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What you need to know about Female Genital Mutilation

Key facts

  • Female Genital Mutilation (FGM) is the partial or complete removal of the female external genitalia or other injuries to the female genital organs for non-medical purposes.
  • There are four types of FGM and the commonest is Type 1 while the most severe is Type 3.
  • It is common in Africa, particularly in the western, eastern, and north-eastern regions.
  • About 200 million women worldwide are living with mutilated genitalia; for example, in Nigeria, about 25% of women aged 15-49 years are living with it.
  • It has short-term and long-term complications that can result in death.
  • Education, awareness, and the creation of policies can help in the elimination of FGM.

So many things require our attention in this world, from climate change to education accessibility to health inequalities, and so on; needless to say, female genital mutilation (FGM) is absolutely one of them.

Just like most African countries abolished twins killing in the nineteenth century1, the target we should focus on FGM practice is its complete elimination.

FGM is never safe! It is a violation of women’s fundamental rights.

To show more support towards the goal of eliminating FGM, the WHO and other multilateral bodies set the 6th February for International Day of Zero Tolerance for Female Genital Mutilation2. It is up to you and me to see that we arrest this tragic practice as soon as possible.

What is it?

FGM is the partial or complete removal of the female external genitalia or other injuries to the female genital organs for non-medical purposes3,4.

The female external genitalia – also called the vulva – is part of the female’s reproductive system that is external to the vagina.

The vulva is made up of the clitoris, mons pubis, labia majora and minora, the vestibules, and the vestibular glands. The urethra (urinary opening) is also housed in this section.

A diagrammatic illustration of the female external genitalia. Source: The Open University

What are the types?

According to the World Health Organization3, there are four types of FGM and here’s what they entail:

  • Type 1: involves the partial or total removal of the clitoris, also called clitoridectomy.
  • Type 2: is the partial or total removal of the clitoris and the labia minora with or without the removal of the labia major.
Pictorial description of types of FGM. Source: My Health5
  • Type 3: is the narrowing of the vaginal opening by creating a covering seal. Sometimes, this is done by stitching, other times by repositioning the labia. Sometimes this type is also accompanied by Type 1 procedure too. This type is also called infibulation and it is the most severe form of FGM.
  • Type 4: involves other harmful procedures to the genitalia for non-medical purposes such as pricking, piercing, scraping, etc.
Another pictorial description of FGM. Source: Teresa Ball in Nursing Standard 6

Where is it common?

FGM is common in many regions of Africa, Asia, and the Middle East7. In Africa, it is more common in western, eastern, and north-eastern regions of the continent.

Most girls are cut before they turn fifteen and, each year, about 4 million girls are at the risk of having FGM performed on them. Globally, about 200 million females are living with mutilated external genitalia8,7,3.

Some countries have a higher practice rate than others, for example, in Somalia and Guinea respectively, 98% and 97% of women aged 15 – 49 are living with mutilated genitalia. In Nigeria, it is 25%4.

25% i.e. 1 out of every 4 women aged 15-49 years living in Nigeria are living with mutilated genitalia.

Source: UNFPA4

Other factors affecting how common it is:

The prevalence and type of the performed FGM also vary even within countries and ethnicity is the most influencing factor of these figures7,9.

In Nigeria, out of the six largest ethnic groups: Igbo, Yoruba, Hausa, Fulani, Ijaw, and Kanuri; only the Fulani do not practice any form of FGM 10.

The commonest performed type of FGM is Type 1 while the least performed (10%) is infibulation (Type 3)10,9.

A recent trend has been noticed amongst some FGM high-prevalent countries, where it is performed by healthcare workers with the claim of being safer. This is called the “medicalization of FGM” and it is absolutely wrong.

FGM is never safe! Medicalization of FGM is an obvious violation of the Physician’s oath to “do no harm”.

Why is FGM performed?

To be straightforward, the main reason why people perform FGM is sociocultural beliefs, particularly the belief that FGM upholds decency and hinders promiscuity in a girl child3,8,4.

Others perform it as a ritual of passage into womanhood or that it will bring good luck to the female’s family and future marriage3,4.

Some even attach religious beliefs to it even though no religion has a scripture or teaching supporting it3,8,4.

People perform FGM for socio-cultural beliefs: claims to upholding decency and preventing promiscuity; ushering into womanhood; better marriageability; religious belief; etc.

What are the implications/consequences?

FGM is a horrible practice that has both short-term and long-term implications, some present as physical complications while others present as psychological challenges.

