While writing our previous article motivated by the International Day of Zero Tolerance to Female Genital Mutilation (FGM), I realized the width of the subject. That is why we came to the decision to create a second more informative article in order to bring greater awareness on the “Cutting” and its effects.
Warning: This topic is very sensitive, emotional and strong, and it may trigger thoughts, memories and emotions. If you feel overwhelmed at any point please do not continue reading. We do not want you to feel uncomfortable or depressed.
© KAMPERI PARASKEVI, SOME RIGHTS RESERVED, 15/2/2020
Definition and Classification
Female Genital Mutilation or Female Circumcision or “Cutting” is a traditional practice of partial or total removal of the external genitalia or other injuries or the female genital organs for non-medical reasons. It has no health benefits and many harmful consequences and complications. It is clearly stated as an act that violates human rights.
Its existence was first stated by an ancient Greek historian named Herodotus during the 5th B.C. century to be practiced in Egypt along the Nile valley. Nowadays, 200 million women and girls are estimated to have undergone FGM worldwide and about 3 million under the age of 15 are at risk of cutting every year. There is fear for more victims, due to the cases being underreported.
Female Genital Mutilation Classification and Subclassification
Potential Reasons
Several factors are considered to contribute to the practice of FGM, including woman’s chastity, certainty of virginity until marriage, monogamy in marriage (the woman will not have any affairs because she cannot experience sexual pleasure), control of female sexual availability, girls’ marriageability, ethnic identity and social acceptance. There are, additionally, economical reasons, since a “pure” bride will attract a rich groom. In some countries it is a factor of social classification; girls and women that have undergone FGM are considered higher class than those who have not. The social pressure, also, occurs to the fact that in some homogenous societies non-mutilated women will end up abandoned by family and this usually ends up in rapes.
Method
Age range varies in different countries from the neonatal period to before the delivery of the 1st child and FGM can be performed individually or in groups. Circumcisers are usually traditional practitioners, birth attendants, elderly women or trained caregivers. Occasionally, there are male circumcisers, mostly barbers. Some of the instruments used are razor blades, unsterilized sharpened kitchen knives, scissors, pieces of glass, sharpened rocks, and even fingernails. There is a debate upon medicalized mutilation that comes down to the belief that a sterilized FGM is better than a traditional unsterilized one. This is true, but it still is an unethical unnecessary non-medical intervention that violates several human rights and can cause plenty of consequences.
WHO strongly urges health care providers NOT to perform FGM.
Consequences and Complications
Some of the immediate complications can be:
Death
Fractured pelvis, clavicle, or femur
Genitourinary infection (local or disseminated), impaired wound healing
Hemorrhage
Human Immunodeficiency Virus infection and other STDs(due to cross-contamination through the instrument used)
Psychological trauma
Shock (due to sepsis or hemorrhage)
Tetanus
Tissue swelling
Urinary retention
Excessive and uncontrollable pain (especially when anesthetics are not used)
Pelvic Inflammatory Disease (PID)
Fever
Problems with wound healing
Some of the long-term consequences (physiological and psychological) may be:
Chronic genital infections, including bacterial vaginosis
Higher risk of future HIV infection during intercourse, due to genital trauma
Dysmenorrhea
Difficulty passing menses
Cesarean or instrumental delivery
Higher risk of hemorrhage during labour
Episiotomy
Prolonged labor and labor dystocia
Stillbirths
Early neonatal deaths
Chronic vulvar, clitoral, vaginal, or pelvic pain
Posttraumatic Stress Disorder (PTSD)
Severe anxiety
Depression
Dyspareunia (pain and discomfort during sex)
Decrease or absence of sexual satisfaction
Reduced sexual desire and arousal
Anorgasmia
Skin cysts
Recurrent urinary tract infections
Painful urination due to obstruction
Treatment
There are some treatment options for both physical and psychological trauma. Psychotherapy and support groups can be helpful when dealing with FGM trauma. There are support groups for FGM and PTSD, but in case there are not in your location you could ask for personalized help from a local psychologist.
When it comes to physical repair, several specialty hospitals that perform defibulation, a surgical process that attempts to reconstruct the labia by undoing the initial mutilation. Although, there is a high chance of this procedure to have mediocre results, without minimizing the possibility of complications that every surgical intervention has.
Conclusion
Female Genital Mutilation is a traditional inhuman act that violates human rights. There are millions of girls and women that got affected by this non-medical procedure. Waris Dirie, a well-known model and human rights ambassador of the UN, wrote her biographic book “Desert Flower” that described all the difficulties of her life including her “cutting”. There are women out there that speak about their hell and help the world to realize the barbarity this tradition comes with. They contribute to a society that does not shame women for their sexuality and “cut” them. If you know someone that needs help dealing with trauma help them speak and reach for support. If you know someone that is at risk of FGM remind them that their body belongs to them and help them find support before it is too late. If YOU are a victim or at risk of FGM, you are not alone, speak out and get help. The only way to prevent future FGM is education. Let’s focus on that from now on!
We strongly encourage you to contact us in whatever way suits you and discuss the article, suggest ideas for upcoming content, tell us your strong and emotional stories or for any other reason you would like.
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Thank you for your support!
The “Being a Midwife” team
Reference List:
American Family Physician, Female Genital Mutilation or Cutting, RANIT MISHORI, NICOLE WARREN, REBECCA REINGOLD (2018)
Reproductive Health Journal, Gender equality and human rights approaches to female genital mutilation: a review of international human rights norms and standards, Rajat Khosla, Joya Banerjee, Doris Chou, Lale Say, Susana T. Fried (2017)
Obstetrics and Gynecology International Journal, Female Genital Mutilation: Health Consequences and Complications—A Short Literature Review, Elliot Klein,1 Elizabeth Helzner,2 Michelle Shayowitz,1 Stephan Kohlhoff,1 and Tamar A. Smith-Norowitz (2018)
Tzu Chi Medical Journal, Female genital mutilation; culture, religion, and medicalization, where do we direct our searchlights for it eradication: Nigeria as a case study, Olalekan Olugbenga Awolola, NA Ilupeju (2019)
Translational Andrology and Urology Journal, Female genital mutilation/cutting in Africa, Akin-Tunde A. Odukogbe1, Bosede B. Afolabi2, Oluwasomidoyin O. Bello1, Ayodeji S. Adeyanju3 (2017)
British Medical Journal, Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis, http://orcid.org/0000-0002-9991-4835Rigmor C Berg, Vigdis Underland, Jan Odgaard-Jensen, Atle Fretheim, Gunn E Vist (2014)
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