“Do you want just clitoral hood or glans as well?”
“The whole infernal packet.”
This gynecological checklist is the focal point of an exchange between Alfie Blessington (Christopher Abbott), the estranged husband of Bella Baxter (Emma Stone,) and a doctor in “Poor Things,” the latest film from director Yorgos Lanthimos. Alfie has summoned the doctor to perform a genital-cutting operation on Bella after learning she had a stint as a sex worker in Paris. A dead woman resurrected by an eccentric surgeon, Bella has returned to Alfie’s sprawling baroque estate after he informs her that they were married in her previous life. However, she quickly finds that he is exceptionally cruel and escapes after overhearing that he’s arranged to remove her clitoris to quell her sexual habits.
“I’m pretty sure people watched it and had no idea it was actually a thing,” Dr. Nicole Warren (Ph.D., MSN, MPH, FAAN, CNM), an associate professor at the Johns Hopkins School of Nursing said of the disturbing scene. “So I was impressed that they [the filmmakers] knew that and wielded it.”
Though the scene is brief, largely buried under other, more drawn-out interactions regarding female genitalia, its significance is undeniable. It’s a reference that speaks to a very real, very horrifying practice that continues to plague millions of women and girls around the world.
Since it debuted in December, “Poor Things” has garnered 11 Oscar nominations, including best picture, best director and best actress. It’s also left audiences somewhat polarized. Some have feted it as a triumphant take on feminism amid what seems to be Victorian-era Europe, stuffed with steampunk fantasy, velvety colors and quirky charm. Others have dubbed “Poor Things” as gratuitously raunchy, citing its many and motley sex scenes; we get an assortment: bondage, leg humping, instructional (a father hires Bella to teach his two sons about sex.)
"This was a way – used in the U.S. and the U.K. and other high resource settings – to control women’s sexuality."
Regardless of your thoughts on “Poor Things'" message, and what it does or doesn’t accomplish, there’s no denying that it’s a film steeped in some genuine themes about the female experience. We see Bella engaging in several multi-contextual relationships with men, who almost exclusively exist to exert some level of control over her: the pseudo-father figure who seeks to keep her away from the world; the paramour who shows her how to globetrot but tries to contain her zeal for liberation; the doting fiancé who doesn’t have a clue how to excite her. And though none of these instances of control will likely sit well with the progressive viewer, Alfie’s desire to control Bella by physically mutilating her is the most barbaric.
Emma Stone in "Poor Things" (Fox Searchlight)Watching “Poor Things,” Warren said she felt the filmmakers did their due diligence.
“At some point the camera actually cuts to a tool to do the procedure, and it made me think they’d done their homework to recognize that this was a way – used in the U.S. and the U.K. and other high resource settings – to control women’s sexuality,” said Warren, who is also the Associate Director of Women’s Health at the HEAL Clinic.
The film’s theme of cutting is introduced from its onset. We see Dr. Godwin Baxter (Willem Dafoe) slicing at splayed cadavers for a room full of medical students — “My father once told me, ‘Always carve with compassion,’” he says.
Godwin’s home is inhabited by a menagerie of sutured creatures from past experiments — a chicken with a pig’s head and a goose with a dog’s body, for example — along with Bella, his most treasured work of reanimation. After Godwin swaps her brain for that of her unborn child, he renders her mind childlike, though her anatomy remains the same.
But despite what it retains in realism insofar as it relates to womanhood, “Poor Things” is ultimately a fantastical movie. So what’s the reality of female genital mutilation as it exists today?
"There's an overarching theme of trying to control behavior so that someone can achieve social acceptability."
According to the World Health Organization (WHO), which has a “zero tolerance stance” on female cutting — which is observed annually on Feb. 6, per The United Nations — female genital mutilation (FGM) has no health benefits. It only harms those it is done to via the removal and damage of normal female genital tissue. The WHO adds that more than 200 million girls and women alive presently have been subject to female genital mutilation across 30 countries in Africa, Asia and the Middle East where it is often practiced as a normative ritual or social norm. As seen in “Poor Things,” the Western world also has a history of physically altering girls and women as a consequence of their “undesirable” behavior, as Warren observed. “It’s important for people to understand that clitorectomies — partial or total — were common in the U.S., in the West through the early 19th century and into the 20th century in the U.S.,” she said.
“It could be a girl who appears to be masturbating too much, could be a girl whose behavior was just considered unacceptable in some way, too rambunctious, maybe too flirtatious.” Warren continued. A woman could also be cut for not responding to her husband’s advances as she was expected to, Warren said, noting how it could be employed to both curb sexuality and align it. For instances of clitorectomies and other forms of female genital mutilation performed in the West, Warren said that it was largely done, not as as routine practice, but in response to behavior deemed to be abnormal or unsavory.