The short-term complications include:

  • Excessive bleeding
  • Severe pain
  • Fever
  • Genital swelling
  • Urinary problems
  • Infections including HIV, tetanus, chlamydia etc.
  • Shock
  • Possible death

Short-term complications of FGM include excess bleeding, severe pain, fever, genital swelling, urinary problems, the spread of infection including HIV, shock, and possible death.

The long-term implications are:

  • Increased risk of childbirth complications such as difficult delivery, increased need for caesarean section, excessive bleeding, etc.
  • Sexuality disorders such as painful intercourse, low libido, and decreased satisfaction
  • Psychological challenges such as PTSD (Post-Traumatic Stress Disorder), anxiety and depression, etc.
  • Urinary problems such as repeated urinary tract infections and painful urination
  • Menstrual problems such as painful menstruation and difficulty passing menstrual blood.
  • Vaginal problems such as discharge, infections, etc.
  • Increased needs for surgeries in the future, e.g., deinfibulation for opening up the sealed vagina in Type 3 FGM
  • Development of keloid scars over the cut area

Long-term complications of FGM include increased risk of childbirth complications, surgery, sexual disorders, urinary problems, psychological challenges, menstrual problems, etc.

What do we stand to gain if we eliminate FGM?

Humans usually think in a direction of “what do I have to gain from this?”

Well then, if we successfully eliminate FGM, here are some things we stand to gain and enjoy:

  • Zero medical expenses from treating FGM complications
  • Increased sexual satisfaction for both sexes
  • Reduction in maternal mortality (non-accidental pregnancy-related deaths)
  • Delivery of healthier children
  • An increased population of stronger and high-esteemed women
  • Zero psychological challenges from FGM experience
  • Reduced risk of spreading infections particularly HIV

What we gain if we eliminate FGM: zero medical expenses from treating complications, reduced maternal mortality, stronger and better-esteemed women, lesser psyche issues, reduced spread of infections, etc.

What can be done?

Eliminating FGM requires actions from different levels, especially ranging from the basic family unit up to the international communities. We need to create more awareness of the dangers of FGM and the obvious fact that it is a violation of human rights.

You can form a peer group, enquire about the practice in your area and give clearer information and education to other people on the health effects of FGM.

Education and awareness help to build individual decision and commitment. Notably, policies can only be created and implemented if there are enough individuals sharing the same opinion and sentiments towards this matter.

We also need to staunchly condemn the recent trend of healthcare workers being used as the medium of this practice.

Also, we need to show more support and care for those already living with mutilated genitals.

We can also modify the cultural practices in societies where it is practiced as a cultural symbol. For example, several centuries ago, ritualistic human sacrifice was a common practice for different events but today11, the norm has drifted significantly.

Finally…

There are NGOs also committed to helping girls and women living with mutilated genitals and to preventing more mutilations. You can partner with them to make more impact.

Remember, FGM is never safe!

If you know anyone living with FGM, kindly reach out to me from here. I am compiling their stories and experiences (with their informed consent) to create more awareness.

Also, if you know any NGO or business putting some work towards FGM, please reach out via here too.

If you have any suggestions, questions, or concerns, kindly use the comment section, or send me a private mail/message from here.

Once more, FGM is never safe and it is a violation of the human fundamental rights of girls and women.

References

  1. Bastian, M. “The Demon Superstition”: Abominable Twins and Mission Culture in Onitsha History. 2001. doi: 10.2307/3773886 []
  2. WHO. The International Day of Zero Tolerance for Female Genital Mutilation (FGM). 2021 []
  3. WHO. Female genital mutilation. 2020 [] [] [] [] [] []
  4. UNFPA. Female genital mutilation (FGM) frequently asked questions. 2020 [] [] [] [] [] []
  5. Prof Schouler-Ocak M, Berlin C. Women’s Health and Female Genital Mutilation. 2020 []
  6. Ball T. Female genital mutilation. Nursing Standard. 2008. doi: 10.7748/ns2008.10.23.5.43.c6679 []
  7. WHO. Prevalence of female genital mutilation [] [] []
  8. UNICEF. What is female genital mutilation? 7 questions answered. 2019 [] [] []
  9. End FGM. Female genital mutilation. 2020 [] []
  10. Okeke T et al. An overview of female genital mutilation in Nigeria. Annals of Medical and Health Sciences Research. 2012. doi: 10.4103/2141-9248.96942 [] []
  11. Schlossberg T. Why some societies practiced ritual human sacrifice. The New York Times. 2016. []

This Post Has 2 Comments

  1. Dr Bush

    This is very illuminating.

    Well written and detailed.

    Another ground breaking piece from Dr STM.

    More grace

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