Female genital mutilation (FGM) is a horrific act, agreed by all the major global humanitarian and legal organisations, and by many nations, to be a gross violation of human rights. But still it continues, perpetrated often on small girls and young women under barbaric conditions. What follows is an attempt to describe and ‘explain’ this act. Possible consequences for those who have it are also listed.
NB: The ** material below is very distressing to read**, but knowledge of #FGM is essential to eradicating the practice.
Why does FGM happen?
FGM may be an early marker of belonging to a particular group, perhaps carried out when the child is only a few days or weeks old. (Similarly, ex-pat groups may adopt it as a way of indicating difference from their host community.)
In some communities FGM is seen as a rite of passage, an initiation to adulthood, occurring as the girl approaches puberty and ‘becomes a woman’.
FGM is sometimes required to ‘preserve’ family ‘honour’.
It may be done in order to ‘cleanse’ a girl, in the belief that it is more hygienic and will stop unpleasant genital secretions and odours as the child develops to maturity.
FGM may be deemed a beautifying procedure, to remove ‘masculine’ aspects of a girl’s or woman’s body.
Some communities believe men’s sexual pleasure will be enhanced by FGM.
Excision of the clitoris may be believed to ensure women will not be like men in regard to sexual appetite or aggression.
Fear of the clitoris may be a factor, with the belief that it must be excised because otherwise it will grow into a ‘third leg’ (c.f. a penis, only perhaps longer), and / or will cause the girl discomfort when she becomes a woman.
Fear of the clitoris, and its consequent excision, is also a rationale in communities which believe a man – or baby – will die if they come into contact with it during intercourse or birth.
Excision of the clitoris is believed to reduce a woman’s sexual pleasure or desire, thus reducing the likelihood that she will become sexually active with anyone other than her husband.
And, often in addition to any or all of these convictions, FGM is a way to ensure that a girl or woman is ‘pure’; she may be sewn up almost completely as she approaches puberty, when she reaches marriageable age, or even after each birth, so that sexual intimacy is almost impossible unless on her husband’s say-so.
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Types of female genital mutilation
Type I:
~ partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
Subgroups:
type Ia – removal of the clitoral hood or prepuce only;
type Ib – removal of the clitoris with the prepuce.
Type II:
~ partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
Subgroups:
type IIa – removal of the labia minora only;
type IIb – partial or total removal of the clitoris and labia minora;
type IIc - partial or total removal of the clitoris, labia minora and labia majora.
Type III:
~ narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).
Subgroups:
type IIIa - removal and apposition of the labia minora;
type IIIb - removal and apposition of the labia majora.
Reinfibulation is covered under this definition. This is a procedure to recreate an infibulation, for example after childbirth when defibulation is necessary.
Type IV:
~ unclassified – all other harmful procedures to the female genitalia for nonmedical
purposes, for example, pricking, piercing, incising, scraping and cauterization.
Source: Global strategy to stop health-care providers from performing female genital mutilation, World Health Organisation (2010)
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Related : ISIS likely to make FGM mandatory for girls from 11 - 46 age
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What health and well-being impacts does FGM have?
Impacts of FGM on physical health: immediate (up to 10 days)
Severe pain
Haemorrhage
Shock (sometimes death)
Infection of the wound
Acute urinary retention (with pain and burning)
Urinary track infection
Abscesses and ulcers
Fever
Septicaemia
Tetanus
Gangrene
Impacts of FGM on physical health: medium and longer-term (after 10 days)
Delay in wound healing due to infection, malnutrition and anaemia
Anaemia (and failure to thrive if malnourished child)
Chronic pelvic infection
Fibrosis (scarring at site of cutting)
Cheloids (abnormal growth of scar tissue)
Synechia (abnormal fusion of labia)
Tissue rotation (abnormal scarring and retraction of anatomical zones)
Chronic back and pelvic pain
Urinary problems / incontinence / kidney failure
Bladder calculus / stone formation
Hypersensitivity of entire genital area, including neuroma on the dorsal nerve of the clitoris
Dysmenorrhoea / menstrual problems
Haematocolpos (accumulation internally of menstrual blood)
Pain at sexual intercourse
Recto/vaginal fistulae (?and subsequent ostracization by the community)
Unwillingness to seek general medical advice, in case FGM becomes evident
Hepatitis and other infections (because of poorly healed wounds)
Impacts of FGM on sexual health
Dysparenuia / discomfort / spasm / pain during intercourse
Anxiety resulting in vaginal dryness
Less sexual satisfaction / difficult to reach orgasm
Less (reported) sexual desire / lack of arousal
Shame or embarrassment about intimacy
Greater risk of HIV (because of cuts which bleed)
Medical checks (e.g. smear tests) difficult, and may be avoided, so early prognoses of ill-health are missed
Morbidity due to anal intercourse, where vaginal access is difficult
Infertility
Impacts of FGM on psychological health (girls & women – specifics may depend on age)
Psychological vulnerability
Anger
Fear
Anxiety
Depression
Confusion
Lack of trust
Post-traumatic stress disorder
Psychosexual problems
Hyper-arousal
Hyper-vigilance
Psychological disturbance
Behavioural problems
Relationship difficulties or disorders
Emotional distance
Sense of helplessness
Somatization
Phobia
Sleep disorders
Low self-esteem and / or sense of self-entitlement
Social isolation / dependent on group disconnected from the mainstream
Flashbacks
Cognitive dissonance (where norms of FGM are not shared)
Rejection by others (e.g. not allowed to handle food or water, not permitted adult status – or even acknowledged as a mother)
Stigma
Impacts of FGM obstetrically: maternal
Difficulties in performing good pelvic examination during labour (resulting in inadequate management of delivery)
Prolongation of second stage of labour
Tearing and recourse to episiotomy
Caesarian section (sometimes unnecessary because obstetrician unprepared)
Perineal lacerations
Torn uterus
Post-partum haemorrhage
Perineal wound infections
Post-partum sepsis
Repeated pregnancies because of infant mortality (presumably?)
Impacts of FGM obstetrically: paediatric
Stillbirth
Need for resuscitation
Neonatal distress and / or mortality
Failure to thrive
Cerebral palsy / brain damage
Death or serious incapacity of mother, so high risk also to child
Source: Hilary Burrage’s blog for NoFGM
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