn back together, and is probably given a bottle, even if this is
against your wishes. You are left weakened and unable to care for your
baby without assistance. Do you scream for help and call the police?
Nope. You thank this person gratefully and pay her/him a great deal of
money. Not surprisingly, you are more likely to be in the US than in any
It doesn't have to be like this! Go to:
Ritual Genital Mutilation in Western Obstetrics
The practice of routinely cutting the perineum during
hospital deliveries in the United States, episiotomy, has been shown to
be the principal risk factor for severe tearing during delivery, which
is the injury that it is supposed to prevent. Nonetheless American
obstetricians continue to overuse this procedure ten times more often
than is called for. Episiotomy is also a major risk factor for
infection, loss of sexual pleasure, and incontinence. Women who have
been subjected to episiotomies take longer to heal from delivery, even
compared to women who have equivalent tears.
Given the completely unscientific, ritual approach
obstetricians have to this practice, it illuminates the Western outrage
over ritual genital mutilation of girls and women in East Africa, which
also has many painful and disabling sequelae. Just as we reach out in
solidarity with African feminists to stop genital mutilation in Africa,
we need to stop the iatrogenic, unscientific practice of episiotomy in
A sample study:
Benefits and risks of episiotomy:
A review of the English-language literature since 1980.
Part I and II. Obstet Gynecol Survey 1995; 50:806-820.
English-language literature published since 1980 on the benefits and
risks of episiotomy can be summarized as follows: Episiotomies prevent
anterior perineal lacerations (which carry minimal morbidity), but fail
to accomplish any of the other maternal or fetal benefits traditionally
ascribed, including prevention of perineal damage and its sequelae,
prevention of pelvic floor relaxation and its sequelae, and protection
of the newborn from either intracranial hemorrhage or intrapartum
asphyxia. In the process of affording this one small advantage, the
incision substantially increases maternal blood loss, the average depth
of posterior perineal injury, the risk of anal sphincter damage and its
attendant long-term morbidity (at least for midline episiotomy), the
risk of improper perineal wound healing, and the amount of pain in the
first several postpartum days.
JOURNAL OF FAMILY PRACTICE,
Volume 41 Number 4, Oct 1995: Page 370-376.
circumcision: associated factors [including episiotomy] and length of
Authors: Mansfield, Christopher J.; Hueston, William J.;
Full Text COPYRIGHT Appleton & Lange 1995
exists regarding the efficacy of routine neonatal circumcision of male
infants. Little is known about parental or provider characteristics or
the use of medical resources associated with this procedure.
Methods. Records of 3703
male infants born during 1990 and 1991 at four US sites were analyzed to
discern associations between circumcision and the above factors.
Analyses were limited to healthy infants.
percent of the infants in the study population were circumcised. White
and African-American male infants were much more likely to be
circumcised than those of other races (odds ratios [Ors], 7.3 and 7.1,
respectively, P<.001). Compared with self-pay patients, those
covered by private insurance were 2.5 times more likely to be
circumcised (P<.001). Logistic regression showed that rates for
obstetricians and family physicians were not significantly different.
Increased odds of circumcision were found if the mother received an
episiotomy (OR=1.9, P<.001) or cesarean section (OR=2.1, P<.001).
Circumcised infants stayed in the hospital an average of
one fourth of a day longer than did those who were not circumcised (mean
difference, 0.26 days; 95% confidence interval, 0.16 to 0.36).
insurance status and race as well as surgical interventions during
delivery are related to circumcision. Associations with episiotomy and
cesarean section suggest physician and/or parental preference for
interventional approaches to health care. Generalizing the difference in
hospital length of stay to the United States suggests an annual cost
between $234 million and $527 million beyond charges for the procedure
itself. words. Circumcision; infant, newborn; male; socioeconomic
factors; cesarean section; episiotomy; specialties, medical, length of
stay; hospital costs. (J Fam Pract 1995; 41:370-376)
Email from a Woman Who Was Cut
name is CJ and I would like to learn more about
Integrity Law" and some history about how it came to be. I am
not a minor as this law seems to be directed towards, but I am a woman
that had requested, verbally and in written form, NOT to have an
performed during the birth of my last child. To make a long story
short, the procedure was performed anyway. In my case, the
episiotomy was inappropriately and improperly performed and has left me
with permanent disfigurement and pain.
to make matters worse my OB/GYN (not the one that did the episiotomy but
the one that should have been there for the delivery) tried covering up
the incompetence starting with my first postnatal visit. In the
state of Michigan where I live it took me nearly 3 years to find a
competent doctor that was even willing to acknowledge I had a real
physical problem. I have had to have corrective surgery in an attempt to
correct the damage done.
I cannot accept the fact that doctors and hospitals continue to treat
people like this and get away with it. Any information would help.
Things need to Change.
[link no longer works]
April 3, 2002 Ob-gyns finding that the kindest cut is nature's By Connie
Lauerman Chicago Tribune staff reporter Published April 3, 2002 After
routinely performing episiotomies in delivery rooms for the better part
of the last century, ob-gyns are putting the knives aside and letting
nature take its course instead....
"One of the most common surgical procedures performed in the United
States -- an incision many pregnant women receive to reduce the risk of
tissue tears during delivery -- has no benefits and actually causes more
complications, according to the most comprehensive analysis to evaluate
Ian Graham has published a sociohistorical
analysis of episiotomy called Episiotomy -- Challenging Obstetric
Intervention (1997: Blackwell Science).