Dr. Francis SANWO

Female genital mutilation (FGM) involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons.

More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated (1).

FGM is mostly carried out on young girls between infancy and age 15.

WHO is opposed to all forms of FGM, and is opposed to health care providers performing FGM (medicalization of FGM).

The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. WHO strongly urges health care providers not to perform FGM.

FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

Types of FGM

Female genital mutilation is classified into 4 major types.

Type 1: This is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans).

Type 2: This is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva ).

Type 3: Also known as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce/clitoral hood and glans.

Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

FGM has no health benefits, and it harms girls and women in many ways. Generally speaking, risks of FGM increase with increasing severity (which here corresponds to the amount of tissue damaged), although all forms of FGM are associated with increased health risk.

Immediate Complications can include: Severe pain, excessive bleeding (haemorrhage), genital tissue swelling, fever, infections e.g. tetanus and urinary problems. Others are wound healing problems, injury to surrounding genital tissue, shock and death.

Long-term Complications can include: Urinary problems (painful urination, urinary tract infections);

Vaginal problems (discharge, itching, bacterial vaginosis and other infections);

Menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.); scar tissue and keloid;

Sexual problems (pain during intercourse, decreased satisfaction, etc.);

Increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths;

Need for later surgeries: for example, the sealing or narrowing of the vaginal opening (Type 3) may lead to the practice of cutting open the sealed vagina later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks;

Psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.).

FGM is mostly carried out on young girls sometime between infancy and adolescence, and occasionally on adult women. More than 3 million girls are estimated to be at risk for FGM annually.

The practice is mainly concentrated in the Western, Eastern, and North-Eastern regions of Africa, in some countries the Middle East and Asia, as well as among migrants from these areas. FGM is therefore a global concern.

Cultural and social factors for performing FGM

The reasons why female genital mutilations are performed vary from one region to another as well as over time, and include a mix of sociocultural factors within families and communities. The most commonly cited reasons are:

Where FGM is a social convention (social norm), the social pressure to conform to what others do and have been doing, as well as the need to be accepted socially and the fear of being rejected by the community, are strong motivations to perpetuate the practice. In some communities, FGM is almost universally performed and unquestioned.

FGM is often considered a necessary part of raising a girl, and a way to prepare her for adulthood and marriage.

FGM is often motivated by beliefs about what is considered acceptable sexual behaviour. It aims to ensure premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist extramarital sexual acts.

Where it is believed that being cut increases marriageability, FGM is more likely to be carried out.

FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male.

Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice. Likewise, when informed, they can be effective advocates for abandonment of FGM.

In most societies, where FGM is practiced, it is considered a cultural tradition, which is often used as an argument for its continuation.

However, in this era at least in Nigeria it is accepted as a criminal act and punishable under the law. With this, it is believed and hoped that this criminality will one day be a thing of the past.