First, do no harm
– Hippocratic Oath


About three years ago, Lisa Irwin, who identifies as a transwoman, travelled from New Zealand to Bangkok for gender reassignment operations. “I hoped that it would make me feel totally complete, as a “woman”,” says Lisa. “So I could get on with my life and start enjoying it.”

Things did not go according to plan.

the surgeon pretty much stuffed things up. Sometimes I can be sitting here and next thing it’s like someone’s got a knife and just starts stabbing me. I instantly knew it was wrong, it was kind of like I got hit by a big truck. I had to come back here to New Zealand, where there was nothing they could do for me.

Lisa now lives with daily pain, having experienced genital mutilation in the name of identity and medicine.

This experience was relayed earlier this year on a TV1 documentary called Born This Way – yet barely problematised. The documentary was aired to promote increased accessibility to these kinds of operations for New Zealanders, in particular for one male high school student who the documentary was centred around.

The symptoms and side effects of so-called “gender reassignment”, whether deemed “successful” or not, include lifelong medical dependency and the likelihood of increased tendency toward suicidal behaviour and suicidal ideation. For children subjected to conversion therapy medically, puberty blockers followed by cross-sex hormones inevitably lead to sterilisation. Many detransitioners have attested to the harms caused by “reassignment”.

When we advocate transgenderism, we collectively say that we believe that the gains to identity outweigh the costs to the body. We say that the risks are worthwhile and the price paid is fair because identity – gender identity, cultural identity – is more important to quality of life than our intact human bodies. This way, we make the pain that Lisa suffers look tolerable, bearable – collateral damage in a fight for identity, but no reason to stop in our tracks.

How does this c’est la vie attitude affect the way we react to the suffering of the 200 million women and girls alive today living with the effects of female genital mutilation (FGM)?

Hibo Wardere has written about her own experience of FGM, currently practiced in 29 countries across Africa, Asia and the Middle East, in her devastating book Cut.

Wardere was awoken one morning as a child, so early she was still half asleep as her mother bathed her. She was then led to an unfamiliar tent at the bottom of the garden.

Upon entering, she was grabbed and held down by two women – family members – while her mother stood by and a “cutter” produced several unclean razors from a leather bag.

Then, with those long pincer nails, she dug between my legs and grasped my clitoris, my kintir. She pulled on it until it burned for a second, as my eyes widened in horror, I thought she was going to pull it clean from my body… But she had something far worse planned.

She lifted up that dirty razor, the one that still had the dried brown residue of others’ blood clinging to it, like filthy reminders of her previous work, and she cut straight through my flesh.

Wardere suffered the most brutal form of FGM: her clitoris and labia were removed like this, with this razor, as she was held down, screaming for her mother who responded with stonefaced instructions that Hibo be “brave”. Wardere was then stitched together so that only a small hole was left for urination and eventual menstruation. The purpose of this was to demonstrate Wardere’s virginity and “cleanliness” to some future husband, to whom she would one day presumably be delivered for sexual use.


This experience was enough to make me want to close the door on the world as I read; as the ache sunk my heart and caught my throat and my crawled in my skin and clouded my face. For Wardere, it was a life sentence to every kind of pain a person can suffer. At first, she says,

I didn’t want to talk to anyone. I didn’t so much as try. My voice had been snatched by the horror of that morning, and even if I had wanted to speak, I’m not sure what I would have said. I didn’t want to see anyone. Who would be there for me now anyway… I had no one.

FGM is forced on 98% of girls born in Somalia. This is what the practice – gudnin – achieves. It is a gruesome tool used to control, silence and sexually subordinate females, as a class.

Wardere’s own response was to face her mother from the day she could speak again, and every single day from then on, and ask her the same, ever-unanswered question. “Why?”

HiboWhen Wardere later escaped Somalia as a refugee during civil war to live in London – she continued to ask. She sought help from doctors, largely unequipped to deal with FGM either as a personal experience or as an issue facing women globally; she hunted through libraries. Wardere spent almost a year whilst raising her first child, born through an excruciating labour, to translate a book on FGM word-for-word with an English-Somali dictionary. This woman breaks my heart in a million ways. Through her pain, through her grief, through her fortitude.

