Fеmаlе genital mutіlаtіоn/cutting (FGM/C) involves thе removal of thе сlіtоrіѕ, іnnеr-аnd-оutеr lірѕ оf thе vаgіnа, and the sewing оr ѕtарlіng tоgеthеr оf thе two ѕіdеѕ of thе vulvа lеаvіng оnlу a ѕmаll hоlе to раѕѕ urіnе and mеnѕtruаtе – dереndіng оn the tуре.
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Female gеnіtаl mutіlаtіоn (FGM) comprises аll рrосеdurеѕ іnvоlvіng partial оr tоtаl rеmоvаl of the female еxtеrnаl genitalia оr оthеr іnjurу tо the fеmаlе genital оrgаnѕ for nоn-mеdісаl rеаѕоnѕ.
Typically FGM is performed with a razor blade on girls between the ages of four and 12, traditionally without anaesthetic.
FGM can lead to severe bleeding, pain, complete loss of sensitivity, complications during childbirth, infertility, severe pain during sex, recurring infections and urine retention. And in some cases it is lethal. Unlike male circumcision, female genital mutilation also inhibits sexual pleasure.
Firstly let looking into the various types of FGM/C that we have. There are 4 types of FGM/C which is been practiced on our females/girl child.
Types of FGM
Female genital mutilation is classified into four types:
- Type I: Also known as clitoridectomy, this type consists of partial or total removal of the clitoris and/or its prepuce.
- Type II: Also known as excision, the clitoris and labia minora are partially or totally removed, with or without excision of the labia majora.
- Type III: The most severe form, it is also known as infibulation or pharaonic type. The procedure consists of narrowing the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or labia majora, with or without removal of the clitoris. The appositioning of the wound edges consists of stitching or holding the cut areas together for a certain period of time (for example, girls’ legs are bound together), to create the covering seal. A small opening is left for urine and menstrual blood to escape. An infibulation must be opened either through penetrative sexual intercourse or surgery.
- Type IV: This type consists of all other procedures to the genitalia of women for non-medical purposes, such as pricking, piercing, incising, scraping and cauterization.
Recent estimates indicate that around 90% of cases include clitoridectomy, excision or cases where girls’ genitals are “nicked” but no flesh removed (Type IV), and about 10% are infibulations (WHO).
Complications of FGM
There are numerous forms of complications in female genital mutilation which are not good to our girl child. The following are complications of FGM/C
Short term complications
Haemorrhage
Haemorrhage is one of the most common complications of FGM, as excision of the clitoris involves cutting across the high pressure clitoral artery and attempts to stop bleeding may not be effective. Acute extensive bleeding can lead to haemorrhagic shock or even sudden death in the case of cataclysmic haemorrhage.
Shock
Shock may occur because of blood loss and the severe pain and trauma of the procedure. Both haemorrhagic and neurogenic shock can be fatal.
Pain
The majority of mutilation procedures are performed without anaesthetics and cause the girl severe pain. Even if a local anaesthetic is used, multiple insertions of the needle are often required.
Urinary retention
Urinary Retention is very common and may last for hours or days. It is commonly due to pain, tissue swelling, inflammation, injury to the urethra, and fear of passing urine on the raw wound.
Injury to adjacent tissue
Injury to the urethra, vagina, perineum and rectum can result from the use of crude instruments, poor light, careless techniques, or from the struggles of the girl.
Infection
Infection commonly occurs for a number of reasons; unhygenic conditions, the use of unsterilized instruments, applications of traditional herbs or ashes to the wound, contamination of the wound with urine and/or faeces, or binding of the legs following infibulation which prevents wound drainage. Septicaemia and tetanus may also develop.
Fracture or dislocation
Fracture of the clavicle, femur, humerus or hip joint can occur if heavy pressure is applied to a struggling girl during the procedure - as often occurs when several adults hold her down.
Failure to heal
Wounds may fail to heal quickly because of infection, irritation from urine, underlying anaemia or malnutrition.
Long term complications
Difficulties with micturition
Difficulties can occur due to damage to the urethral opening, obstruction of the urinary opening, or scarring of the meatus - and can lead to chronic incontinence or difficulty passing urine. For many infibulated girls, passing urine can take up to 20 minutes when they are still virgins.
Recurrent urinary tract infections (UTIS)
Partial occlusion of the vagina and urethra means the normal flow of urine is deflected and the perineum remains constantly wet and susceptible to bacterial growth. Retrograde UTI's therefore commonly occur, affecting the bladder, uterus and kidneys. Damage to the lower urinary tract during the procedure can also result in urinary tract infections.
