WOMENAID INTERNATIONAL

FEMALE GENITAL MUTILATION


INFORMATION PAPER FGM/40

All societies have norms of care and behaviour based on age, life stage, gender and social class. These norms, often referred to as traditional practices, may be harmless and beneficial, but some may be harmful. Female genital mutilation is a key example of a traditional custom which is harmful and in some cases fatal. Female circumcision is a form of violence which is an infringement on the physical and psychosexual integrity of women and girls.

DEFINITION

"Female genital mutilation comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons"

Female Genital Mutilation - A joint WHO/UNICEF/UNFPA Statement (1997)

BACKGROUND & ORIGIN

TYPES OF SURGERY
There are five types of Female Circumcision from partial to complete clitoridectomy to the removal of the labia minora and/or majora. The child is held down by three or four women while the operation is being performed which lasts between 10 to 20 minutes.

The completion of the procedure is normally finalised by inserting a match stick into the opening of the vagina to maintain a sufficient opening while the surrounding tissue scars and eventually, if at all, heals. The instruments used vary from razors, small knifes, broken glass to sharpened sticks which in nearly all cases are not sterile. These instruments are used repeatedly on numerous girls, thus increasing risk of blood transmitted diseases including HIV/AIDS. Cold water and shock are the usual anaesthetics.

'Sunna' circumcision is the mildest, and least common form of Female Genital Mutilation. It involves the cutting of the prepuce or clitoral hood. As such it need not physically impair a woman's sex life, however due to the traumatic nature of the custom, psychological problems are highly evident.

'Excision or clitoridectomy' involves the removal of the clitoral glands or even the whole clitoris, surrounding tissue and/or labia minora. It is the most common form of female circumcision and the medical problems associated with it are paramount.

'Infibulation or Pharaonic' circumcision is the most severe and radical form, involving the removal of the clitoris, the labia minora and majora, the two parts of the vulva are then sewn together or through the natural fusion of the scar tissue. What is left is a very smooth surface, and a small opening to permit urination and the passing of menstrual blood. This artificial opening is sometimes no larger than the head of a match. After the operation is performed, the child's legs are bound together to impair mobility for up to 40 days.

'Introcision' is another rare form of female genital mutilation reported to be practiced by the Pitta-Patta aborigines of Australia. When a girl reaches puberty, the whole tribe - both sexes- assembles. The operator, an elderly man, enlarges the vaginal orifice by tearing it downward with three fingers bound with opossum string. This is usually followed by compulsory sexual intercourse with a number of men.

It is reported that 'introcision' is also practised in eastern Mexico, Brazil, and Peru. In North-Eastern Peru, among a division of the Pano Indians, the operation is performed in front of the whole community where an elderly woman, using a bamboo knife cuts around the hymen from the vaginal entrance and severs the hymen from the labia, at the same time exposing the clitoris. Medical herbs are applied, followed by the insertion into the vagina of a penis-shaped object made of clay.

Unclassified includes pricking, piercing or incising of the clitoris and/or labia : stretching of the clitoris, cauterization by burning of the clitoris and surrounding tissue, introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it .

In all cases of female mutilation if the child dies from complications, the excisor is not held responsible: rather, the death is attributed to evil spirits or fate.

THE PROCEDURES DESCRIBED ABOVE ARE
IRREVERSIBLE AND THEIR EFFECTS LAST A LIFETIME

MEDICAL COMPLICATIONS

SHORT TERM AND IMMEDIATE EFFECTS
Acute pain, shock, haemorrhaging, ulceration of the genital region, retention of urine, damage to the urethra, anus and adjacent tissue, fractures or dislocations (when a struggling girl is restrained) and a series of bacterial infections are the immediate consequences of the operation. Most physical complications result from infibulation although cataclysmic haemorrhage can occur during circumcision with the removal of the clitoris; accidental cuts to other organs can also lead to heavy loss of blood.

Acute infections are commonplace due to operations being carried out in unhygenic surroundings and with the utilisation of unsterilized instruments. Many excisors apply traditional medicines to the wound. Examples include: mixtures of local herbs, earth, cow-dung, ash or butter, and this often leads to infections which can lead to tetanus and general septicaemia.

LONG TERM COMPLICATIONS
There are many long term effects of female genital mutilation including difficulty in passing urine, recurring urinary tract infections, incontinence, pelvic inflammatory, keloid scarring formation and sexual dysfunction. Haematocolpos, or the inability to pass menstrual blood (because the remaining opening is often too small) can lead to infection of other organs and also infertility. Fistulae (holes or tunnels between the vagina and the bladder or rectum) is a common result of the operation. In some cases where infibulation prevents or impedes vaginal intercourse, anal intercourse may be used as an alternative. The resulting damage to tissue is also a possible route of infection by HIV.

Obstetric complications are the most frequent health problem, resulting from vicious scars in the clitoral zone after excision . These scars open during childbirth and cause the anterior perineum to tear, leading to haemorrhaging that is often difficult to stop. Infibulated women have to be re-opened, or deinfibulated on delivery of their child and it is common for them to be reinfibulated after each delivery. Although little reliable data is available, it is likely that the risk of maternal death and stillbirth is greatly increased, particularly in the absence of skilled health personnel and appropriate facilities. Female genital mutilation may also be associated with long term maternal morbidity.

PSYCHO SEXUAL AND PSYCHOLOGICAL HEALTH
Almost all types of female genital mutilation involve the removal of part or all of the clitoris, which is the main female sexual organ. The more severe types, such as infibulation, remove larger parts of the genitals and close off the vagina, leaving areas of tough scar tissue in place of the sensitive genitalia, thus creating permanent damage and dysfunction. This often results in sexual dysfunction in both partners causing painful intercourse and reduced sexual sensitivity.

Genital mutilation may leave a lasting mark on the life and mind of the woman or child who has undergone it. The psychological complications may be submerged deep in the child's subconscious and may trigger behavioural disturbances. In the longer term, women may suffer feelings of incompleteness, anxiety, depression, loss of trust, chronic irritability and frigidity. Many women and girls, traumatised by their experience but with no acceptable means of expressing their fears, suffer in silence.

Source:
* Human Rights booklet 29 1989 - 'Traditional Practices against women'
* Female Genital Mutilation - A joint WHO/UNICEF/UNFPA statement
*The State of the World Report 1997 - UNFPA

For further information see FGM INFORMATION PAPERS

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