12:06pm

Wed March 20, 2013
Author Interviews

'Sex And The Citadel' Peeks Inside Private Lives In The Arab World

Originally published on Wed March 20, 2013 1:49 pm

"I know of young women who have been returned to their families by their husbands because, as you say, they did not bleed on defloweration," Shereen El Feki tells Fresh Air's Terry Gross.

El Feki, the author of the new book Sex and the Citadel: Intimate Life in a Changing Arab World, spent five years traveling across the Arab region asking people about sex: what they do, what they don't, what they think and why.

Her ambition was to learn about the lives of young single people, married couples, gay people and sex workers, and how the sexual aspects of their lives reflect larger religious, cultural and political shifts.

What she learned, she says, is that "the patriarchy is alive and well in Egypt and the wider Arab world," and that women, too, "are some of the staunchest upholders of patriarchal attitudes."

Women, for example, decide whether or not to circumcise their daughters and granddaughters. Men are not traditionally part of the decision-making process when it comes to female genital mutilation (FGM).

"[Women] are making the decisions about their daughters' well-being and FGM, to cut or not to cut," El Feki says. "They are making these decisions based on faulty information, but the fact is, they have agency; and the key to moving forward is to recognize that power and to shift it to a decision which is recognizing and respecting their child's physical and mental rights."

Not everyone could get away with asking such intimate questions, but El Feki's prior work prepared her for the task. She's the former vice chair of the U.N.'s Global Commission on HIV and Law, and a former health care correspondent for The Economist.

El Feki grew up in Canada, the daughter of an Egyptian father and Welsh mother, who converted to Islam, the religion El Feki was raised in. El Feki moved to Cairo in 2008, and now divides her time between there and London.


Interview Highlights

On the desire of Arab women to express their sexuality

"For married women, what I found was very much a sense of longing for a more fulfilling sexual life, for more pleasure, for more communication with their husbands, [for an] ... ability to express their sexual desire and their sexual needs, and a greater sense of companionship and friendship within marriage.

"But many, many women I spoke with felt constrained on this and, for example, as one woman told me, 'It would be a shame for me to show my husband that I want to have sex.' That being said, women find ways of getting around this. Lingerie sales, for example, are thriving across the Arab world, and many of the women I met showed me their rather spectacular bed attire, and it was really highly, highly sexual.

"It was interesting because these women did not conceive of lingerie as being a tool of male oppression. For them it was a tool of empowerment because they could signal their sexual desire not by actually saying, 'I would like to have sex tonight,' but by putting on this lingerie and then sending out more subtle signals."

On a 2008-2009 survey of Egyptian youth that asked about the social acceptability of wife beating

"It was interesting that many of these young people — significant percentages, men and women — agreed that a man should beat his wife if she refuses to have sex with him unless she had a very, very good excuse, or that a man is justified in beating his wife if she is unfaithful. ... I would say that it's going to take considerable effort, education, economic empowerment, political change, legal change to shift these attitudes, and that's going to be the work of a generation."

On female genital mutilation in Egypt

"According to a 2008 survey of ... married women in Egypt under the age of 50, about 90 percent of them are circumcised, and ... about 80 percent of 15- to 17-year-olds have been circumcised. ... There are several reasons that women will circumcise their girls — and I need to point out [that] this is actually a decision that is made by mothers and grandmothers rather than fathers — they're really not part of the decision-making process in this regard.

"Women will say that it is tradition. They will invoke aesthetics that the area looks tidier if this is done. They will often invoke Islam, and they will cite a hadith — an account of ... the deeds of the prophet — that suggests that circumcision is desirable. But that is of dubious authenticity, to say the least.

"The major religious figures in Egypt have come out very strongly against FGM — female genital mutilation — saying it is completely contrary to the teachings of Islam and Christianity. The major reason that it is done is that it is thought to control female sexual drive. So the clitoris is somehow seen as an engine of libido, and it needs to be tamed. And if you don't clip the clitoris, then girls will stray before marriage or wives will make excessive demands of their husbands, and both of these are marriage killers."

On how some Egyptian women who've had FGM understand sexual satisfaction

"They felt sexual pleasure nonetheless, and the reason for that is they did not see sexual pleasure as having an orgasm. They saw sexual satisfaction, for example, in that their husbands were happy in bed or that their overall life was happy in marriage, in that the kids were fed and the bills were paid and they had a roof over their head. So they conceived of their own sexual pleasure in a different way than perhaps one might find with most women in the West."

