Female genital mutilation (FGM), also sometimes known as female genital cutting (see Types of FGM below), is defined by the World Health Organisation (WHO) as the range of procedures which involve “the partial or complete removal of the external female genitalia or other injury to the female genital organs whether for cultural or any other non-therapeutic reason”.
FGM and male circumcision The most important difference is that FGM impedes the natural functioning of the female body in ways that male circumcision does not. Use of the term ‘circumcision’ implies that it is the female equivalent of male circumcision, but this masks the severity of the practice and tries to suggest that it is far less severe than is the case. Type III in particular has far-reaching consequences for women throughout her whole life, and in particular in childbirth.
Childbirth In childbirth the tissue of the vagina stretches to accomodate the baby’s head and shoulders; this is how nature intended things to happen. However, if much or all of this tissue is cut away, especially with Type III FGM (see later), there is nothing to stretch and so serious difficulties, including extensive tearing and ripping are the result. With significant risks of hemorrhage for the mother, FGM will often lead to the increased risk of death or the need for resuscitation of the baby. In addition, a women with Type III FGM is at inreased risk of traumantic fistula from having her genitalia cut open during labour to allow the birth of the baby.
Types of FGM (diagrams and text courtesy of the charity Daughters of Eve)
Type I – Clitoridectomy: Involves the removal of the prepuce with or without excision of all or part of the clitoris.
Type II – Excision: Removal of the clitoris with partial or total excision of the labia minora (FGM types I and II constitute 80% of female genital mutilation performed world-wide).
Type III – Infibulation: Removal of part or all of the external genitalia (the clitoris, labia minora and labia majora) with stitching/narrowing of the vaginal opening (infibulation). This involves removal of almost two thirds of the female genitalia. The procedure consists of cutting of the labia majora to create raw surfaces which are then stitched or held together in order to form a cover over the vagina when they heal. A small hole is left to allow urine and menstrual blood to escape.
Type IV: All other harmful procedures to the female genitalia for non-medical purposes, e.g. includes pricking, piercing, incising of the clitoris and/or labia; cauterisation by burning of clitoris and surrounding tissue; scraping of the tissue surrounding the vaginal orifice (angurya cuts) or cutting into the vagina (gishiri cuts), introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it, and any other procedure which falls under the definition of FGM given above.
As a result of immigration and refugee movements, FGM is now being practised by ethnic minority populations in other parts of the world and, increasingly in the UK, where it’s estimated that over 20,000 girls are at risk each year.
It is sometimes rather awkward to explain to people, face to face, just what FGM is and what it is not. So the UKPAC has put together a small FGM information card that you can simply hand to people to get the message across. We recomend that you print it (double-sided) onto A4 card, cut it through the middle which will then give you two cards that you can carry in your handbag or pocket.
What are the Health complications of FGM?
FGM is traditionally carried out by elderly women ‘specialised’ in this task, usually without anaesthetics and with crude instruments such as razor blades, knives and broken shards of glass. In some communities, affluent families take their girls to medical personnel in an attempt to avoid the dangers of unskilled operations performed in unsanitary conditions.
The range of health complications associated with FGM is wide and some are severely disabling. They vary according to the type of procedure performed, extent of cutting, skill of the excisor, cleanliness of the tools and the environment and the physical condition of the girl or woman concerned.
Short-term Health Complications
- Intense pain: Intense pain and/or haemorrhage that can lead to shock during and after the procedure. A Sierra Leone study found that nearly 97% of the 269 women interviewed experienced intense pain during and after FGM and more than 13% went into shock.
- Bleeding: Haemorrhage can also lead to anaemia.
- Infection: Wound infection, including tetanus. A survey in a clinic in Freetown, Sierra Leone, showed that of 100 girls who had undergone FGM, one had died and 12 required hospitalisation. Of the 12 hospitalised, 10 suffered from bleeding and five from tetanus – which is fatal in 50-60% of all cases.
- Urine retention
- Injury to adjacent tissue
Long-term health Complications
- Extensive damage of the external reproductive system
- Cysts and neuromas
- Uterine, vaginal and pelvic infections
- Difficulties in micturation and menstruation
- Increased risk of vesico vaginal fistula or recto-vaginal fistula
- Complications in pregnancy and child birth
- Sexual dysfunction
- Psychological damage
- Infertility: In the Sudan, 20-25% of female infertility has been linked to FGM complications. In areas in the Sudan where antibiotics are not available, it has been estimated that one-third of the girls undergoing FGM will die.
