The World Health Organization (WHO) defined Female genital mutilation (FGM) as all procedures that involve the partial or total removal of the external parts of the female genitalia for cultural and non-medical reasons; it also involves other types of injuries to the female genital organs. Female Genital Mutilation is also known as Female Genital cutting and female circumcision.
It is estimated that 200 million girls and women between the ages of 15 to 49 have been subjected to some form of FGM; despite modern civilization and increased scientific knowledge, the rate of the unhealthy act is increasing.
Africa countries that this practice can be found are Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Democratic Republic of Congo, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda and Zambia.
India, Indonesia, Malaysia, Pakistan and Sri Lanka are Asian countries that have certain ethnic groups that uphold this practice; countries of the middle east that this practice are common are Oman, the United Arab Emirates, Yemen, Iraq, Iran, the State of Palestine and Israel. Georgia and the Russian Federation are eastern European countries that practice FGM; Columbia, Ecuador, Panama and Peru are South American countries that practice this and many western countries also engage in this act, some of them are Australia, Canada, New Zealand, the United States, the United Kingdom and various European countries.
This act is predominantly practiced in Arab countries and sub-Saharan African; it is also practiced in more than 29 countries like in some parts of Europe, Australia, New Zealand and North America.
This harmful act is of four different types:
- Type 1: This type of FGM is called CLITORIDECTOMY; this form involves the partial or total removal of the clitoris and in rare cases, only the prepuce is removed. The clitoris is a small, sensitive and erectile part of the female genitals and the prepuce is the fold of skin surrounding the clitoris.
- Type 2: This type is called EXCISION; it involves the partial or total removal of the clitoris and labia minora without touching the labia majora. The labia minora is the inner folds of the vulva while the labia majora is the outer folds of the skin of the vulva.
- Type 3: This type is called INFIBULATION and it is the narrowing of the opening of the vagina by creating a covering seal; this is done by cutting and repositioning either the labia minora or labia majora and sometimes the clitoris is removed along with any of the mentioned parts.
- Type 4: This involves all other harmful procedures to the female genitalia for non-medical reasons; some of the procedures are pricking, piercing, incising, scraping and cauterizing the genital area.
Of these four types; type 1 and 2 are most common; type is experienced by 10% of affected women and it is commonly practiced in Somalia, Northern Sudan and Djibouti.
There are other terms related to FGM and they include:
- Incision: This is the practice of making cuts in the clitoris or cutting the prepuce; incisions are also made in the wall of the vagina, the perineum and the symphysis.
- Deinfibulation: This is the practice of cutting open a woman who has been infibulated (that is she has gone through type iii FGM); this is to allow for smooth intercourse and also to facilitate childbirth.
- Reinfibulation: This practice involves sowing the labia majora back together after Deinfibulation.
This practice has no health benefits; it only harms the women involved and leave them with emotional damages; before we look at the health implications of this dangerous act, we should take a look at the functions of the various parts of the female external genitalia because if they had no functions or role to play, they wouldn’t have been there in the first place.
Functions of the female genitalia
The female external genital organs are very important as the inner ones; their main function is to allow for easy passage of sperm into the body and to protect the internal genital organs from infections and infection causing organisms. The female internal genital organs are vagina, uterus (womb), ovaries and fallopian tubes; they depend on the external parts for protection and to aid fertility.
The labia majora: The literal meaning of this part is “large lips”; they are large and fleshy and can be compared to the scrotum in males. They contain sweat and oil-secreting glands and the main function of this part is to enclose and protect the other external reproductive organs. The other functions are:
- To cover and protect the inner delicate and sensitive female reproductive structures of the vulva like the clitoris, urinary orifice, vaginal orifice and labia minora.
- It protects the parts of the vulva from mechanical stress, exterior stress and friction.
- After puberty, it is covered with hair and many exocrine glands are associated with the hair follicles of the labia majora.
- Eccrine sweat glands that are associated with the hair follicles of the labia majora produce watery sweats thus helping with thermoregulation.
- Sebaceous glands also present in the hair follicles helps in producing oil to lubricate the skin and hair shaft.
- The hair follicles of the labia majora are also associated with the apocrine sweat glands which produce a fatty secretion that is consumed by the bacteria living on the skin; this in turn will produce a particular form of body odour. Many doctors and anatomists believe that this odour once acted as a pheromone to attract males.
The labia minora: The literal meaning is “small lips”; they are very small and lie inside the labia majora, it also surrounds the opening of the vagina. Their main function is to protect the structures that surround the clitoris and the openings of the urinary tract and vagina. They have a rich supply of blood vessels that gives it its characteristic pink colour; they also aid sexual stimulation because during sexual intercourse these blood vessels become engorged with blood, then they swell up and become sensitive to stimulation.
Bartholin’s glands: These glands are located besides the opening of the vagina and they secrete fluids. When they are stimulated they secret a thick fluid that supplies lubrication for sexual intercourse.