On how the question of a bride's virginity is not a private matter

"The blood is collected on a sheet, which is then shown to family members — and, potentially, friends — to prove that a virgin bride has been delivered. This is key because it's not just a question of individual reputation or honor of the bride. The virginity and an intact hymen is connected to the family's honor, and in particular to the honor of the menfolk of the bride's family. So it's a collective concern rather than an individual issue. The concern is so deep for young women that hymen repair surgery — a shadowy business — is doing a very nice trade in many countries in the Arab region."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. My guest has spent five years traveling across the Arab region asking people about sex: what they do, what they don't, what they think, and why. Shereen El Feki's ambition was to learn about the lives of young single people, married couples, gay people and sex workers, and how the sexual aspects of their lives reflect larger religious, cultural and political shifts.

Not everyone could get away with asking such intimate questions, but her work prepared her for it. She's the former vice chair of the U.N.'s Global Commission on HIV and Law and a former health care correspondent for The Economist. El Feki grew up in Canada, the daughter of an Egyptian father and Welsh mother who converted to Islam, the religion Shereen El Feki was raised in.

El Feki moved to Cairo in 2008 and now divides her time between there and London. Her new book is called "Sex and the Citadel: Intimate Life in a Changing Arab World." Shereen El Feki, welcome to FRESH AIR. Let's start with something that happened last week in Egypt. I read about this in the New York Times.

The Muslim Brotherhood, the group that President Morsi is part of and has the largest bloc in the Egyptian parliament, responded to a U.N. declaration condemning violence against women. And in the list of the Muslim Brotherhood's objections, included were wives should not have the right to file legal complaints against their husbands for rape; husbands should not be subject to the punishments meted out for the rape of a stranger; a husband must have, quote, guardianship over his wife, not an equal partnership with her; and daughters should not have the same inheritance rights as sons.

These objections also said the law should not cancel the need for a husband's consent in matters like travel, work, or the use of contraception. What does this say about the Muslim Brotherhood, the president of Egypt, and the parliament of Egypt?

SHEREEN EL FEKI: Well, first things first - we don't really have a parliament of Egypt at the moment given recent electoral confusion. We have an upper house and one which has a fairly tenuous existence. And we are awaiting new parliamentary elections.

This statement is not a surprise. It is the classical kneejerk response to any possible move on issues of gender or sexual rights at the United Nations. The Mubarak regime had a similar stance. They were quite obstructive at any attempt to progress human rights as they relate to women and sexuality. So this is nothing new coming from Egypt.

Nonetheless, what's interesting is that when the Brotherhood issued this statement that there was an immediate response from NGOs, Arab NGOs, at the meeting in New York, from NGOs in Egypt, women's rights groups across the Arab world. And they stood up and said, you know what? No. This is not the only interpretation of Islam, and it should not be presented as such.

There is a wide variety of interpretations on various issues related to women, related to sexuality in Islam, and one of the points that my book makes is that there have been periods in history in which these more open interpretations have had more sway.

GROSS: The New York Times also quoted a Muslim Brotherhood family expert speaking at a recent seminar for women who are training to become marriage counselors. And he went on to say if a wife is beaten by her husband, she should be shown how she had a role in what happened to her. If he is to blame, she shares 30 or 40 percent of the fault. That's just, you know, appalling to me. Is this a common way of looking at marital abuse, that the woman shares 30 to 40 percent of the blame?

FEKI: I'm not sure that the percentages are as closely defined as that in most people's minds.

I must say, however, that the patriarchy is alive and well in Egypt and the wider Arab world. Just because we got rid of the father of the nation in Egypt or Tunisia, Mubarak or Ben Ali, and in a number of other countries, does not mean that the father of the family does not still hold sway.

And what is most interesting about these patriarchal attitudes is that they are often dressed up in Islam. And they are given this veneer. But as I said, the reality is that there are multiple interpretations within Islam, and it doesn't have to be this way.

Nonetheless there is a strong advocacy of these attitudes by ordinary men and women across the board, and it's the women that's the key, because they too are some of the staunchest upholders of patriarchal attitudes. And I can tell you that I was involved in a national survey of Egyptian young people in 2008, 2009, and we asked a wide variety of questions relating to political participation, economic activity, leisure activities.

