I saw my first when I was doing a rotation at the clinic on East Lake Street.  The girl, thirteen or fourteen, came in with a sprained ankle and asked for a woman doctor.  I was the only one on staff that day.  She had slipped on the icy sidewalk and twisted her ankle:  a common enough injury for a Minnesota winter, though certainly a shock for a girl from Mogadishu.

It wasn’t serious, a simple splint would be enough, but I figured that while she was there we might as well do a general exam. It’s hard to get the children of immigrants to come to the clinic, and I had learned to take full advantage of any visit.

When she scooted backwards to lie down on the table, her paper gown rode up over her thighs.  And that’s when I saw the white and gray scar tissue, the jagged stitches, and the mess that had been her labia majora.  She covered her eyes and looked away.  I glanced back at her mother, a tall, thin woman with only her face exposed under her dark scarf and long black dress.  She stared past me, silent and blank-faced.

In our OB/GYN lecture last term, we covered the varieties of female genital mutilation.  The practice ranged from ritually nicking the clitoris to full infibulation, with the clitoris and labia minora removed and the remaining flesh stitched shut.  This girl’s mutilation was just short of infibulation; her clitoris and inner lips were gone, with rough, dead scars in their place.  She had been stitched, and the wreck of her labia majora had fused together, but it wasn’t the tight, almost seamless stitching I had seen in the lecture slides.

“When did this happen to you?” I asked the girl.  My heart was pounding so hard my chest hurt.  She didn’t answer.

I touched the scar tissue where her clitoris should have been; there was a smooth crevice where it was cut away.  The scars were old and thick: she probably had been cut four or five years ago, before puberty.

“When did you move here?” I asked.  She didn’t answer.

Somali girls and women are hard to read; they’re so often silent, blank, almost invisible.  The men and boys adjust quickly, learning to drive, listening to rap, becoming football fans.  But the women in their heavy scarves and dresses, even when it’s summertime and sticky humid, seem not to be here at all, seem to be walking still in Mogadishu, not Minneapolis.

Except for her ruined genitals, the girl was beautiful, almost perfect.  Her skin, which probably hadn’t seen a scorching sun or felt blistering wind since she was a small child, was smooth and soft, the color of creamy coffee.  Her hands and feet were long and agile.  Unlike most of the kids I saw at the East Lake clinic, there wasn’t an extra ounce of fat on her; her hips and breasts were only just starting to swell, but she still had a lean, boyish body.

“Did this happen in Somalia, before you came here?” I asked.  She nodded.  I looked back at the mother, but she continued to stare, unblinking, at a spot on the wall above my head.  Perhaps she didn’t speak any English at all.

I set the girl’s splint and showed how it worked, told her stay off it as much as possible and to be careful on the sidewalks.  She slid gracefully off the table and retrieved her carefully folded clothes, apparently greatly relieved to be covered again.  I walked them out to the front desk and made an appointment for them to come back in a week.  They went out together, slowly, the girl leaning against her mother, and I watched until they disappeared behind a snow bank, two black smudges against the gray and white of winter.


“She was probably afraid you’d report her,” Jake said when I told him about the mother’s silence.  We were getting ready for bed, going through our “nightly ablutions,” as Jake called them: standing at the sink brushing our teeth together, gracefully dancing around each other in the cramped bathroom while he passed me my face cream and I retrieved his pajama pants from the hook on the door, finally finishing together with a gargle of green mouthwash.

“I think she was ashamed,” I said.

“I doubt it.  She’s probably circumcised herself.”

“It’s not circumcision.  It’s barbaric.”

“It’s hard to pronounce ‘infibulation’ around a toothbrush,” he said, letting a little froth drip down his chin for effect.  I wiped his mouth with my washcloth and kissed his cheek.

“I just can’t understand why she would let her daughter be mutilated like that,” I said.  “Shouldn’t her first instinct be to stop it?”

Jake spat into the sink.  “It’s how they’ve always done it.  Like First Communion.  Bar Mitzvah.”

“Bat Mitzvah for girls,” I said, poking him in the ribs.  “And that was just psychologically scarring—everything’s in physically good condition.”

“I’m not convinced,” he said.  I looked over at him; he had his pajama pants, a powder-blue plaid pair I bought for his birthday, halfway up.


“No,” he said, putting his hands on my waist and squatting beside me.  “I think I’m going to have to inspect for myself.”

“Stop it,” I said, smacking his hand away from the hem of my nightgown.  But he didn’t stop; his fingers walked up the outside of my leg and under my nightgown and across my belly, tickling all the way.  I giggled into my fist.