Clitoris: This is a small and sensitive organ that protrudes out and its functions is similar to the penis of the male; it is covered by a fold of skin called prepuce which is similar to the foreskin at the end of the penis, the labia majora and the labia minora meets at the clitoris and the main function is for sexual stimulation and orgasm. It is an extremely sensitive organ because it contains thousands of nerve endings; when touched or pressured it produces sensation of sexual pleasure and it is responsible for sexual sensation, pleasure and orgasm in the human female. The function of the prepuce of the clitoris which is a small fold of skin is to protect the clitoris anteriorly.
We can see the important roles these parts play in protecting the female reproductive system and how they aid fertility and reproduction; how they make sex sweet and give the woman a sense of sexual satisfaction. Now imagine these parts being lacking; the role they play will also be lacking, the women will be prone to infections, infertility, sexual dissatisfaction and many more.
What is even more fearful about this practice is that it is not carried out by professional or trained medical personnel but by the elderly people in the family; in some cultures barbers, herbalists, members of secret societies, a relative or anyone who says they can do it are allowed to do it. Then the alarming part is the instrument used; FGM is carried out with special knives, scissors, scalpels, piece of glass or razor blades; anesthetics and antiseptics are not uses and this raises the risk of infection and HIV.
The age at which FGM is carried out varies; in some culture it is carried out during infancy (as early as a couple of days after birth); others do it during childhood, some do it at the time of marriage or during a woman’s first pregnancy or after the birth of her first child.
In some countries, medical professionals carry out FGM on some women; some of these countries are Egypt, Sudan, Kenya, Nigeria and Guinea, this is referred to as “medicalization of FGM” and anesthetics and antiseptics are used which reduces the risk of infections and HIV. Although in this mention countries most people still make use of local circumcisers especially in Nigeria; only few of them go to the hospital to have medical personnel do it for their wards.
Now we will be looking at the health consequences of this dangerous practice. There are immediate effects; long term consequences, reproductive consequences and psychological effects. We will be looking at each of this in details.
Immediate repercussion of FGM
- Severe pain: Due to lack of anesthetic and use of crude and blunt instrument; the lady will experience severe pain and may be unable to move for days. Also cutting the nerve ends and sensitive tissues of the genital tissues can cause extreme pain; the period of healing is also very painful. Type 3 has the most severe pain and the healing is also prolonged and painful.
- Infections: Infection can arise due to contaminated instruments used; sharing of instruments and lack of antiseptics to use in sterilizing the instruments. Infections can also come in during the period of healing.
- Hemorrhage: Heavy bleeding and loss of blood occurs when the clitoral artery or other blood vessels is cut and in some cases some of them bleed to death.
- Fever: Fever can occur as a result of shock, infection, loss of blood and emotional trauma.
- Genital tissue swelling: This barbaric act leads to the swelling of the vulva due to the inflammatory response of the body and it raises the risk of infection.
- Urinary problems: This can lead to feeling of pain when passing urine due to tissue swelling and pain or injury to the urethra; it can also lead to slow passing of urine, urine retention and urinary tract infection.
- Wound healing problems: This can cause delayed wound healing due to the procedure and equipment used; antiseptics are not used, the instrument may not be sterilized or they can cause reaction on the skin (like razor blades, blunt knifes or glass), wound infections can set in and all this can delay the healing of the wound which may lead to other health complications like tetanus infection, pain, other infections and abnormal scarring.
- Injury to surrounding genital tissues: Other tissues surrounding the clitoris, the labia majora and minora like the Bartholin’s glands can be injured and this can cause pain, swelling and scars; it can also impair their functions in the future.
- Shock: This inhuman act can throw the whole body into shock due to the severe and intensified pain, bleeding and infection.
- HIV: Using the same instrument for many ladies without sterilizing it can increase the risk of Human Immunodeficiency Virus (HIV) infection in the ladies or girls who underwent the female genital mutilation together.
- Death: Excessive bleeding, tetanus infections, shock and other medical complications can cause the death of the person concerned.
Long term consequences of FGM
- Pain: Tissue damage and scarring can result in trapped or unprotected nerve ending and this will put the individual in perpetual pain.
- Vaginal problems: Years after this act has been carried out; it can still cause vaginal problems like itching, discharge, bacterial vaginosis and other infections.
- Urinary problems: It can cause urinary problems as already stated above; problems like UTI, slow urination and painful urination due to obstruction of the urethra and recurrent UTI.
- Menstrual problems: It can lead menstruation problems like dysmenorrhea, irregular menses and difficulty in the passage of menstruation blood due to obstruction in the opening of the vagina. Menstrual problems are common in those who went through type 3 mutilation.
- Infections: This can lead to long term infections and some of the infections are: Chronic genital infections (this is characterized by chronic pain, vaginal discharge and itching; this in turn can lead to cysts, abscesses and genital ulcers); Chronic reproductive tract infections (which is characterized by chronic back and pelvic pain) and urinary tract infections (this infection can affect the kidneys and this will ultimately lead to kidney failure, septicaemia and death).
- Keloids and scar tissues: The injuries done to the external genital organs and surrounding genitals can cause keloids and scar tissues at the site of cutting that won’t go away.