Reasons for performing FGMBy now you must be wondering why on earth anyone would want to mutilate and torture a child in this way. Here are some of the ‘reasons’ and ‘justifications’, although reason seems to have little to do with it.
- Control over women’s sexuality: Virginity is a pre-requisite for marriage and is equated to female honour in many communities. FGM, in particular infibulation, is defended in this context as it reduces (or removes) a woman’s sexual desire and lessens temptations to have extramarital sex thereby preserving a girl’s virginity. Often sex is so painful for the rest of a woman’s life that there is no desire to indulge in sexual behaviour at all.
- Hygiene: There is a belief that female genitalia are unsightly and dirty. In some FGM-practicing societies, unmutilated women are regarded as unclean and are not allowed to handle food and water.
- Gender-based factors: FGM is often deemed necessary in order for a girl to be considered a complete woman, and the practice marks the divergence of the sexes in terms of their future roles in life and marriage. The removal of the clitoris and labia — viewed by some as the “male parts” of a woman’s body — is thought to enhance the girl’s femininity, often synonymous with docility and obedience. The trauma of mutilation may have this effect on a girl’s personality.
- Cultural identity: In certain communities, where mutilation is carried out as part of the initiation into adulthood, FGM defines who belongs to the community. In such communities, a girl cannot be considered an adult in a FGM-practicing society unless she has been mutilated and she would certainly not be marriagable.
- Religion: FGM predates Islam but it has acquired a religious dimension. Where it is practiced by Muslims, religion is frequently cited as a reason, although there is no requirement in Islam. Many of those who oppose mutilation deny that there is any link between the practice and religion, but Islamic leaders are not unanimous on the subject.
- Marriageability: Those who support FGM believe that it will empower their daughters, ensure the girls get married, and protect the family’s good name.
- Enhancement of male sexual pleasure: Sewing up the labia minora makes sex more pleasurable for the man as the entrance is made tighter.
- Superstition: There are also many superstitions about FGM, such as:
- The clitoris will continue to grow as a girl gets older and so it must be removed.
- The external genitalia are unclean and can actually cause the death of an infant during delivery.
What FGM is not
Female Genital Mutilation (FGM) is NOT a requirement of, and pre-dates all current religions, originating around 2,200BC in what is now part of Egypt and the Sudan. At that time it was mostly Clitoridectomy (see above) that was performed on all women, whatever their station in life. Women were thought to be unclean and immoral unless they had been cut. It was also male approval of the practice (a woman was unlikely to ‘stray’ if she derived little or no pleasure from sex) that encouraged parents, even aware of the dangers, to require their daughters to be cut – otherwise they were unmarriagable. This is still the case.
Male circumcision versus female genital mutilation
The following is taken from a report, Male Circumcision, which was the result of collaborative work between the London School of Hygiene and Tropical Medicine, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
“Male circumcision and female genital mutilation (FGM) are steeped in culture and tradition, the health consequences of each are drastically different. Male circumcision may seem similar as far as definition is concerned – “partial … removal of the external genitalia” – but in practice is substantially different. FGM, also referred to as “female circumcision”, comprises surgical procedures involving partial or total removal of the external female genitalia.
“It is the manifestation of deep-rooted gender inequality that assigns women an inferior position in societies, and is unambiguously linked to a reduction in women’s sexual desire and an irreversible loss of capability for a type of sexual functioning that many women value highly.
“FGM frequently involves complete removal of the clitoris, as well as additional cutting and stitching of the labia resulting in a constricted vaginal opening.The procedures are linked to extensive and in some cases lifelong health problems. The immediate complications include severe pain, shock, haemorrhage, tetanus or sepsis, urine retention, ulceration of the genital region and injury to adjacent tissue. Haemorrhage and infection can be of such magnitude as to cause death. Moreover, the WHO collaborative prospective study in six African countries on female genital mutilation and obstetric outcomes, published in June 2006, showed that deliveries to women who underwent FGM (all types considered) were significantly more likely to be complicated by Caesarean section, postpartum haemorrhage, episiotomy, extended maternal hospital stay, resuscitation of the infant and hospital inpatient perinatal death than deliveries to women who have not had FGM. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries.
“There are no health benefits associated with FGM and no research evidence that such procedures could reduce the risk of HIV transmission. For these reasons, bodies such as WHO, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), the International Council of Nurses, the American Academy of Pediatrics and the Royal College of Obstetricians and Gynaecologists consider FGM to be universally unacceptable, as it is an infringement on the physical and psychosexual integrity of women and girls and is a form of violence against them.”