Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or another injury to the female genital organs for non-medical reasons.
This practice is carried out in regions of the world that have traditions and cultures that see it as a rite of passage. There are a few medical personnel who have taken to performing this practice under the belief that it is safer than it is done traditionally, however WHO (World Health Organisation) discourages this.
FGM is internationally recognized as a violation of the human rights of the female gender since it reinforces inequality between the sexes and the fact that it is almost always performed on minors.
While programmes to address FGM/C initially focused on associated health risks, the practice was reconceptualised as a human rights violation at the 1993 World Conference on Human Rights in Vienna. National legislation was subsequently established in many countries to prohibit the practice and to step up action against it.
Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change: UNICEF
The above statements are all blanket terms describing a broad range of practices performed on girls and women, mostly before the age of 15 and often in infancy or early childhood. More precise descriptions are provided by a typology developed by WHO in 1995 and updated in 2007:15
Type I: clitoridectomy
Partial or total removal of the clitoris and/or the prepuce. This is also referred to as ‘clitoridectomy’. A number of practicing communities also refer to it as Sunna, which is Arabic for ‘tradition’ or ‘duty’.
Type II: excision
Partial or total removal of the clitoris and labia minora, with or without excision of the labia majora. 2007 WHO definition recognizes that although this form of cutting is more extensive than Type I, there is considerable variability in the form or degree of cutting.
Type III: infibulation
Narrowing of the vaginal orifice by cutting and bringing together the labia minora and/or the labia majora to create a type of seal, with or without excision of the clitoris. In most instances, the cut edges of the labia are stitched together, which is referred to as ‘infibulation’. The adhesion of the labia results in a near complete covering of the urethra and the vaginal orifice
Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example pricking, piercing, incising, scraping and cauterization. Pricking or nicking involves cutting to draw blood, but no removal of tissue and no permanent alteration of the external genitalia. This is sometimes called ‘symbolic circumcision’, and some communities have described it as a traditional form of FGM/C. All the above procedures are carried out using special knives, scissors, razors or pieces of glass by the village elderly women or healers (in a traditional setting). Anesthetics are rarely used. The reasons why many traditions carry out FGM is rather unclear and a bit complex with clashing origin stories, however, the effects of FGM are the same. Harmful!
The Health Consequences of FGM
The range of complications associated with this practice is wide and some crippling. They include immediate problems following the procedure, gynaecological and obstetric problems including infertility, urinary problems, sexual and psychological problems as well.
Major blood arteries and veins are damaged by this practice. As a result, severe bleeding is one of the immediate complications of FGM. It may also be a result of the crust that formed over the healing wound coming loose, usually due to infection.
The Haemorrhaging experienced during the procedure coupled with the pain and anguish of the ritual often cause the patients to go into shock which can sometimes be fatal.
The environment and the tools used for this practice are usually less than ideal and are often not properly sterilized, properly stored and properly refined. Infections such as Tetanus from the blade can lead to potentially fatal blood poisoning which causes death to the surrounding tissue.
4. Urine retention
The pain and swelling of around the wound make it difficult to freely pass urine for long periods of time after the procedure. This causes urinary tract infections
5. Injury to neighbouring organs
Like with other procedures carried out on the human body, this practice can cause damage to the organs near the intended ones. Damage to the urethra, vagina, rectum, and bladder may be sustained and cause complications such as fistula
Long Term Complications
1. Bleeding #
With a wound formed, the chances of bleeding out from it are high. Each time force is applied and opens it up, blood is drawn and can cause anaemia. Actions such as sexual intercourse, childbirth, and re-stitching after childbirth all lead to bleeding from the wound created
2. Difficulty in passing Urine
Damage can be sustained to the urethra or bladder during the procedure and can cause complications that in turn make it difficult to pass urine.
3. Recurrent urinary tract infections
Just like in the above situation, damage can cause altered operation of the urinary tract and enable continuous reinfection and growth of bacteria in some parts of the body. Sometimes it spreads and affects the bladder a Kidney’s
Once there is damage on the Urethra or rectum as a result of the procedure, the patient will continuously leak urine and feces from the openings formed
5. Chronic Pelvic infection
Infection from the vulva may spread internally to the uterus, fallopian tubes, and ovaries, causing pelvic inflammatory disease (PID). This condition is often accompanied by an offensive smelling discharge.
PID can lead to scarring of the ovaries and the fallopian tube. However, the contribution of FGM to infertility is uncertain.
In cases where the infection is buried under the wound edges or an embedded stitch fails to dissolve, an abscess can form which will usually need to be opened surgically and drained.
8. Dermoid Cysts
These are one of the most commonly reported long-term complication of all types of FGM. A dermoid cyst forms as a result of skin tissue becoming embedded in the scar. The gland that normally lubricates the skin will continue to secrete under the scar and form a cyst, or sac, full of cheesy material. The cyst may grow to the size of an orange or even bigger. Dermoid cysts are not a serious threat to physical health, but they can be extremely uncomfortable and distressing.
If the clitoral nerve becomes trapped in scar tissue it may develop into a neuroma, which is a tumor consisting of a mass of nerve fibers. The whole genital area becomes permanently and unbearably painful to touch.
A keloid is excessive growth of scar tissue which is also abnormally thickened. Many of the ethnic groups who practice FGM are especially susceptible to keloid formation. Keloids around the vulva are disfiguring and psychologically distressing, and they have the effect of shrinking the genital orifice, which may cause problems of its own.
A vesicovaginal (involving the vagina and the bladder) or recto-vaginal (involving the vagina and rectum) fistula may develop as a result of injury during mutilation, or due to de-infibulation or re-infibulation, intercourse, or obstructed labor. Continuous leakage of urine and feces can plague the woman all her life and turn her into a social outcast.
12. Calculus Formation
Calculus is a stone that forms abnormally in the body from chemicals that are in high concentration in certain fluids. Calculi may develop as a result of urine or menstrual products getting trapped in the vagina behind the wall of skin created by infibulation.
13. Menstruation difficulties
The opening of the vagina following FGM may be so small that menstrual blood cannot flow freely and may accumulate. Trapped menstrual blood is known as haematocolpos. FGM may also result in dysmenorrhoea (painful menstruation).
14. HIV/AIDS and other blood were borne diseases.
15. The risk of transmission of bloodborne organisms such as HIV and hepatitis B and C viruses may be increased for women with FGM because tearing and abrasions are more likely during intercourse, or as a result of anal intercourse when the vagina is impossible to penetrate -but this has not been the subject of detailed research. Bloodborne diseases may also potentially be transmitted when groups of children are simultaneously mutilated with the same unsterile instrument. As yet, however, there is no published evidence that FGM is a major contributor to the spread of these diseases.
Problems in pregnancy and Childbirth
Problems in pregnancy and childbirth are common in women who have undergone type I11 FGM because of the rigidity and obstruction of scar tissue. If a miscarriage occurs the fetus may become trapped in the uterus or the birth canal. During childbirth, tough scar tissue may prevent dilatation of the birth canal and obstruct labor – a condition that is hazardous and potentially fatal for both mother and baby. During prolonged obstructed labor, the mother may suffer lacerations and perhaps fistulae caused by the grinding of the baby’s head against the walls of the vagina, as well as severe bleeding. The baby may suffer brain damage or even die from lack of oxygen.
Psychological and sexual consequences of FGM
Many who have been subjected to FGN recall it as a traumatic event that stirs up negative emotions and feelings. They tend to lose trust in those family members and caretakers who let the procedure to go on. It also leads to contorted self-perception and low self-esteem.