Female Genital Mutilation (FGM) also known as female circumcision or female genital cutting comprises all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons as defined by the World Health Organization (WHO). This is unlike the male circumcision which is widely acceptable and recommended by WHO.
The external organs of the female reproductive system consist of the mons pubis, labia majora, labia minora, Bartholin glands and clitoris. They are contained in an area called the vulva. These organs have three functions:
- To enable sperm to enter the body
- To protect the internal genital organs from infectious organisms
- To provide sexual pleasure
FGM is a tribal practice and common in Africa, Asia and the Middle East. It is usually performed on the girls between the days after they are born (before the age of 1 year) till puberty and beyond. Research shows that in half the countries that this procedure is done, most girls are cut before the age of five.
The procedures vary according to the country or ethnic group. The procedure is usually done by traditional circumcisers. WHO has strongly urged health professionals not to perform such procedures although in some settings, some do perform the procedure with the belief that it is safer when medicalized.
Internationally, female genital mutilation is recognized as a violation of the human rights of girls and women. It is a violation of the rights of children when it is done on minors. It also violates the right to health, security, physical integrity, the right to be free from torture and cruel treatment and the right to life when the procedure results in death.
Cultural and Social Reasons for FGM
Reasons for female genital mutilation vary from place to place. However a few common reasons are as follows:
- It is a social norm and it is performed on every girl to avoid being rejected by society.
- It is considered a necessary part of raising a girl child, preparing her for adulthood and marriage.
- It aims to ensure premarital virginity and marital fidelity. It is believed to reduce a woman’s libido so therefore believed to help her resist extramarital sexual acts.
- It is believed to increase marriageability.
- It carries the notion that girls are clean and beautiful after the removal of body parts that are considered unclean, unfeminine or male.
- Some practitioners believe the practice has religious support although no religious scripts prescribe it.
- It is a cultural tradition and must be carried on.
What are the Classifications of FGM?
FGM can be classified into 4 types:
1. Type 1: Clitoridectomy – This is the partial or total removal of the clitoris. The clitoris is a small, sensitive and erectile part of the female genitals. Rarely, only the prepuce which is the fold of skin surrounding the clitoris is removed.
2. Type 2: Excision – This is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva) with or without excision of the labia majora (the outer folds of the vulva).
3. Type 3: Infibulation – Here, the vaginal opening is narrowed through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora or labia majora, sometimes through stitching with or without the removal of the clitoris.
4. Type 4 – This includes all other harmful procedures to the female genitalia for non-medical reasons. They consist of pricking, piercing, incising, scraping and cauterizing the genital area.
Complications of FGM
There are no health benefits for female genital mutilation and it is associated with many complications. These complications can be grouped into immediate and long-term.
Immediate complications include:
- Severe pain
- Genital tissue swelling
- Excessive bleeding
- Infections e.g. Tetanus
- Urinary problems
- Injury to surrounding genital tissue
Long-term complications include:
- Urinary problems e.g. painful urination, urinary tract infections.
- Vaginal discharge, itching and infections e.g. bacterial vaginosis.
- Painful menstruations and difficulty passing menstrual blood.
- Scar tissue and keloid.
- Painful sexual intercourse and other sexual problems like decreased satisfaction.
- Increased risk of childbirth complications e.g. difficult delivery, excessive bleeding, and newborn deaths.
- Need for later surgeries e.g. In the case of type 3, a procedure called deinfibulation is needed to cut open the stitches to allow for sexual intercourse and childbirth, hence, the woman goes through repeated opening and closing procedures, increasing complications. See what happens during normal childbirth.
- Psychological problems like depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.
Preventive Measures Against FGM
Work is being done by the World Health Organization (WHO) and United Nations against the practice of female genital mutilation.
Some of the efforts by WHO include:
- Strengthening the health sector response – guidelines, tools, training and policy to ensure health professionals can provide medical care and appropriate counselling to girls and women living with FGM.
- Building evidence – generating knowledge about the causes and consequences of the practice which includes, why some health professionals carry out the procedures, how to eliminate it and how to care for those who have experienced it.
- Increasing advocacy – developing publications and other advocacy tools for international, regional and local efforts to put an end to FGM within a generation.