In-depth: Razor’s Edge – The Controversy of FGM

AFRICA: When culture harms the girls – the globalisation of FGM

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Health complications associated with FGM:

Although it is widely known that FGM can have devastating and harmful consequences for a woman throughout her life, because most communities practising it are very poor and do not have access to modern health facilities, medical emergencies arising from FGM are common, and often lead to death.

See: BURKINA FASO: Girl’s death prompts search for new strategies to fight FGM.  

It is difficult to determine the actual numbers of women who die from FGM-related complications, given the highly guarded nature of the practice. Medical record-keeping systems are also rarely configured to record FGM and FGM-related complications as causes of death.

The health problems a girl can experience are largely dependent on three factors.

  • First, the severity of the procedure: girls and women who undergo type II and type III are likely to experience more severe health complications, but health consequences for type I have also been widely reported. Discussions with a doctor on the possible medical effects of type I FGM found that complications were most evident during childbirth, due to the reduced elasticity of the vagina caused by scar tissue formed as a result of the surgery. To compensate for the reduced elasticity during childbirth, tiny tears are caused around the vagina. These are too small to stitch, and end up forming more scar tissue, compromising the vagina’s elasticity even further. Labour becomes longer and more painful with each subsequent birth. The tears themselves predispose the woman to infection, while her ability to experience sexual satisfaction is undermined, as the tearing leads to an ever-loosening vagina.
  • Second, the sanitary conditions in which the procedure is performed, and the competence of the person who performs it: most circumcisers are professionals with years of experience, but the tools and sanitary conditions of their trade are often rudimentary at best, with knife-like implements or razor blades used as the basic surgical instruments. Close adherence to traditions that dictate what type of instrument is suitable do not allow for innovation, or the adoption of new, more suitable instruments that may be available. Typically, the circumcision ceremony takes place once a year and all eligible girls within a community are cut on the same day, using the same instrument – without the benefit of sterilisation between procedures – thus increasing the chances of infection, and the risk of exposure through such practices to HIV/AIDS.
  • Third, the health of the girl or woman undergoing the procedure, and her ability to heal and resist infection passed on by the procedure, is critical: if a woman is prone to infection, or has a poor immune system, she has a greater chance of becoming infected. Literally, only the strong survive. The secret nature of FGM poses a great threat to the health of girls and women who undergo it. It is highly confidential, and outsiders are strictly prohibited from having any contact with the girls and women during and after the ceremony. Therefore, most of them have no access to a medical professional, should they need one during or after the procedure.

The 40-day isolation that characterises type III FGM, for example, means a woman might die of infection before she ever gets the chance to receive proper medical care. When qualified medical personnel perform FGM in the sanitary conditions of a hospital, the risk of infection may be reduced, but the long-term consequences remain.

Some immediate physical problems resulting from FGM are:

  • 1. Bleeding (often haemorrhaging from rupture of the blood vessels of the clitoris), sometimes leading to death
  • 2. Post-operative shock
  • 3. Damage to other organs, resulting from the lack of surgical expertise of the person performing the procedure, and the aggressive resistance of the patient when anaesthesia is not used
  • 4. Infections, including tetanus and septicaemia, through using unsterilised or poorly disinfected equipment
  • 5. Urine retention caused by swelling and inflammation

Some longer-term consequences include:

  • 1. Chronic infections of the bladder and vagina:
    - in Type III, the urine and menstrual blood can only leave the body drop by drop
    - the build-up inside the abdomen and fluid retention often cause infections and inflammation that can lead to infertility
    - infections and inflammation that can lead to infertility
  • 2. Dysmenorrhoea, or extremely painful menstruation
  • 3. Excessive scar tissue at the site of the operation
  • 4. Formation of cysts on the stitch line
  • 5. Childbirth obstruction, which can result in:
    - the development of fistulas
    - tearing of the vaginal and/or bladder wall
    - chronic incontinence
  • 6. Risk of HIV infection. (There is a growing speculation of a potential risk of HIV/AIDS associated with the procedure, especially when the same unsterilised instruments are used on multiple girls, but this has yet to be scientifically proven). See: UGANDA: FGM among the Pokot heightens HIV risk.
  • 7. Reinfibulation must be performed each time a child is born. When infibulation (Type III) is performed, the opening left in the genital area is too small for the head of a baby to pass through. Failure to reopen this area can lead to death or brain damage of the baby, and death of the mother. The excisor must reopen the mother and re-stitch her again after the birth. In most ethnic groups the woman is re-stitched as before, leaving the same tiny opening. In other ethnic groups the opening is left slightly larger to reduce painful intercourse. (In most cases, not only must the woman be reopened for each childbirth, but also on her wedding night, when the excisor may have to be called in to open her so she can consummate the marriage.)

There is a dearth of scientific studies on the psychological effects of FGM on girls and women. In the course of conducting research for this study, discussions were held with some women who had undergone one or other form of FGM. This information does not claim to be scientific, nor is it a substitute for a scientific approach, but it does begin to provide some insights on the possible psychological impact of FGM on survivors.

Some of the psychological impacts of FGM appear to be pavlovian in nature and effect:

  • women who have undergone any form of FGM or its attendant painful rituals are so traumatized that they can only associate their genitals with pain and possible death from childbirth, of which there is always a much higher possibility than with uncircumcised women
  • the idea of sexual intercourse as a pleasurable activity is inconceivable for most of them

The complexity of the psychological effects of FGM on women is demonstrated by the stories of Jane and Hawa, who underwent type 2 (excision) and type 3 (infibulation) FGM respectively.

Jane’s Story: … (full long text).

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