Why Does Female Genital Mutilation Occur? What Are Its Health And Wellbeing Impacts?
Female genital mutilation (FGM) is a horrific act, agreed by all the major global humanitarian and legal organisations, and by many nations, to be a gross violation of human rights. But still it continues, perpetrated often on small girls and young women under barbaric conditions. What follows is an attempt to describe and ‘explain’ this act. Possible consequences for those who have it are also listed.
NB: The ** material below is very distressing to read**, but knowledge of FGM is essential to eradicating the practice.
Why does FGM happen?
- FGM may be an early marker of belonging to a particular group, perhaps carried out when the child is only a few days or weeks old. (Similarly, ex-pat groups may adopt it as a way of indicating difference from their host community.)
- In some communities FGM is seen as a rite of passage, an initiation to adulthood, occurring as the girl approaches puberty and ‘becomes a woman’.
- FGM is sometimes required to ‘preserve’ family ‘honour’.
- It may be done in order to ‘cleanse’ a girl, in the belief that it is more hygienic and will stop unpleasant genital secretions and odours as the child develops to maturity.
- FGM may be deemed a beautifying procedure, to remove ‘masculine’ aspects of a girl’s or woman’s body.
- Some communities believe men’s sexual pleasure will be enhanced by FGM.
- Excision of the clitoris may be believed to ensure women will not be like men in regard to sexual appetite or aggression.
- Fear of the clitoris may be a factor, with the belief that it must be excised because otherwise it will grow into a ‘third leg’ (c.f. a penis, only perhaps longer), and / or will cause the girl discomfort when she becomes a woman.
- Fear of the clitoris, and its consequent excision, is also a rationale in communities which believe a man – or baby – will die if they come into contact with it during intercourse or birth.
- Excision of the clitoris is believed to reduce a woman’s sexual pleasure or desire, thus reducing the likelihood that she will become sexually active with anyone other than her husband.
- And, often in addition to any or all of these convictions, FGM is a way to ensure that a girl or woman is ‘pure’; she may be sewn up almost completely as she approaches puberty, when she reaches marriageable age, or even after each birth, so that sexual intimacy is almost impossible unless on her husband’s say-so.
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Types of female genital mutilation
Type I:
~ partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
Subgroups:
type Ia – removal of the clitoral hood or prepuce only;
type Ib – removal of the clitoris with the prepuce.
Type II:
~ partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
Subgroups:
type IIa – removal of the labia minora only;
type IIb – partial or total removal of the clitoris and labia minora;
type IIc - partial or total removal of the clitoris, labia minora and labia majora.
Type III:
~ narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).
Subgroups:
type IIIa - removal and apposition of the labia minora;
type IIIb - removal and apposition of the labia majora.
Reinfibulation is covered under this definition. This is a procedure to recreate an infibulation, for example after childbirth when defibulation is necessary.
Type IV:
~ unclassified – all other harmful procedures to the female genitalia for nonmedical
purposes, for example, pricking, piercing, incising, scraping and cauterization.
Source: Global strategy to stop health-care providers from performing female genital mutilation, World Health Organisation (2010)
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What health and well-being impacts does FGM have?
Impacts of FGM on physical health: immediate (up to 10 days)
- Severe pain
- Haemorrhage
- Shock (sometimes death)
- Infection of the wound
- Acute urinary retention (with pain and burning)
- Urinary track infection
- Abscesses and ulcers
- Fever
- Septicaemia
- Tetanus
- Gangrene
Impacts of FGM on physical health: medium and longer-term (after 10 days)
- Delay in wound healing due to infection, malnutrition and anaemia
- Anaemia (and failure to thrive if malnourished child)
- Chronic pelvic infection
- Fibrosis (scarring at site of cutting)
- Cheloids (abnormal growth of scar tissue)
- Synechia (abnormal fusion of labia)
- Tissue rotation (abnormal scarring and retraction of anatomical zones)
- Chronic back and pelvic pain
- Urinary problems / incontinence / kidney failure
- Bladder calculus / stone formation
- Hypersensitivity of entire genital area, including neuroma on the dorsal nerve of the clitoris
- Dysmenorrhoea / menstrual problems
- Haematocolpos (accumulation internally of menstrual blood)
- Pain at sexual intercourse
- Recto/vaginal fistulae (?and subsequent ostracization by the community)
- Unwillingness to seek general medical advice, in case FGM becomes evident
- Hepatitis and other infections (because of poorly healed wounds)
Impacts of FGM on sexual health
- Dysparenuia / discomfort / spasm / pain during intercourse
- Anxiety resulting in vaginal dryness
- Less sexual satisfaction / difficult to reach orgasm
- Less (reported) sexual desire / lack of arousal
- Shame or embarrassment about intimacy
- Greater risk of HIV (because of cuts which bleed)
- Medical checks (e.g. smear tests) difficult, and may be avoided, so early prognoses of ill-health are missed
- Morbidity due to anal intercourse, where vaginal access is difficult
- Infertility
Impacts of FGM on psychological health (girls & women – specifics may depend on age)
- Psychological vulnerability
- Anger
- Fear
- Anxiety
- Depression
- Confusion
- Lack of trust
- Post-traumatic stress disorder
- Psychosexual problems
- Hyper-arousal
- Hyper-vigilance
- Psychological disturbance
- Behavioural problems
- Relationship difficulties or disorders
- Emotional distance
- Sense of helplessness
- Somatization
- Phobia
- Sleep disorders
- Low self-esteem and / or sense of self-entitlement
- Social isolation / dependent on group disconnected from the mainstream
- Flashbacks
- Cognitive dissonance (where norms of FGM are not shared)
- Rejection by others (e.g. not allowed to handle food or water, not permitted adult status – or even acknowledged as a mother)
- Stigma
Impacts of FGM obstetrically: maternal
- Difficulties in performing good pelvic examination during labour (resulting in inadequate management of delivery)
- Prolongation of second stage of labour
- Tearing and recourse to episiotomy
- Caesarian section (sometimes unnecessary because obstetrician unprepared)
- Perineal lacerations
- Torn uterus
- Post-partum haemorrhage
- Perineal wound infections
- Post-partum sepsis
- Repeated pregnancies because of infant mortality (presumably?)