“Well, the tickle reflex works.”  He nuzzled against my thigh while his fingers walked down my belly and between my legs.  I smacked his hand again, but ineffectually.  “Everything seems in working order here,” he said into my nightgown.

“You jerk,” I whispered, and pulled his head closer.


After Jake fell asleep with his pajama pants in a pile on the floor, I thought about Murray Horvitz, the first boy I let feel me up.  He was a “good boy,” the kind who does better with mothers than daughters:  chess club and Honor Society; volunteer work for the Jewish Federation; delivered both the Torah and Haftorah at his marathon Bar Mitzvah on his thirteenth birthday.

My mother recruited Murray, who was a year younger than me, to help me with my Bat Mitzvah reading.  Murray was twelve, and though still a year from his Bar Mitzvah he had already memorized his Torah passage and was mastering the additional Saturday Haftorah that would be his crowning glory.  I was two months away from my Bat Mitzvah and still struggling with the meager eight lines about Rachel and Leah that I would deliver on the first Friday in May.  There would be no Haftorah for me, to my father’s eternal disappointment.

Every Saturday for two months, after morning Hebrew lessons at temple, Murray and I sat in my parents’ basement while he coached me.  Hebrew didn’t come easily for me, requiring more phlegm than a teenage girl should have to produce.  And I was more interested in boys and music than I was in the analysis of Torah.  Murray, who had thick glasses, good manners, and a rabbinical streak even at thirteen, wrote the d’var Torah for me while I scribbled in my diary and whispered on the phone with my best friend Tabby.

It wasn’t until three years later, that awful Bat Mitzvah behind me and all the thank you notes to my parents’ friends long ago mailed out, that I realized Murray was still around.  He was there to hold the big glass doors into the high school in the morning, and to walk me halfway home in the afternoon.  When I had trouble in geometry, he was there to help me make sense of the proofs and axioms that seemed like so much Torah again.  He was almost an axiom himself, an assumption from which flowed proofs of which I was only barely aware.

He was so axiomatic, in fact, that I hadn’t really looked at him until the day Tabby passed me a note in geometry class that said, “Murray’s getting kinda cute, huh?”

Sure, he still had those glasses, but his face had grown into them, and his ears didn’t stick out anymore from the weight of his spectacles.  His skinny body was starting to develop definition and shape, probably from toting bags of groceries to widows and opening doors for inattentive teenage girls.  And even more beautiful, he was as unaware of it as I had been; in his head, he must still have been the chess-playing, Hebrew-tutoring nerd my mother called “that sweet Horvitz boy.”

The boys I liked—brooding poets or gregarious jocks—were born cute.  They carried themselves with an air of entitlement, and they were clearly entitled to more than a skinny Jewish girl with crooked teeth.

So one night in my parents’ basement, when Murray was explaining one more time how to calculate the area of an isosceles triangle, I made my move.  While he was looking down at the geometry book in his lap, his finger tracing the picture of a triangle, I lifted his glasses off the bridge of his nose and pressed my lips against his cheek.

Chess and charity must be some powerful sublimations, because it wasn’t long before we were touching tongues and stretched out on the futon.  We fumbled around until I was on top of him, and I didn’t resist at all when he started to work his hand under the waistband of my jeans.  The look of awe and gratitude on his face when he made contact with the mysteries between my legs made me feel powerful and alluring.  I was more than willing to let him explore all he wanted, but the position was uncomfortable—mostly-clothed teenage sex is challenging more than fulfilling—and my mother ruined the mood when she called down the stairs to ask if we wanted cookies.

I let Murray resume his explorations several more times that year.  He approached the topic almost scientifically; I half expected him to bring a magnifying glass to our “study” sessions.  He would keep up a whispered interview about the effects of different movements and pressures from his dexterous fingers.  I explored Murray a little bit, too, but more to be polite than out of any real curiosity.  There’s no mystery in the penis.

I’m not sure if it was Murray’s inquiries into the puzzles of womanhood that did it, but about that time I stopped being a ditzy teenager and started thinking about how things work.  Suddenly biology and physics and math were less chores to get through so I could move on to the telephone, and more like shining a flashlight into the secrets of the universe.  Geometry’s legalisms still left me cold, but the wonders of fetal pigs excited me almost as much as Murray’s fingers.  My mother noticed the change, and commented that Murray must be having a good influence on me, but she never fathomed the real cause.