But one set of questions that were asked had to do with wife beating. And it was interesting that many of these young people, significant percentages, men and women, agreed that a man should beat his wife if she refuses to have sex with him unless she had a very, very good excuse; or that a man is justified in beating his wife if she is unfaithful, for example.

And so these attitudes run very, very deep in society. And I would say that it's going to take a considerable effort - education, economic empowerment, political change, legal change, to shift these attitudes, and that's going to be the work of a generation.

GROSS: When you were interviewing women about their lives as women and about their sexual lives, what were the most common complaints that you heard?

FEKI: Well, let me point out that one thing we don't have in the Arab world is a Kinsey Report or Hite Report on Female Sexuality. So we don't have very good quantitative data about what women and men really want out of sexual life. So that's something that's definitely required, I think, and I hope it will come in the new freedom of intellectual openness and expression that we're seeing emerge in the region.

In my snapshots of women's lives, in my discussions with mainly middle-class women across the Arab region, certainly for single women the biggest concern was virginity and the crushing pressure to preserve a hymen. Because virginity, interestingly, is defined as a piece of anatomy, essentially. And this actually speaks to what is an interesting disconnect in Arab society across the board, not just in sex, which has to do with appearance versus reality.

And the pressure to maintain virginity has really stunning and often quite tragic consequences for single women. For married women, what I found was very much a sense of longing for a more fulfilling sexual life, for more pleasure, for more communication with their husbands, with a greater ability to express their sexual desire and their sexual needs, and a greater sense of companionship and friendship within marriage.

But many, many women I spoke with felt constrained on this, and for example, as one woman told me: it would be a shame for me to show my husband that I want to have sex. That being said, women find ways of getting around this. So lingerie sales, for example, do - are thriving across the Arab world.

And many of the women I met showed me their rather spectacular bed attire, and it was really highly, highly sexual. And it was interesting because these women did not conceive of lingerie as being a tool of male oppression. For them it was a tool of empowerment because they could signal their sexual desire not by actually saying I would like to have sex tonight but by putting on this lingerie and then sending out more subtle signals.

But there really was this sense of wanting to have more. And if I can just give you one example, many of the women complained that there was virtually no foreplay in their relations with their husbands at all. As one woman told me, it's five minutes, it's over, he goes to sleep, then he puts on the television.

GROSS: If you're just joining us, my guest is Shereen El Feki, and she's the author of the new book "Sex and the Citadel: Intimate Life in a Changing Arab World." And it's about how sexual views are changing or not changing in the Arab world, with a focus on Egypt. She lives part-time in Cairo. Her father is Egyptian. Shereen El Feki was raised in Canada.

(BREAK)

GROSS: Before we continue the conversation, I want to let you know that we'll be discussing a traditional practice now often referred to as female genital mutilation. Some listeners may find parts of this section disturbing or inappropriate for children.

You write about what's often called female genital mutilation, FGM, which is the removal of the clitoris and sometimes other parts of the vaginal area. It's a practice dating back to the times of the pharaoh. I had thought that this practice had more or less died out in Egypt except for rural parts of Egypt. But after reading your book, I think that it's much more widely practiced.

FEKI: Absolutely. According to a 2008 survey of ever-married women in Egypt under the age of 50, about 90 percent of them are circumcised. And more recently that youth survey I mentioned of Egyptian young people, about 80 percent of 15- to 17-year-olds have been circumcised.

GROSS: And, you know, in the Western world, in most parts of the Western world, that is considered to be mutilation and kind of like a crime against women, an amputation of sorts. What is the rationale that you've heard given for it in contemporary Egypt?

FEKI: There are several reasons that women will circumcise their girls, and I need to point out that this is actually a decision which is made by mothers and grandmothers rather than fathers. They're really not part of the decision-making process in this regard.

Women will say that it is tradition. They will invoke aesthetics, that the area looks tidier if this is done. They will often invoke Islam, and they will cite a hadith, an account of the sayings or deeds of the prophet that suggests that circumcision is desirable, but that is of dubious authenticity, to say the least, and the major religious figures in Egypt have come out very strongly against FGM, female genital mutilation, saying that it is completely contrary to the teachings of both Islam and Christianity.

The major reason that it is done is that it is thought to control female sexual drive. So the clitoris is somehow seen as an engine of libido and that it needs to be tamed, and if you don't clip the clitoris, then girls will stray before marriage, or wives will make excessive demands of their husbands, and both of these are marriage killers.

So it's the desire to keep women under control sexually. And again, that feeds back into these patriarchal attitudes towards women.