- Sexual problems: This act destroys sex and the satisfaction gotten from it; it also causes painful intercourse and most women that have gone through avoid sex.
- Impaired sexual health and life: Removal of the external genital organs of the female especially the clitoris; including damage to highly sensitive genital tissues, scars, pain and traumatic memories associated with the procedure can lead to sexual problems. It will affect sexual sensitivity, decreased sexual desire and pleasure, painful sexual intercourse, difficulty during penetration, decreased lubrication during sexual intercourse and reduced frequency or absence of orgasm.
- Increased risk of childbirth: This act leads to complications during pregnancy and when given birth; it can lead to difficult delivery, most women that have been circumcised go through caesarean section just to give birth. Excessive bleeding can also occur, they might be need to resuscitate the baby and there are records of newborn deaths in some cases. Other complications are post-partum hemorrhage, recourse to episiotomy, difficult labour, obstetric tears/lacerations, instrumental delivery, prolonged labour, and extended maternal hospital stay. The risks increase with the severity of FGM.
- Human Immunodeficiency Virus (HIV): FGM increases the risk of bleeding during intercourse and this will increase the risk of the woman getting or spreading the virus.
- Need for later surgeries: Type 3 FGM which involves creation of a partial opening in the vaginal orifice will have to be cut open to allow for sexual intercourse and childbirth. Sometimes the genital tissue is stitched several times including after childbirth; hence the affected woman goes through repeated opening and closing procedure and this will in turn increase both immediate and long term risk.
Many women who have gone through this describes it as a traumatic event; the pain, shock and use of physical force by those performing the procedure all lead to emotional and psychological problems.
This leads to Depression, Anxiety, Low self-esteem, Post-traumatic stress disorder, behavioral disturbances, loss of trust and confidence especially in caregivers and sexual dysfunction which will in turn lead to marital conflicts and divorce. So what is the gain in this?
With the above reasons, Female genital mutilation should be banned and made illegal; punishment should be given to offenders because the act is abusing the human rights of girls and women.
Are the reasons worth it?
Many cultures and societies where this act is still practiced and upheld give their reasons for doing so; but looking at the health complications you will see that some of the claims or benefits are false and the disadvantages are higher than the so called social benefits.
Many people are aware of the harm this barbaric practice but because of persecution, condemnation, harassment, ostracism and social segregation; it is difficult for them to abandon the practice or speak out against it. This is why government and health organizations need to step in and rescue females by being the voice for the voiceless.
Some reasons why some cultures and communities still hold on to this practice are:
Psychosexual reasons: This is carried out to control the sexuality of women; some cultures believe that sex is insatiable if parts of the genitalia especially the clitoris is not removed and from the functions of the clitoris we can see that this is not true, it is also carried out to ensure virginity before marriage and fidelity afterward and to increase male sexual pleasure. Cutting the clitoris leads to sexual dissatisfaction, avoiding sex and many emotional disturbances that can lead to a failed marriage. So these reasons are not worth it.
Social and cultural reasons: Some cultures see this as a way of initiating young girls into womanhood and it forms part of their cultural heritage; to perpetuate this practice they quote myths that an uncut clitoris will grow into the size of a penis or that FGM enhance fertility or promote child survival. We all know that these are lies.
Hygiene and aesthetic reasons: Some communities feel that the external parts of the female genitalia are dirty and ugly and because of this reason they are removed; they believe this will promote hygiene and aesthetic appeal. For crying out loud, the parts we are talking about here are hidden; why should women rights be abused because of flimsy reasons as this?
Religious reasons: Although there is no proof that this act is endorse by Christianity or Islam yet some people claim that their religious practice justifies this act, see an example here. Many women that went through this were told it is a religious requirement; it is practiced among many Muslim groups but not all Islamic sects practice it. Some Christians, Ethiopian Jews and followers of African Traditional Religions practice this.
Socio-economic reasons: In many communities were this practice is held onto, FGM is a prerequisite for marriage; it is also a prerequisite for the right to inherit and it can be a source of income for practitioners.
This act can and should be condemned, irrespective of culture and religious views because the harm and repercussions that follows cannot be treated or forgotten easily. It affects marriages and is the leading cause of divorce and marital conflicts in areas where this is a common practice.
The United Nations, World Health Organizations, religious leader and organizations and other governing bodies can come to the aid of these helpless women. Many voices are protesting against this act but it is not enough; some countries have also banned this act but we need more to follow suit.
African countries that have banned FGM are: Africa: Benin, Burkina Faso, Central African Republic, Chad, Cote d’Ivoire, Djibouti, Egypt, Eritrea, Ethiopia, The Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Mauritania, Niger, Nigeria, Senegal, South Africa, Sudan (state of South Kordofan, state of Gedaref, Tanzania, Togo, Uganda and Zambia.
Others countries to ban act are: Australia, Austria, Belgium, Canada, Colombia, Cyprus, Denmark, France, Italy, Luxembourg, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom and United States.
Offenders are faced with minimum of six months imprisonment to a maximum of life imprisonment; others include monetary fines in the penalty.