In the summer I took another generalist rotation at a clinic on Franklin Avenue.  Somali immigrants who lived on the West Bank frequently used the free clinic, and I became accustomed to their genitals.  The worst cases still shocked me, like the mother of six children who had been cut open and stitched back up so many times that her genitals resembled lean hamburger, and she had a chronic urinary infection that probably would never heal.  But I knew that any Somali girl over ten years old stood a good chance of bearing those scars.

I was pleased that the girls who were born in America, or emigrated very young, had all their parts in order.  Only once was I asked to perform the surgery, by the mother of an eight-year-old girl.  I flatly refused, citing the state law that made the operation a felony and suggesting that I would be compelled by that law to report any mutilation I discovered.  The mother may not have understood English very well, but I never saw the girl again.

“Maybe it shouldn’t be illegal,” Jake said when I told him about the woman with six children.  We were lying in bed, covers off because it was so hot in the apartment.  It was late July, and for two weeks now there had been no rain, only dense, humid air and constant sun.  I wore nothing but a long T-shirt; Jake wore nothing at all because he’s a warm sleeper even in the winter.

“What do you mean by that?”  I felt the urge to grab the lamp off the nightstand and bash in his skull.  Or his balls.

“I mean—well, I agree, it’s horrible and barbaric.  It’s clearly wrong,” he said, and I could hear him back-pedaling, his hand instinctively covering his crotch.  “But if the girl’s parents really want it done, they’ll find a way to get it done.  Or do it themselves.”

“And then they should be thrown in prison, too.”

“Only if someone finds out.  I’m just saying, if it were legal, it could be regulated.  Done by a doctor, in a hospital.  Instead of by some old woman with a broken piece of glass.”

Now it was my turn to cringe.  The week before I brought home some pamphlets from Amnesty International about genital mutilation.  The testimony of survivors, particularly of a woman from Sierra Leon who had been dragged into the forest and raped by a group of women, including her aunts, with the jagged lid of an aluminum can, had made me nauseous.  I couldn’t remember how many girls and women died of infection—10 percent?  20 percent?  How could they even know?

“It’s like the back alley abortion argument, right?” Jake continued.  “Maybe it’s distasteful, maybe it’s wrong, but it’s better done by a doctor than someone with a coat hanger.”

“Appeal to emotion,” I said as if I were a high school debater in cross examination.  I had turned on my side, legs crossed at the knees and thighs pushed together tightly.  I couldn’t banish the image of the girl being raped by her mother’s sisters with a circle of sharp aluminum.  “False analogy!  It’s not like abortion at all, it’s child abuse.  It’s rape, damn it.”

“Don’t get angry,” Jake said.  “I was just trying to contribute.  Seems like that’s all you talk about lately.”

“Sorry,” I said.  “It’s just—I don’t know.  This is Minnesota, damn it, doctors in Minnesota shouldn’t have to see this kind of thing.”

Jake reached over and pushed the hair out of my face.  I almost started to cry.

“When does this rotation end?” he asked.

“Three weeks.  Then another twelve weeks of classes, then intern applications.”

“You’re almost through it.”

And then I was crying, silently, my eyes leaking out onto Jake’s hand.  I pulled my knees up under my T-shirt and shivered.


Later that week I was browsing in the medical research library at the university.  Even though I had some coursework to finish up and a report on my experiences at the Franklin Avenue clinic that I hadn’t even started, I was drawn to the crisp, regular shelves of journals.  Each article was a gloss on some aspect of the human body, a commentary on the fleshy pages of the mortal Torah.  When I worked directly with my patients’ bodies, I felt overwhelmed sometimes by the inscrutable mysteries they contained; these commentaries helped me see the sharp lines under all the bulges and bumps.

The “hot” intern slots were at Region’s Hospital and Abbot-Northwestern, the emergency rooms that took in the drive-by shootings, crank overdoses, and bridge jumpers.  Everyone in my program wanted that adrenaline buzz, the challenge to think fast, work nimbly, test their skill on the urban battlefield.  I coveted an oncology research position at the university, where I was unlikely to see many patients, let alone mutilated genitals, where I could work ploddingly slow under the bright glow of laboratory lights.

I read an article in a plastic surgery journal about clitoral excision done the way Jake had proposed:  in a hospital, by a doctor, with a sterile scalpel instead of a can lid.  The authors had a practice in California, and claimed that the surgery—removing the clitoral hood, or sometimes the whole clitoris—was helpful to women with a variety of sexual dysfunctions.

One of their references was to an article about labial cosmetic surgery.  I chased that one down, too.  Women with very large labia minora could have them trimmed back to a more normal size.  Patients who underwent the procedure reported greater sexual satisfaction for themselves and their partners, though the authors’ attempts to quantify this were unconvincing.