GROSS: So what you're saying seems contradictory because on the one hand you're saying that a lot of the women who you interviewed don't feel sexually satisfied, that they're not getting enough sex from their husband, or it's not long enough. At the same time, an overwhelming majority of women have had, you know, female genital mutilation, which one would assume would inhibit their sexual drive, and in fact you've said that's one of the reasons why mothers and grandmothers have it performed on their daughters.

So what have you learned about how it actually affects a woman's sexual feelings?

FEKI: It's very complex, and I was associated with a study which asked just that question, the connection between female sexuality and FGM, because one of the arguments that is used by NGOs to promote the eradication of FGM is that it inhibits a woman's right to sexual satisfaction and sexual pleasure.

The problem is that in asking women about this, some certainly did see the connection between the clipping of the clitoris and their sexual satisfaction, but a lot of women in this particular study did not see that connection at all. They felt sexual pleasure nonetheless, and the reason for that is they did not see sexual satisfaction as having an orgasm. They saw sexual satisfaction, for example, in that their husbands were happy in bed or that their overall life was happy in marriage and that the kids were fed, and the bills were paid, and they had a roof over their head.

So they conceived of their own sexual pleasure in a different way than perhaps one might find with most women in the West. And so these arguments trying to connect FGM with sexuality and sexual pleasure need to be very carefully constructed.

I need to point out, however, that rates of FGM have been declining in particular populations in Egypt. And if the campaigns were to continue at the same speed and extent as they had under the Mubarak regime, and I can tell you that's not guaranteed given the power, the political power of Islamic conservatives at the moment, but if that were to happen, then by 2025 only about 50 percent of 15 to 17-year-olds would be circumcised.

Now, I know that's a huge number, but you need to compare that to 90 percent of ever-married women today.

GROSS: If this isn't too personal, your grandmother, who you quote a lot in the book, was she circumcised?

FEKI: I believe so, yes.

GROSS: You're not sure?

FEKI: My father has mentioned this to me, and I gather my aunts were also circumcised. But certainly their daughters and their daughters are uncircumcised.

GROSS: So is there a correlation between how educated you are and the likelihood that you would be circumcised?

FEKI: To a certain extent, but again, if you look at rates of circumcision in certain populations in Egypt, yes, you find some dramatically lower rates amongst educated individuals, but I know educated women who have gone on to circumcise their daughters, and these are actually nurses and doctors who have done it.

And their argument is very interesting. Aside from the sort of - the traditional arguments for FGM that I mentioned earlier, they actually invoke politics as well, which is extremely interesting, because in 2008 the Mubarak government passed a law which criminalized female genital mutilation, those who practice it, and by extension parents as accomplices.

The law has had virtually no effect on people's behavior in Egypt. And I have actually found women who said that they are going to circumcise their daughters in part because of a response to the government, because they said, look, this Mubarak regime is completely unrepresentative of the people, it is a dictatorship, and more to the point it's in hock to the West, and it is trying to push a Western agenda of sexual rights and freedoms on us.

And it is not the government's role to be involved in my private affairs - you know, an argument which may be familiar to many American listeners in terms of the balance between the government and the private responsibility. So they actually conceived of this as a form of resistance as well.

What I think is interesting moving forward is now that we have Islamic conservatives in government, will we see people turning against FGM as a form of resistance to this government? It's an unknown question.

GROSS: That's a really interesting question. And just one more thing about FGM, you know, you say that more and more it's being performed by doctors in order to avoid infection. So it's becoming less of, you know, a customary practice performed by somebody in the neighborhood to becoming something that's done in a more sterile environment. So at least there's that. But it also kind of means it's becoming a kind of medical practice, a fairly standard medical practice.

FEKI: Absolutely. About 70 percent or possibly 80 percent now of FGM procedures on youth today, young women today, are done by the doctor. And it's a salutary tale of what happens when you try to invoke arguments against FGM. So one of the earliest arguments brought against the practice, when it was done by traditional midwives, is that it is unsafe, it causes excessive bleeding, there is a chance of infection, and there is a chance of death. And indeed girls have died from FGM in quite spectacular and tragic cases.

But the problem with that argument is that parents, mothers in particular, made a very rational decision based on that information. They said right, if the traditional midwife is dangerous, then I'm going to have it done by a doctor. And the problem is that doctors, by and large in Egypt, are struggling. Everyone's struggling in the current economic climate, but doctors in particular find it very hard to make ends meet.

