What Is Female Genital Mutilation? Why Does It 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
~ partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
type Ia – removal of the clitoral hood or prepuce only;
type Ib – removal of the clitoris with the prepuce.
~ partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
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.
~ 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).
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.
~ 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
- Shock (sometimes death)
- Infection of the wound
- Acute urinary retention (with pain and burning)
- Urinary track infection
- Abscesses and ulcers
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
Impacts of FGM on psychological health (girls & women – specifics may depend on age)
- Psychological vulnerability
- Lack of trust
- Post-traumatic stress disorder
- Psychosexual problems
- Psychological disturbance
- Behavioural problems
- Relationship difficulties or disorders
- Emotional distance
- Sense of helplessness
- Sleep disorders
- Low self-esteem and / or sense of self-entitlement
- Social isolation / dependent on group disconnected from the mainstream
- 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)
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
- 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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FURTHER INFORMATION AND ACTION
Readers are invited to support these two FGM e-petitions:
[See also HM Government e-petition, No. 35313, to STOP Female Genital Mutilation (FGM / ‘cutting’) in Britain (for UK citizens and residents - now closed).]
There is a free FGM hotline for anyone in the UK: 0800 028 3550, or email: email@example.com
The #NoFGM Daily News carries reports of all items shared on Twitter that day about FGM – brings many organisations and developments into focus.
For more on FGM please see here.
Facebook page: #NoFGM – a crime against humanity
More info on FGM in the UK here.
Email contact: NoFGM email
** Hilary Burrage is currently writing a book, Eradicating Female Genital Mutilation: A UK Perspective