Chronic pelvic infections
Partial occlusion of the vagina and urethra increases the likelihood of infection and ascending pelvic infections are common. The infections are often painful and may be accompanied by a noxious discharge spreading to the uterus, fallopian tubes and ovaries - and frequently become chronic.
Infertility
Infertility can occur due to chronic pelvic infections causing irreparable damage to the reproductive organs.
Vulvul abscesses
Vulval abscesses develop due to deep infection resulting from faulty healing or an embedded stitch causing the formation of an abscess.
Neurinoma
Neurinoma can develop when the dorsal nerve of the clitoris is cut or trapped in a stitch or in scar tissue. The surrounding area becomes hypersensitive and unbearably painful.
Keloid scars
Keloid scars result from slow and incomplete healing of the wound and the production of excess scar tissue. The scars may obstruct the vaginal opening and be so extensive that they prevent penile penetration.
Dermoid cysts
Dermoid cysts result from inclusion of the epithelium during healing, leading to swelling or pockets producing secretion. The cysts vary in size, are extremely painful and can prevent sexual intercourse.
Calculus formation
Calculus formation develop due to menstrual debris or urinary deposits in the vagina or in the space behind the bridge of the scar tissue.
Fistulae
Vesico-vaginal or recto-vaginal fistulae can form as a result of injury during circumcision, de-infibulation, re-infibulation, sexual intercourse, or obstructed labour. Urinary and faecal incontinence may be lifelong with severe social consequences.
Difficulties with menstruation
Partial or total occlusion of the vaginal opening commonly results in dysmenorrhoea or amenorrhea. Haematocolpos occasionally occurs from the retention of menstrual blood due to the almost complete coalescence of the labia.
Increased risk of HIV transmission
There is an increased risk of HIV transmission due to the use of the same unsterile instruments in-group circumcisions, repeated cutting and stitching during labour, and the higher incidence of lacerations and abrasions during intercourse.
Sexual complications
Many women who have undergone FGM experience various forms and degrees of sexual aberrations. These may include fear associated with initial sexual intercourse, pain associated with sexual intercourse, difficulty or inability to have sexual intercourse, vaginismus, and decreased sexual pleasure and fulfilment.
It is difficult to assess the impact of FGM on women's sexual fulfilment however, as each individual woman with FGM will be affected differently. Factors such as the type of FGM and the amount of tissue removed, the extent of scarring, the experience of the initial procedure, cultural and social expectations, and affection and bonding in sexual relationships will all impact directly on sexuality and sexual functioning. [back to top]
Childbirth complications
There are a range of childbirth complications that can be associated with FGM, particularly with Type 3 FGM (infibulation). The extent of the complications varies depending on factors such as the type of FGM, parity, and the nature of the scar tissue. Complications that can occur following infibulation, particularly amongst primigravidas, are as follows:
- in the event of a miscarriage the foetus may be retained in the uterus or the birth canal, and performing a dilation and curettage maybe difficult
- incorrect assessment of the stage of labour, cervical dilation, and foetal presentation due to the inability to perform vaginal examinations
- inability to perform an induction with prostaglandins due to the very narrow introitus
- difficulty applying a foetal scalp electrode, performing a foetal blood sample, or inserting a urinary catheter due to the very narrow introitus
- difficulty identifying some obstetric emergencies such as cord prolapse due to an inability to perform a vaginal examination
- increased risk of bleeding, wound infection, and damage to surrounding tissues due to repeated deinfibulation, particularly if it is not performed correctly
- prolonged and obstructed labour due to partial or total occlusion of the vaginal opening. This can lead to increased risk of uterine inertia, rupture or prolapse, tearing to the perineum, haemorrhage, and fistula formation. The baby may have an increased risk of suffering neonatal brain damage or death as a result of birth asphyxia
- repetition of deinfibulation and reinfibulation weakens the scar tissue and at the beginning of menopause a woman may have a mass of fibrous tissue resulting in incontinence and prolapses of the vaginal wall.
Psychosocial complications
There is very limited research on the impact of FGM on psychological health. The research that has been conducted is sparse and as FGM is condoned in many of the countries where it is practiced, research is likely to have been limited by social and cultural restrictions on the exploration of any negative impacts of the practice. Some of the negative psychological effects that have been reported include feelings of anxiety, fear, bitterness and betrayal, loss of trust, suppression of feelings, feelings of incompleteness, loss of self esteem, panic disorders and difficulty with body image.
When considering the psychosocial consequences of FGM, it is important to balance the traumatic impact of the initial FGM procedure and its long-term sequelae, against the social and cultural benefits that FGM brings to young girls in the communities where it is practiced