If they can cut them back, I wondered, could a skilled plastic surgeon mold brand new genitals for these mutilated girls?  Could he restore their magic and mystery?  Would Murray Horvitz be able to tell the difference?

I imagined teams of plastic surgeons dispatched to Somalia and Sudan, intent on restoring mutilated girls to their womanly glory.  Every year a surgeon from St. Joseph’s takes a team to Guatemala to repair cleft palates and harelips, so why not repair other ruins as well?

“It makes sense,” Jake said.  We were sleeping naked on the living room floor on wrinkled sheets, because the bedroom was hot and humid as a sauna.  “I’m just not sure how the fund-raising pictures would go over.”

“Fund-raising pictures?”

“Well, they always show those before and after pictures.  Kid with a harelip, kid with a big smile.  Donors might be a little shocked at your pictures.”

“I’m not joking.”

“I know you’re not.”  He traced his finger down my spine to where the sweat pooled above my buttocks.  “I know this is hard for you.”

I rolled onto my back and Jake pressed his palm against my belly.  “It’s just so cruel,” I said.  “They’ve been murdered; it’s worse than rape.”

“It makes them anonymous, like ripping off their faces.”

“Hmm?”  His fingers were slipping lower, and I wasn’t paying much attention to his words.

“Well, naked men are all pretty much identical,” he said.  “Each woman is unique.”

I squirmed under his hand.  “And just how many naked women have you seen?”

“Enough to be able to tell them apart,” he said against my throat.


On the last day of my rotation at the clinic, a Somali woman in labor appeared in the waiting room with her mother and aunt.  If not for the occasional involuntary cry followed by gasping breaths, they might have sat there, patiently waiting, until the baby came out.  The nurse on duty hurried them into an examining room and called for me.

It was clear there was no time for the niceties of epidurals, Lamaze breathing, and gentle music.  The baby was well on the way down the birth canal, apparently in a rush to be born.

The nurse helped the woman onto the examining table and hitched up her dress.  I steeled myself and pulled the metal stool by the desk between the woman’s legs.

It was the worst I had seen, a full infibulation that looked like it had been performed with a dull chainsaw and a hunk of dental floss.  She had started to tear, and thick, pus-streaked blood trickled from the tiny opening to her vagina.  Unless the baby was made of Play Dough, there was no way it was going to come out.

I asked the nurse to give the woman an injection of lidocaine, then started to work with surgical scissors.  The scar tissue was so hard and thick I had a difficult time cutting.  With each squeeze on the scissors, a little more blood and pus ran out, like a lake slowly escaping from a dam rupturing one thin fracture at a time.

I had only just finished cutting when the baby crowned, its head covered with downy black fuzz.  Except for those strangled, sharp gasps from the woman giving birth, the room was silent.  The woman’s mother and aunt stood against the closed door, barely inside the room, while I worked the baby out of its ruined portal to the world.

“It was a girl,” I told Jake that night.  He had taken the day off to shop for an air conditioner, and we were snuggled up together under our winter blankets in the decadent chill of the humming gray box in the bedroom window.  “A tiny, fuzzy little girl.”

“That’s really exciting,” he said.  “It’s a great way to end your stint at the clinic.”

“It happened so fast I didn’t have time to think,” I said.  “But that wasn’t the end of it.”


I shook my head against his chest.  “No.  She was a mess.  God, what a mess.  She probably hadn’t been opened up since her wedding night.”

“But she’s open now, right?”

I shook my head again.  “No.  Once it’s done, it’s done.”

While the nurse whisked the baby off for her APGAR tests, I went to work cleaning up the woman’s open wound.  When the baby and placenta came through, they had torn her badly despite the opening I had cut.  Ragged strips hung around her vagina, which yawned like a toothless mouth.

I staunched the bleeding as best I could, but no bandage would put this damage right.  The nurse brought me the sutures and applied more lidocaine, and I set to work to close her womb again.  I cried at first, but I couldn’t see through my tears so I stopped by pulling my stomach tight and squeezing my shoulders together.

“Make sure it is tight,” said the woman’s mother, the first words I heard her speak.

I looked over my shoulder at her, at her blank eyes and flat face.  I imagined her with a sliver of glass, an iron knife, a sharp can lid, then with a long needle and rough-spun thread, pulling tighter, tighter, tighter.  And I knew that this new girl, this miniature woman already so full of mystery, would be initiated with dexterous fingers, not sharp knives.  I looked at the baby, red-faced at her first shocking taste of air, and I wished her a long life with Murray Horvitz.

Photo Source: Anne of Carversville