Impacts of FGM obstetrically: paediatric
- Stillbirth
- Need for resuscitation
- Neonatal distress and / or mortality
- Failure to thrive
- Cerebral palsy / brain damage
- Death or serious incapacity of mother, so high risk also to child
“Many women believe that FGM is necessary to ensure acceptance by their community; they are unaware that FGM is not practised in most of the world.” Quote: FORWARD
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Please see more posts on FGM HERE; and for further references and reading see also:
#NoFGM: A Listing For Action & References On Female Genital Mutilation.
If you have a Twitter account and would like to draw more attention to this issue, please use the hashtag #NoFGM and follow @NoFGM1.
You can also follow NoFGM developments and campaigns via #NoFGM Daily News (free no-obligation on-line subscription).
NB: This is work in progress. Your observations and additional information / references are welcome, via the Comments box below. Thank you.
If you are a UK citizen or resident, please sign and forward to others this e-petition, which is on the HM Government website and open until 25 June 2013:
Thank you for this extensive list of complications from FGM. I hope that this practice will be eradicated in my lifetime to stop this useless suffering and death of girls and women.
Your work on the topic of FGM is very encouraging and hopefully it will be eradicated in Britain at least soon. However do we in the west have the right to tell another culture in the south, to stop a practice that has been a rite of passage long before colonialism?
What about the women who want to have the FGM done?
I am also running a blog for a university project, http://genderhcp.wordpress.com/
Thanks for the nice comment!
In reply to your question, I have no doubt at all that everyone must work however they can to get FGM stopped everywhere. There are significant numbers of people from the most affected nations who have devoted their lives to just that end, and they need 100% support.
Additionally, there is the ‘disinterested’ (and in my view clinching) argument that torture of any kind – but even more especially of course to children – must be opposed by every means possible, wherever it occurs.
There are always some people who, for a vast range of ‘reasons’, will demand that they be left to continue the practices of ‘their’ communities. This position has been promulgated over the centuries in defence of all sorts of atrocities but cruelty is cruelty.
Another issue is that FGM is usually inflicted on children who obviously cannot give consent in any meaningful way; and since it has NO positive health impacts, there cannot be any rationale which suggests others, as parents or guardians, may give consent on behalf of the child.
And yes, of course some adult women want FGM for themselves (though many vociferously don’t), but there is no medical or health reason for any practitioner to carry out the procedure, and the prime rule of good medical practice is ‘do no harm’. It might be suggested that there is a rationale in terms of individual psychological ‘benefit’, but that has to be weighed against the commonality of interest of everyone (which is why the ‘just a nick to observe traditions options’ is ruled out by the law and most professionals).
And yes, too, there is the difficult issue in the West of designer vaginas, but that’s a matter of commercial medicine and (at least in skilled hands) is done hygienically and does not actually impair vital functions – though it is to be brutally frank a very worrying development because it suggests that even the most intimate parts of women’s bodies need to be sculpted to look ‘attractive’; not a position most women would adopt.
So to my mind this is absolutely not a question of western imperialism or anything remotely like it. It’s an issue about, amongst other things, the protection from a horrifying experience (and outcomes) for children, the sovereignty of healthy bodies and the resistance of patriarchy and subservience to male domination of vulnerable women.
I have on the website likened FGM to the dreadful instance of Baby P. I don’t see it as a matter of white or black girls, of western or traditional ways. I see it as the grimmest of cruelties which often has life-long and extremely damaging impact on girls who are forced to undergo it (please see list of impacts as above).
In December 2012 the UN / WHO at last managed to secure a resolution (statement) representing every nation to the effect that FGM is simply unacceptable and must be stopped…. which is good enough for me.
Having said that, however, I do believe ways must be found to give status and the right to individual development to girls and women in (previously) FGM-practising communities – my post above on the Sande Society explains this issue further. That shift to girls’ and women’s self-determination won’t happen whilst they are married off very young, passed from father to husband (who may well also have other wives) as items for sale.
To be autonomous girls need education and women need personal dignity and ways to earn a living without becoming ‘circumcisers’.
PS Thanks, too, for signing my e-petition to Stop FGM in Britain. We very much need to keep up the pressure. You may like to follow this to get extra info (free) for your own blog: #NoFGM Daily News (and there are more posts on FGM here). Our Twitter feed is @NoFGM1.