Hibo Wardere has deserved the world to listen to her from the moment she screamed inside that tent. She deserved a world of attention when she confronted her mother with the same question every single day before she left Somalia. Her pain alone should have ended the practice of FGM altogether. Not that it could have – but it should have. When she arrived in London and was first seen by a doctor – this revelation, too, should have stopped the practice of FGM. Her post-traumatic difficulties with intimacy, her pain in labour should have stopped the practice being carried out on any other girl.

Yet Hibo Wardere has had to fight for every scrap of help and attention she has managed to gain for herself, and for what is now, finally, her cause. In 2013, 83% of British school teachers reported that they had received no adequate training to deal with cases of FGM, even though FGM takes place in Britain, and girls are often taken out of school to have it carried out in their home countries. Wardere has worked with schools, police, media and medical practitioners to raise awareness and build opposition to FGM to save girls’ lives, and quality of life, for several years now.

Wardere’s work began the day that she began to question her mother, the day she began to fight for an understanding and an analysis of gudnin or FGM – of what happened to her and why. Having fought for that knowledge, Wardere now shares it to create change. This does not mean merely advocating for the prosecution of ‘cutters’ – many girls would not co-operate with such a strategy, because of family repercussions. A 2013 UNICEF report revealed that social acceptance is still the most frequently cited reason for supporting the practice of FGM. This is what Wardere is up against: social acceptance.

Challenging the social acceptance of a practice so often understood in terms of ‘culture’, ‘identity’, ‘tradition’ and even ‘choice’, means working to examine each of those critically, whilst establishing a human rights basis for understanding FGM. It seems obscene that this would be necessary, since we are talking about the routine butchering of children – but this is Wardere’s work.

In critically examining ‘choice’, Wardere herself recalls reporting to her mother as a child, “I want to be cut, too, Hoyo. Then they’ll let me play again.” This statement needed to be viewed in context, not taken at face value. Wariness from the bullying led Wardere to ask to be cut – she was bullied and called “dirty” in the playground for still having kintir (clitoris). When this lead her to make a request to fit in, she was spoiled, rewarded with a party and gifts, and lavished with praise for her “bravery”. She remembers, “I felt more loved than I ever had in my whole life.”

Connecting “choice” to peer pressure and social rewards, and in turn to social norms and sex roles in Somalia is part of Wardere’s educational work. This is crucial, particularly considering that shockingly, only 33% of girls in Somalia are reported to be supportive of FGM abolition. This is still no reason to continue subjecting girls to brutality: Wardere’s activism is based on zero tolerance to FGM, because the right to intact sexual organs, the right to live free of pain and infection is inalienable and universal.

This is the place to consider again the documentary Born This Way, and the way Lisa’s experience of genital mutilation did not cause a stir among a New Zealand audience, because the piece aired to increase support for genital operations to be carried out here at home on demand. There are several ways in which this is dangerously counterproductive to the work of women like Wardere.

In Born This Way, media figures, sexual health physicians, clinical psychologists, youth workers, family and community members all advocated that the story’s main subject, Awa, receive surgical genital mutilation whatever the risk. At no time was any clear evidence given as to why this was necessary, what gender is, how genital surgery relates to it and improves quality of life. While it was understood that the possible damage and side effects caused by surgery could and would be unpleasant and that Awa would need support, it was agreed by everyone portrayed in Born That Way that this was Awa’s choice, and that the costs would be outweighed by gains in cultural and gender “identity”.

In the documentary, Auckland District Health Board (ADHB) sexual health physician says

What we do appreciate now… is that your gender identity seems to be decided before you are born. So that your journey in life is fundamentally decided before birth. Gender identity seems to be something that is a biological thing – so perhaps it’s affected by genetics, or hormones, rather than something that happens after we are born, so we don’t think that parenting styles or society pressure is determining what your gender identity is.

