Agnes Arnold-Forster

Over the last year Female Genital Mutilation (FGM) has received significant media attention in Britain. Leyla Hussein’s film The Cruel Cut aired on Channel 4 in November 2013, in March 2014 the first people in the UK were charged under the 2003 FGM Act, and in July 2014 UNICEF and the UK government hosted the Girl Summit to end FGM and child, early and forced marriage. Today FGM is most common in the western, eastern, and northeastern regions of Africa, in some countries in Asia and the Middle East, and among migrants from these areas. While the justifications for FGM are diverse and context-specific, reflecting different histories, different cultures and different gender dynamics, across multiple otherwise disparate communities certain justifications recur. It is often motivated by beliefs about proper sexual behaviour and the preservation of chastity; the desire to maintain hygiene and cleanliness; and efforts to confirm power inequalities and the compliance of women to the dictates of their communities. Within Britain, some have understood it as evidence of ‘alien’ values in conflict with modern British culture, and it can be supported by and feed into negative stereotypes of immigrant communities.

However, beliefs surrounding this kind of control of female sexuality are not confined only to communities that practice FGM today. Historicising FGM and placing genital mutilation within Britain’s own history re-contextualises a practice that is typically externalised and thought of as foreign to British culture. Indeed, in Britain in the second half of the nineteenth century doctors performed ‘clitoridectomies’ – the removal of the clitoris – on women explicitly to eradicate elements of female libido.

Black and white sketch of Isaac Baker Brown sitting in chair with open book on lap. Dressed in dark coat with white bow tie. Beard and balding head.
Isaac Baker Brown believed that ‘unnatural irritation’ of the clitoris was the cause of serious medical disorders. From Medical Circular and General Advertiser, 1852. (Wikimedia Commons)

Since the 1970s, the prevailing historical model of modern medicine suggests that the nineteenth century in particular was a time of significant change with respect to women’s ability to negotiate their own bodies. In 1973, Carroll Smith-Rosenberg and Charles Rosenberg wrote, ‘Since at least the time of Hippocrates and Aristotle, the roles assigned women have attracted an elaborate body of medical and biological justification. This was especially true in the nineteenth century.’ Many historians have since written about nineteenth-century medical ideology’s insistence on the pathological (inherently diseased) nature of woman.

In 1881 Sinclair Coghill wrote in the British Medical Journal (BMJ), ‘Menstruation and pregnancy, although strictly physiological in design and general issue, are yet conditions of such extreme organic tension that they may pass, by almost imperceptible degrees, into the domain of pathology.’ He went on to say, ‘The sexual system dominates the other organic systems in woman.’ This encapsulated the two strands of Victorian medical thought: that the female body by definition walked the precarious line between health and illness; and that the female reproductive system governed not only her other biological functions, but her mental and emotional capacity as well.

It is in this theoretical context that clitoridectomies were seen as having therapeutic benefit. The late nineteenth century saw a proliferation of increasingly extreme gynecological surgeries performed on women deemed neurotic or hysterical. The ovary was seen as the seat of neurosis and oophorectomies (removal of the ovaries) were performed to ‘cure’ hysteria, amongst other disorders of the mind and body. The most prominent supporter of clitoridectomies in Britain was the English gynecologist Isaac Baker Brown (1812-1873). He believed that the ‘unnatural irritation’ of the clitoris caused a range of disorders including epilepsy and mania and he worked ‘to remove [the clitoris] whenever he had the opportunity of doing so.’ The procedure was most frequently performed in response to masturbation. In 1865 Baker Brown was sent a woman who, ‘would not discontinue the habit to which she was addicted.’

Clitoridectomies captured both the popular and academic imagination. However, by 1867 the practice was already drifting into impropriety. In this year, Baker Brown wrote to the BMJ to ‘move for the appointment of a committee to investigate the results of clitoridectomy in some twenty or thirty cases.’ He said, ‘If the investigation should prove that my views have a false foundation, and that the operation is useless, I will give it up altogether.’ In the same year, the secretary of the London Surgical Home for Women (founded by Baker Brown) wrote that they had ‘determined not to perform the operation in this institution, pending professional inquiry into its validity as a scientific and justifiable operation.’

Clitoridectomy’s excision from British medical orthodoxy was almost complete by the close of the nineteenth century. In 1895 the BMJ wrote, ‘Clitoridectomy was odious and unscientific’, consigning it to the pile of past mistakes. What is interesting about this move is the reasons given for the practice’s rejection. They were almost exclusively framed in the language of scientific practice and propriety, not humanity or the bodily rights of women. In 1866 the surgeon Dr. West wrote in the BMJ, ‘Of the alleged cures of hysteria, epilepsy, insanity, and other nervous diseases of women by excision of the clitoris, a very large number were not permanent.’ Clitoridectomies were rejected as proper practice because they were deemed ineffectual, grounded in unsound science, and thus an affront to medicine’s professional authority. This language of rejection made no reference to the deeper assumptions inherent in the procedure’s practice: the pathologisation of women, the control of female sexuality, and medical violation of bodily autonomy.

These three approaches to women were central to nineteenth-century scientific medicine, and crucial in the development of ‘modern’ medical thought and practice. The clitoridectomy was not a surgical aberration; rather it was firmly embedded in the justifications and ideologies of mainstream medicine.