And so when a woman fetches up and wants to have her girl circumcised, they're more likely to say yes out of financial need, but also the fact is that many doctors, they're coming from the same climate, the same cultural climate. So they too believe that FGM is necessary. And I have to say that the medical curricula in most universities in Egypt don't really touch on this subject to any great degree, and there have been studies which have shown that medical students are in favor of it as well.

So there is a lot of work to be done on this subject across the board. But I think the most important thing to keep in mind as we move forward on FGM is that women are not helpless in this situation. They actually have tremendous power. They are making the decisions about their daughters' well-being and FGM, to cut or not to cut.

They are making these decisions based on faulty information, but the fact is they have agency, and the key moving forward is to recognize that power and to shift it to a decision which is recognizing and respecting their child's physical and mental rights rather than the current situation, which promotes FGM.

(BREAK)

GROSS: This is FRESH AIR. I'm Terry Gross back with Shereen El Feki, author of the new book "Sex and the Citadel: Intimate Life in a Changing Arab World." It's about how the sex lives of single people, married couples, gays, lesbians, and sex workers reflect political, cultural, and religious shifts in the Arab world; with an emphasis on Egypt. El Feki divides her time between Cairo and London. She was raised in Canada, the daughter of an Egyptian father and Welsh mother who converted to Islam.

We're having an adult conversation about sexual issues, which you might find inappropriate for children.

You had said that one of women's biggest concerns now in Egypt is virginity. You were talking about single women here, about preserving their virginity or at least preserving their hymen, because the hymen has such value. What happens if you marry and you do not bleed on your marriage night? And the implication, thereby being, that your hymen had already been broken. What are the consequences?

FEKI: Well, it depends on the circumstance, really. But it can be severe, to say the least. And I know of young women who have been returned to their families by their husbands because, as you say, they did not bleed on defloration. And it's important to point out that in Egypt this is not just a private matter. There is a ceremony or a practice known as dhokla. It used to involve the midwife and the mother and the mother-in-law and the husband going into the wedding chamber and the bride's hymen would be pierced by a razor or a finger. Now it's become a more private affair and essentially, there is defloration as usual, but the blood is collected on a sheet, which is then shown to family members and potentially friends, to prove that a virgin bride has been delivered. And this is key because it's not just a question of individual reputation or honor of the bride. The virginity and an intact hymen, is connected to the family's honor, and in particular, to the honor of the menfolk of the bride's family. So it's a collective concern rather than an individual issue.

The concern is so deep for young women that hymen repair surgery - a shadowy business - is doing a very nice trade in many countries in the Arab region, and doctors are divided on it. There are some who refuse to do it. But there are others, again, along the same lines of FGM, who want to supplement their incomes. But there are also female doctors who say look, it has very serious consequences for a young woman if she cannot demonstrate her virginity and so I believe that if she is desperate, I think I should help. And there is a wide variety of religious opinion, Islamic opinion, on the validity of hymen repair surgery, the permissibility of it within Islam.

GROSS: You know, from what you report from your interviews and from questionnaires, a lot of unmarried men are engaging in sex. But an unmarried women, a single woman who has never been married, if she engages in sex, there's terrible consequences, potentially. She could be accused of ruining the honor of two families, you know, her side and her husband's side of the family. So, like, the math doesn't really work there, if young men are having sex and young women are, you know, punished if they're not virgins.

FEKI: Yes, there's a word for that math. It's double standard.

GROSS: Yes, thank you.

FEKI: And it's more than just the concerns about, will the marriage last if the woman is proved not to be a virgin or, you know, the shadowy question of honor killings, which are a real issue in Egypt and the wider Arab region. It takes subtler forms. When I was in Morocco, I had the good fortune to work with one of the country's leading NGOs on HIV-AIDS. And they do outreach to people who are at most at risk for HIV, and that includes female sex workers. And I went out with these incredibly determined, energetic and brave women who are trying to help female sex workers in Casablanca. And in a bar, we met two young women. They were students and they were supplementing their rather meager allowance from their parents by turning tricks on the Atlantic Corniche.