This statement is both free of evidence, and completely contradicts Wardere’s work against FGM. In Wardere’s advocacy, “gender” would be another word for the “sex roles” that are sanctioned in the kind of patriarchal systems that lead women to be mutilated in the interests of male sexual entitlement. In Somalia that system leads 98% of females to be cut. Fighting this, as well as fighting for the rights to sexual health and freedom for  girls in 29 other countries throughout Africa, Asia, and the Middle East, means resisting the sexual subordination of females. The same goes for looking at other trades and practices that that brutalise, enslave, commodify and subordinate women globally: like child marriage, sex trafficking, prostitution, the surrogacy trade and trades in hair and breast milk, domestic violence and compulsory hijab.

Advocating for gender identity and “gender reassignment” changes the narrative so much that these forms of enslavement become invisibilised. We do not discuss them. According to a gender identity narrative, biological sex is a construct, and oppression stems from identity. This would mean that the 98% of girls who are subjected to FGM in Somalia experience this because of “cis privilege” – they have female bodies, and they are treated accordingly, as females.

With regard to the matter of “choice”: Wardere’s work asks that we look critically at “choices” that, on the surface, appear to be freely made, especially by children. Transactivism on the other hand, places pressure on parents to take a child’s stated wish at face value. Any questioning of a child’s claim to be “really a girl” or “really a boy” – because of identification with sex roles that don’t match the child’s biology – is deemed reppressive and pathologising, bad parenting.

Choice, culture, identity, social acceptance, making the body align with sex roles – these are all issues that FGM demands we look at critically, while transactivism entrenches more deeply. Transactivists are, therefore, eroding the very human rights basis for activism that Wardere and fellow advocates are working to build to liberate girls and women from brutality. When we go along with gender identity, we make ourselves wilfully blind to the very things we need to examine if we want to fight genital mutilation.

Awakening from this blindess becomes all the more necessary as FGM is increasingly medicalised. British doctors are carrying out FGM for a price, with surgeon’s tools under anaesthetic, in the name of “safety”. At the same time, other kinds of cosmetic “enhancing” and “reassignment” surgery are promoted in the West, like labiaplasty and gender reassignment, so that the issue becomes blurred and rendered too nuanced and philosophical for clear positions.

Reading Naomi Wolf’s The Beauty Myth, Robert Jay Lifton’s Nazi Doctors, and Janice Raymond’s Transsexual Empire however – I am not convinced of any fundamental difference between a white male doctor cutting a child under anaesthetic and a Somali woman cutting a child without. Do we truly believe that what Somali women do to children who tell their mothers “I don’t fit in, I want to be cut,” makes them butchers – but what white, male doctors to do people who say “I don’t fit in, I want to be cut,” makes them heroes? Why? In Nazi Doctors, Lifton makes clear that what made a Nazi doctor was nothing other than the carrying out of acts that took them from healers to killers. What makes a butcher is the same process, the same abandonment of that oath: first, do no harm.

Transactivism is making fashion and philosophy out of what should be an impassioned human rights battle against the brutality of patriarchal sex roles.

There is a choice to make here, that no disingenuous politics of “inclusivity” and “kindness” can transcend, that no liberal philosophy can shield you from having to make.

You can look at FGM through the lens of transactivism, and moderate your impulse to fight for an end to the butchering of girls – you can call it culture, or simply out of your hands. This choice may give you relief: it is easier. You need do little but show up to pride marches, and follow the lead of your peers. This is the position that grants you the rewards of social acceptance.

Or you can look at transactivism through the lens of FGM, and see more mutilation, more invisibilising of women as a class in the interests of reinforcing patriarchal sex roles. You can decide to join Wardere in the fight for a world in which women and girls – females – are free, because there are no dehumanising sex roles, justifying no state-sanctioned butchery, and no butchers to make profit from either.

You cannot have it both ways. Either genital mutilation is a crime against humanity to you, like it is to Wardere – or it is tolerable.

Your choice.