Today FGM is mostly carried out by an older woman with no medical training. However, more than 18% of procedures are performed by health care providers, and the WHO claims that the trend towards medicalisation is increasing. This detail, along with genital mutilation’s medical history, disrupts the idea that FGM is entirely alien to modernity and to supposed ‘Western’ values. Instead, genital mutilation needs to be understood, in part, as an example of the continuous re-negotiation of medicine, culture and sexuality – both at home and abroad.

Agnes Arnold-Forster is a PhD Candidate at King’s  College London, researching the history of breast  cancer in nineteenth-century Britain and the US. She is  broadly interested in issues of gender, sexuality and  race, as well as NHS reform and global health. She  works for a small women’s health charity that  advocates for sexual & reproductive rights in sub- Saharan Africa. She tweets from @agnesjuliet.

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  1. You’re quite right about the need to contextualize–I see far too much writing that ascribes this practice to the supposed barbarism of a particular people or religion. Such that anti-FGM activism in Europe and the US easily devolves into more “white people saving brown and black women from brown and black men.” Thank you for writing.

  2. While I see the parallels you are drawing in terms of intent to control women’s sexuality, and the scientific legitimizing of the practices, the circumstances in which clitoral surgery was done were very different in these two contexts. I feel like it matters a lot that 19th c clitoridectomy was an exceptional surgery, done in an attempt to treat mental illness, on small numbers of mostly middle-class white women, while current FGM is practiced in many communities as a standard part of every woman’s physical and social maturation. They are both wrong. But surely they will require very different kinds of solutions. I see stronger and potentially more useful analogies in routine, medicalized, “modern” American surgeries and procedures around reproduction such as male circumcision, cesarean section, and mid/late 20th century routine use of drugs to dry up breast milk.

  3. I don’t think the examples you’ve provided recontextualize anything. They certainly don’t do much to challenge the idea that FGM is alien to British culture.

    You neglect to mention that Isaac Baker Brown’s views on clitoridectomies were never medical orthodoxy, or even close to it. His use of of the procedure only became public knowledge in 1866, when he published a monograph on the subject, and rather than “captur[ing] both the popular and academic imagination” it provoked outrage. In the public debates that followed his publication, British doctors compared his procedure to cutting off a man’s penis and jeered him off the stage. He was expelled from the Obstetrical Society of London less than a year later and forced to shut his surgical practice. He died destitute and friendless in 1873.

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  6. The only legitimate reason for clitorectomy is disease or injury of the tissue.
    An adult should be able to have her own clitoris altered or removed if she truly wishes. She should receive counseling but as if she is determined enough she will find someone to do it, so if after counseling she insists a competent surgeon should be allowed to do the operation so that she will not go to an unqualified person or do it herself.
    Cosmetic clitorectomy does not go past the juncture of the crura and bulbs. Most of the clitoris is internal. The nerve will remain.

  7. If Female Genital Modification/Mutilation (FGM), which depends upon one’s attitude, was done only by technically qualified medical practitioners the opposition would be only a small fraction of what it is now.
    Even radical feminist Germaine Greer has come out in favor of Female Genital Cutting (FGC) when it it is a cultural custom. Naturally she supports clitoridectomy only when done only by technically qualified medical practitioners, not by ignorant, untrained, unqualified cutters in woefully unsanitary condition with broken pieces of dull, rusty razor blades and shards of glass or flint.
    The American Pediatric Association attempted to accomodate people of cultures that practice various degrees of FGM so that they will not take their daughters to traditional cutters or to their homelands to be cut. The APA guidelines encouraged practitioners to urge parents to do the least required by their customs, but unfortunately the anti-FGM activists would not accept so much as a pinprick, so the APA dropped it.

  8. The context of the medical society was that Baker-Brown was performing (external, not total) clitoridectomies without husbands’ or fathers’ permission. He was far from being the sole medical practitioner performing external clitorectomies.

  9. Muslims: Cutting off a girl’s or woman’s external genital parts is NOT required by the Qur’an (Neither is prepucectomy, but that is an issue on its own.). Muhammad authorized ONLY the external, visible part of the clitoris to be removed, not the prepuce (hood), labia minora or labia majora.
    The clitoris itself, like the head of the penis, is relatively insensitive. The sensitive parts are the prepuce, the “G-spot,” and the labia minora, which should not be removed or trimmed. The “G-spot” in the male is the “Sweet spot” on the end of the corpus spongiosum, which runs along the underside of the penis. In the female this highly sensitive sensory nerve center is on the back side of the urethra, between the corpus spongiosum that has the urethra embedded in it. Its sensitivity is determined largely by the thickness of the front wall of the vagina and by any space between the wall of the vagina and the urethra/corpus spongiosum. This is why insertion of a penis from behind induces pressure and massaging of the G-spot in women. Insertion from the front puts little to no pressure and massaging of the G-spot, inciting women to become centered on stimulation of their clitorises, actually of their prepuces and labia minora.
    Because the corpus spongiosum in the female is quite separate from the clitoris, and does not connect to the head of the clitoris, as the corpus spongiosum does in the penis, removal of the outer clitoris is not comparable to removal of the external penis. Removal of the clitoris also does not inherently remove the prepuce, as in the female the prepuce is not part of the clitoris, being connected only by a frenum or frenulum, or not at all.
    So those who for some cultural reason insist on altering a girl’s genitals, have only the external clitoris removed, not the other parts – the prepuce (hood), labia minora and labia majora. Her sexual sensitivity will be diminished the least by this as compared with the radical female genital alterations.

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