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FEMALE GENITAL MUTILATION (FGM) AND ITS HEALTH RISKS

Female genital mutilation (FGM), also known as female genital cutting and female circumcision, is the ritual cutting or removal of some or all of the external female genitalia. Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. In many settings, health care providers perform FGM due to the belief that the procedure is safer when medicalized.

It is estimated that more than 200 million girls and women alive today have undergone female genital mutilation in the countries where the practice is concentrated. Furthermore, there are an estimated 3 million girls at risk of undergoing female genital mutilation every year. The majority of girls are cut before they turn 15 years old. The practice is found in Africa, Asia and the Middle East, and within communities from countries in which FGM is common.

FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

TYPES OF FGM

Female genital mutilation is classified into 4 major types.

Type 1:  This is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans).

Type 2:  This is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva ).

Type 3: Also known as infibulation, this is the narrowing of the vaginal opening 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 removal of the clitoral prepuce/clitoral hood and glans (Type I FGM).

Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

Deinfibulation refers to the practice of cutting open the sealed vaginal opening of a woman who has been infibulated, which is often necessary for improving health and well-being as well as to allow intercourse or to facilitate childbirth.

HEALTH RISKS OF FGM

FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies. Generally speaking, the health risks of FGM increases with increasing severity (which here corresponds to the amount of tissue damaged), although all forms of FGM are associated with increased health risk.It can lead to immediate health risks, as well as a variety of long-term complications affecting women’s physical, mental and sexual health and well-being throughout the life-course.  

 Immediate complications can include:

  • Severe pain: Cutting the nerve ends and sensitive genital tissue causes extreme pain. The healing period is also painful.
  • Excessive bleeding (haemorrhage): Can result if the clitoral artery or other blood vessel is cut.
  • Genital tissue swelling:  Due to inflammatory response or local infection.
  • Fever
  • Infections e.g., tetanus: May spread after the use of contaminated instruments (e.g. use of same instruments in multiple genital mutilation operations), and during the healing period.
  • Urinary problems:  These may include urinary retention and pain passing urine. This may be due to tissue swelling, pain or injury to the urethra.
  • Wound healing problems: Can lead to pain, infections and abnormal scarring.
  • Injury to surrounding genital tissue
  • Shock: Can be caused by pain, infection and/or haemorrhage.
  • Death: Death can result from infections, including tetanus, as well as haemorrhage that can lead to shock.

Long-term complications can include:

  • Urinary problems (painful urination, urinary tract infections): If not treated, such infections can ascend to the kidneys, potentially resulting in renal failure, septicaemia and death. An increased risk of repeated urinary tract infections is well documented in both girls and adult women who have undergone FGM. Painful urination due to obstruction of the urethra and recurrent urinary tract infections can also occur.
  • Vaginal problems (discharge, itching, bacterial vaginosis and other infections);
  • Menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.):  Obstruction of the vaginal opening may lead to painful menstruation (dysmenorrhea), irregular menses and difficulty in passing menstrual blood, particularly among women with Type III FGM.
  • Scar tissue and keloid: Excessive scar tissue can form at the site of the cutting.
  • Sexual problems (pain during intercourse, decreased satisfaction, etc.): FGM damages anatomic structures that are directly involved in female sexual function, and can therefore also have an effect on women’s sexual health and well-being. Removal of, or damage to, highly sensitive genital tissue, especially the clitoris, may affect sexual sensitivity and lead to sexual problems, such as decreased sexual desire and pleasure, pain during sex, difficulty during penetration, decreased lubrication during intercourse, and reduced frequency or absence of orgasm (anorgasmia). Scar formation, pain and traumatic memories associated with the procedure can also lead to such problems.
  • Increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths:  FGM is associated with an increased risk of caesarean section, postpartum haemorrhage, 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.
  • Need for later surgeries: for example, the sealing or narrowing of the vaginal opening (Type 3) may lead to the practice of cutting open the sealed vagina later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks;
  • Psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.): The pain, shock and the use of physical force during the event, as well as a sense of betrayal when family members condone and/or organize the practice, are reasons why many women describe FGM as a traumatic event.
  • Obstetric fistula: A direct association between FGM and obstetric fistula has not been established. However, given the causal relationship between prolonged and obstructed labour and fistula, and the fact that FGM is also associated with prolonged and obstructed labour, it is reasonable to presume that both conditions could be linked in women living with FGM.

Even though FGM may be normative and considered to be of cultural significance in some settings, the practice is always a violation of human rights, with the risk of causing trauma and leading to problems related to girls’ and women’s mental health and well-being.

How do we curb the problem of FGM?

What is the role of traditional and religious leaders in ending FGM?

Should FGM be made a crime and punishable under the law?

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