“The common thread no matter what century you're talking about, no matter what context,” she said, “is there's an overarching theme of trying to control behavior so that someone can achieve social acceptability.”
As Dr. Christina Pallitto, a scientist and the Technical Lead on Female Genital Mutilation at the WHO noted, using the practice as a way to keep young girls and women chaste and virginal is a main reason for its enduring prevalence today. “There are other driver and social norms as well,” Pallitto observed. “It’s very complex why it’s done and why it’s maintained over generations and the pressure of community members on others to maintain the practice.”
Speaking about the medicalization of female genital mutilation, Pallitto clarified, “When we talk about medicalization it's not necessarily that it's done by a doctor.” And it’s largely harmful because it perpetuates the practice by legitimizing it, drawing upon the respect we typically hold for health care providers.
“What we also know is that it may be reported as medicalized FGM, but the people that are considered health providers aren't actually licensed health providers as well,” she said. “So they may wear a white coat. It may be sort of somebody who is helping in a health facility who may you know, then off-site perform FGM but they have absolutely no training. They're not actually any kind of licensed provider.”
“It's still a harmful practice. It still causes harm regardless of who's performing it,” Pallitto added.
Warren also spoke candidly about the stigma surrounding female genital mutilation, both within some of the ethnic communities that practice it and in the U.S., where it is considered a human rights violation and is illegal to perform on a child under the age of 18. “I've heard anecdotes from some women in the places where the cutting is associated with coming of age ceremonies and gifts and new clothes. I have heard anecdotes of women saying, ‘Yes it was painful yes it was horrible but it was also one of the proudest most wonderful days of my life, and I don't know why you're making such a big deal about this. I have other issues that I need help with, so can you please stop talking about the status of my genitals?’”
Emma Stone in "Poor Things" (Yorgos Lanthimos/Searchlight)“We don't really leave room for that right — certainly not in healthcare interactions — and we need to listen,” Warren continued, noting how the focus of her work has been improving care for people who have already been cut. Primary prevention or stopping cutting altogether, also needs to be met by other techniques, Warren said. Offering therapies is one useful method of providing support to those who have already been adversely affected. Additional difficulties arise, Warren noted, for those people who migrate from countries where cutting is normal to places where it’s not.
“What we are really good at is giving women shock and disgust and horror,” she said. “We traumatize them again, we shame them again, we stigmatize them right back into silence and they are subjected to more harm because they don't have access to these evidence-based therapies that we know could work for them. So we are making a problem worse by not being prepared to care for them. There's the harm of the original cut and then there's the harm of the neglected treatment.”
The consequences of female genital mutilation, which the WHO categorizes into four major types, can be intensely physically damaging. In the immediate aftermath of being cut, women and girls can be subject to hemorrhaging, infection, shock and death, amongst other issues. Long-term effects include keloids and scarring, urinary issues, sexual dysfunction and vaginal and menstrual problems.
Dr. Ivona Percec, (MD, Ph.D.) a plastic surgeon at the University of Pennsylvania, also noted the potential for survivors of female genital mutilation to develop psychological complications. “There’s not just a personal trauma, but there’s also a generational trauma,” Percec said of women who live in communities where cutting is commonplace. “The older you are, the more you remember, the more traumatic it is.”
Percec, who developed a reconstructive procedure for survivors of female genital mutilation that can increase sexual function, spoke about the variation in patients she sees. “Everybody comes at a different psychological and physical stage,” she said. “Some women know what it’s like to have an orgasm, some people don’t even know what an orgasm is. So each case is tailored to the woman and what they’re trying to achieve. I have them use vibrators and things like that. Read books and learn about their bodies, learn about what pleasure is.”
Emma Stone in "Poor Things" (Fox Searchlight)Perhaps equally as important as offering forms of therapy and healing for women affected by female genital mutilation is educating the public on the risks it poses, as well as the significant prevalence of it in today’s world. “I think it’s certainly something that we need to highlight and discuss more openly,” Percec said. “I think talking about it in a very open, non-political but culturally sensitive way is the way it should be done.”
In Warren’s view, this is part of what “Poor Things” has accomplished through Bella’s character. Responding to criticisms of the film’s sexually graphic nature, Warren said, “Bella’s a lot of things but she’s definitely sex-positive.
“Clitoral oppression is just one sort of oppression she was subjected to. [Alfie] didn’t want her to keep reading, he didn’t want her to keep asking questions. I think sexual oppression is just one of many ways in which we try to silence women.”
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