And when the outreach workers mentioned to them that they should really be using condoms, these young women said eh, it's not necessary. There is no risk of us becoming pregnant, we only engage in anal or oral sex. And the reason for this particular specialty is that they wanted to preserve their hymens because they wanted to get married. And yet, these young women engaging in these practices, unable to negotiate condom use with their clients, again, because of imbalances in power between men and women, were leaving themselves open to tremendous risk of sexually transmitted infections, and in particular, HIV-AIDS. And this was all in the name of an intact hymen. So the primacy of virginity for women - again, not so socially important for men, although Islam does enjoin both men and women to remain chaste before marriage - but the emphasis of this on women is really crushing for many.

GROSS: You know, you write about marriage and the different forms of marriage in parts of the Arab world, including Egypt. And there is like marriage, regular marriage, but there is a kind of marriage that is sometimes called a pleasure marriage in which there is a contract that these two people will be married for an agreed-on, limited amount of time. You know, it might be two weeks. It might be the whole summer. It might be a few months. What is the purpose of this kind of marriage and how - is it something that's traditional or is it something that's new?

FEKI: There is a wide variety of forms of marriage, as you point out, in Islam. The one that you've mentioned is called zuag(ph) mut'a, and that is a particular construct in Shia Islam, and as you say, it's for a limited time, it doesn't involve all the financial bells and whistles of a real official marriage. It is considered to be Islamically permissible. It has an unvarnished intent, which is to have sexual relations with some sort of cover of marriage and yet, it is not socially acceptable. And a young woman with a reputation to uphold would probably not put mut'a marriage on her CV.

The point is that the only socially accepted context for sexual life is marriage. And so many young people I've encountered want to give their relation some sort of Islamic cover. And so if they can't afford an official marriage - and this is one of the major problems in the Arab world - that marriage has become very expensive and therefore, the age of marriage is rising, and young people don't have jobs, which is one of the major drivers of the uprising. So if you can't fit inside the citadel what are you going to do? And so they turned to these other forms of marriage, which are historical in Arab society and also have a long tradition in Islam.

GROSS: Now you said that one of the obstacles that make it difficult for young people to get married now in Egypt, which is undergoing financial difficulties, is that getting married is very expensive. What do you mean by that? Is it because ceremonies are fancy and expensive or are there other reasons why getting married is expensive?

FEKI: It's not just the wedding, it's marriage itself, so - happily ever after, basically. What has happened in Egypt and most of the Arab region is that countries have opened up to the full flood of global capitalism. So there are things to buy, there is 24/7 advertising. It's a very consumer culture now, and marriage becomes an exercise in conspicuous consumption. And you will often find young men - certainly they've told me that frankly, brides and their families, they ask for too much. They want to have the perfect apartment and a car, and the appliances. And then there are all sorts of financial aspects to a marriage. There's something called mahr which is the money that is enshrined in Islam, that a husband gives his wife on marriage. And then there are things like shabka, which is the jewelry, which is - a bride is expected to be given. So there are all these things and it's very hard for men to afford this. And this is true, not just in Egypt, but if you look to the wealthier Gulf states, they have funds which try to help young men with loans to actually, you know, be able to step up and meet the financial demands of marriage. And it's a huge source of anxiety in the Gulf, because there is a concern that man will marry foreigners as opposed to local women, because local women have families and they're demanding so much, and that this will somehow dilute the identity of the indigenous population. In a place like United Arab Emirates, for example, Emiratis make up a tiny minority of the population. It's mainly expat workers, and so there is a real drive, now, to connect economics, marriage, to national identity and preservation.

(BREAK)

GROSS: My guest is Shereen El Feki. She's the author of the new book "Sex and the Citadel: Intimate Life in a Changing Arab World." Can we talk briefly about birth control in marriage? Is it considered acceptable in Islam as interpreted by the Islamic leadership in Egypt?

FEKI: Contraception has a long history in Islam and there are Hadiths, as I said, accounts of the sayings and deeds of the prophet, which are in favor of contraception. At the time it was withdrawal, which is the particular method which was endorsed by the prophet. Throughout Islamic history there have been debates about the permissibility of contraception. But the bottom line is that it is permitted, and you see this reflected in practice today. So if we look in Egypt, for example, according to the most recent survey, about 60 to 70 percent of married women are using modern forms of contraception.

What's interesting in Egypt, it's a bit of an anomaly. Virtually no married couple uses contraception in the first year of marriage.

GROSS: Because?

FEKI: It's negligible rate. Negligible rate of use. And that is because in Egyptian society you are expected to produce a child by the first year of marriage, nine months, preferably. And if you don't, it's something of a family calamity, really. And mothers and mothers-in-law will start to get very, very anxious. And such is the drive to produce a child within the first year of marriage that I know of young women who are starting to undergo infertility treatment after six months of marriage. And this is...

