Female Genital Mutilation
Female genital mutilation (FGM), also known as female circumcision or female genital cutting, is a common practice in most African and some Middle-Eastern countries. FGM can be classified into five types:
- Type 1: Sunna (traditional)—removal of varying degrees of the clitoral prepuce.
- Type 2: Intermediate—developed by a midwife in the early 1950s in response to an edict by the government of Sudan forbidding Pharonic circumcision (see below). This method includes the removal of the clitoris, labia minora, and parts of the labia majora.
- Type 3: Pharonic—similar to the intermediate, but usually more severe and encompassing the removal of greater parts of the labia majora.
- Type 4: Infibulation (sometimes used synonymously with the Pharonic circumcision)—after the Pharonic and intermediate forms of circumcision, the left and right raw edges of the female genitalia are sewn together using suture, string, thorns, silk, or whatever might be available.
- Type 5: Incision—incising the clitoral prepuce, which is the technique for female circumcision in most parts of the world other than subSaharan regions of Africa.
Today the practice of Female genital mutilation is primarily associated with certain ethnic groups and has no relation to political or religious boundaries. It is found across the African continent in a broad, triangular east-west band that stretches from Egypt in the northeast and Tanzania in the southeast to Senegal in the west. Infibulation occurs most frequently in the Horn of Africa, namely, Ethiopia, Djibouti, Somalia, and Sudan. The World Health Organization estimates that between 85 and 114 million girls and women have been subjected to this practice. There are many cultural beliefs surrounding Female genital mutilation that vary by region and ethnic origin. Some of the more universally accepted beliefs include that Female genital mutilation will decrease the woman’s sexual desire, prevent promiscuity, and ensure chastity before marriage; that it enhances physical beauty; that it helps maintain cleanliness and health; and that it provides greater pleasure for men.
In addition to cultural beliefs, there are many religious beliefs surrounding Female genital mutilation. Many relate the practice to the Islamic religion because of the wide use of the term “Sunna” for one type of circumcision, which means “following the traditions of the Prophet Mohammed.” However, it is mistaken to believe that this practice is limited only to the Islamic religion. Some groups that practice Christianity also practice Female genital mutilation. There are also a number of social commonalities associated with Female genital mutilation, including tradition, rights of passage, ancestor worship, sacrifices to fertility gods, and protection of the family honor.
Female genital mutilation presents several health risks. The most frequent complications include severe pain, blood loss, inability to empty the bladder, infection of the wound, and damage to adjacent tissues. More severe immediate effects are sepsis (severe infection sometimes called “blood poisoning”), shock, and tetanus. HIV and hepatitis may be passed through the use of unsterile instruments, especially when groups of girls undergo Female genital mutilation at the same time. Long-term complications include chronic pelvic inflammatory disease, chronic urinary tract infection, sexual difficulties, infertility, and problems with labor and delivery. Menstrual and urinary blockages are very common. Urinary dermoid cysts are very common and can grow to the size of a grapefruit. Keloid scars, which commonly form on the vulval wound, can become so enlarged that they obstruct walking. However, they do not threaten health except during labor. It is estimated that 31% of circumcised women develop at least one, and more commonly several, of these complications.
Decircumcision, the splitting of the circumcision skin fold, is always necessary during labor. Despite the suffering, most women request recircumcision after delivery. Infibulation causes prolongation of labor and obstructed delivery, with increased risk of brain damage to the infant and stillbirth. Another problem related to childbirth is the development of a passage between the bladder and the vagina (vesicovaginal fistulae). This is caused when the head of the fetus exerts friction or pressure against the urinary bladder for a long time, which can occur for several hours as the infant’s head slowly passes through the birth canal. As a result, the thin membranes between the vagina and bladder break down, leaving a hole. Postpartum blood loss is another concern due to the cutting of scar tissue, often by untrained midwives.
The World Health Organization has taken an active role in eliminating the practice of Female genital mutilation, providing technical and financial support for grass-roots initiatives. In 1995, the 104th Congress of the United States passed Senate Bill 1030, the Federal Prohibition of Female Genital Mutilation Act of 1995, outlawing the practice of Female genital mutilation of girls under the age of 18. Several states have implemented similar laws.
SEE ALSO: Immigrant health, Infertility
- Lightfoot-Klein, H. (1989). Prisoners of ritual: An odyssey into female circumcision in Africa. New York: Harrington Park Press.
- Toubia, N. (1994, September). Female circumcision as a public health issue. The New England Journal of Medicine, 712-716.
- Toubia, N., & Izett, S. (1998). Female genital mutilation: An overview. Geneva: World Health Organization.