GROSS: Wow, not giving it a long time. Yeah.

FEKI: And this is contrary to all, to international best medical practice. And, you know, quite frankly, given how little sexual education young people in Egypt are receiving, the definition of primary infertility is that you're unable to conceive after a year of productive intercourse. Well, I wonder about the productive part, given how little young people know going into marriage, quite frankly.

Nonetheless, there are concerns in a place like Egypt. The Mubarak regime, for example, was staunchly in favor of family planning, primarily because if Egypt loses a grip on population growth, then any economic gains will be wiped out and any hope that we have now for democracy will be undermined, to put it lightly. There is concern however, that Islamic conservatives are not going to promote family planning in the same way and that funding will decline and that we will start to see birth rates increase. On average now, women in Egypt have about three kids. And in national surveys of youth, they said they wanted between two or three. And this is a dramatic decline from, you know, even a generation ago, when it was at, you know, five or six.

GROSS: You devote a chapter of your book to the lives of gay and lesbian people in Egypt, particularly young people. How acceptable or unacceptable is homosexuality now?

FEKI: In Islam homosexuality is considered by the vast majority of people to be haram, forbidden. This translates into legal structures which criminalize male sodomy or homosexuality acts, variously defined in most countries in the Arab region. Interestingly, Egypt is one of about five countries in the Arab world which does not explicitly criminalize male same-sex relations, male sodomy. Nonetheless, many, many men who have sex with men, whom I know in Egypt, have been routinely arrested and subjected to tremendous abuse in police stations and in prison, and essentially, they are charged with, under laws which criminalize prostitution, something called habitual debauchery or other trumped-up charges. All this reflects entrenched homophobia in society at all levels.

If one looks at the medical profession, a very interesting study that was done in Lebanon which shows that the majority of doctors are loath to treat men who have sex with men. It's reflected in the media, still, in Egyptian media, for example, the language in Arabic which is used to describe homosexual men or women is shoaz(ph), which essentially translates to deviance. So most people I know in the Arab world who have sex with their own sex keep this under wraps, basically, and essentially, they're not really looking for the freedom to come out. What they're looking for is the ability to stay in and do as they choose in the privacy of their own homes. And that is enshrined in Islam. There is a real emphasis on privacy in sharia, in Islamic law, for example - so it is one point of possible accommodation between Islam and same-sex relations.

GROSS: You're writing about sex because you think - and I think justifiably so - that when you understand things about people's sexual lives it reveals a lot about their larger lives, about the culture, about the religion, about politics. But it's amazing to me that you're able to speak so openly and get real responses in your interviews with women in a culture that is, you know, very private - I think that's fair to say - about sexual issues. So what has your approach been to talking to Egyptian women about such a personal subject?

FEKI: It's been surprising how willing people have been to speak to me. And I think it's due to three elements. One, the fact that I am Egyptian, I am Muslim and people, particularly women, felt comfortable talking to me because they thought I would know where they're coming from. On the other hand, I look quite Western. I have all the fair features of my Welsh mother and that was an advantage, as well, because people in the Arab region, many of them have ideas about Western sexual life and Western sexual attitudes and they believe that people in the West are much more open and less judgmental on these issues, and that was a real advantage, again, particularly talking to women because they often have questions, they have fears and aspirations and desires that they want to articulate, but they're afraid of being judged. And they saw me as coming from the West and therefore, would be less prone to jump to conclusions. And that was a real advantage as well.

The third element was my background in HIV/AIDS. It's much easier to talk about sex, still, in the Arab world, if you put a white coat on. It gives it a respectability. And so if I were to talk about HIV or reproductive health or sexual violence, these more sort of clinical aspects, public health aspects, just make it easier to get into the conversation that if you were to sit down and say hah, I want to talk about sexual rights, I want to talk about gay rights. That's sort of a nonstarter with many people. But I was able to enter the door with my white coat and once I got in there, I took off the white coat and then we started talking. And the exchanges were funny, frank, highly informative and helped me realize my personal quest to reconnect to the region and its people.

GROSS: Well, Shereen El Feki, I want to thank you so much for talking with us.

FEKI: Oh, it's been my pleasure.

GROSS: Shereen El Feki is the author of "Sex and the Citadel: Intimate Life in a Changing Arab World." You can read an excerpt on our website, freshair.npr.org.

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