Female Genital Mutilation

Female genital mutilation (FGM) is the cutting, or partial or total removal, of the external female genitalia for cultural, religious, or other non-medical reasons. It is usually performed on girls between the ages of four and 10. It is also called female circumcision.

Purpose

FGM results in the cutting or removal of the tissues around the vagina that give women pleasurable sexual feelings. This procedure is used for social and cultural control of women's sexuality. In its most extreme form, infibulation, where the girl's vagina is sewn shut, the procedure ensures virginity. In some cultures where female circumcision has been a tradition for hundreds of years, this procedure is considered a rite of passage for young girls. Families fear that if their daughters are left uncircumcised, they may not be marriageable. As in most cultures, there is also the fear that the girl might bring shame to the family by being sexually active and becoming pregnant before marriage.

Precautions

It is illegal to perform FGM in many countries, including the United States, Canada, France, Great Britain, Sweden, Switzerland, Egypt, Kenya, and Senegal. This procedure is usually done in the home or somewhere other than a medical setting. Often, it is performed by a family member or by a local "circumciser," using knives, razor blades, or other tools that may not be sterilized before use.

Description

Female circumcision includes a wide range of procedures. The simplest form involves a small cut to the clitoris or labial tissue. A Sunna circumcision removes the prepuce (a fold of skin that covers the clitoris) and/or the tip of the clitoris. A clitoridectomy removes the entire clitoris and some or all of the surrounding tissue; this procedure occurs in approximately 80% of cases. The most extreme form of genital mutilation is excision and infibulation, in which the clitoris and all of the surround tissue are cut away and the remaining skin is sewn together. Only a small opening is left for the passage of urine and menstrual blood. Infibulation accounts for approximately 15% of FGM procedures.

The World Health Organization (WHO) estimates that between 100 million and 140 million girls and women have undergone some form of FGM. As a very deeply rooted cultural and religious tradition still practiced in over 28 African and Asian countries, up to two million girls per year are at risk. The following countries have the highest number of occurrences of FGM: Djibouti (98%), Egypt (97%), Eritrea (95%), Guinea (99%), Mali (94%), Sierra Leone (90%), and Somalia (98-100%). As more people move to Western countries from countries where female circumcision is performed, the practice has come to the attention of health professionals in the United States, Canada, Europe, and Australia.

In an effort to integrate old customs with modern medical care, some immigrant families have requested that physicians perform the procedure. While trying to be sensitive to cultural traditions, health care providers are sometimes put in the difficult position of choosing to perform this procedure in a medical facility under sanitary conditions, or refusing the request, knowing that it may be done anyway with no medical supervision. Some families who are intent on having this procedure done will take their daughters back to the country they immigrated from in order to have the girls circumcised.

Many national and international medical organizations including the American Medical Association (AMA), Canadian medical organizations, and WHO oppose the practice of female genital mutilation. The United Nations (UN) considers female genital mutilation a violation of human rights. WHO has undertaken a number of projects aimed at decreasing the incidence of FGM. These include the following activities:

• publishing a statement addressing the regional status of FGM and encouraging the development of national policy against its practice,
• organizing training for regional community workers,
• developing educational materials for local health care workers,
• providing alternative occupations for individuals who perform FGM procedures.

Aftercare

A girl or young woman who has recently had the procedure performed may require supportive care to control bleeding and antibiotics to prevent infection. Women who were circumcised as children may require medical care to treat complications. Pregnant women who have been infibulated may have to have the labial tissue cut open to allow the baby to be delivered. Aftercare should be provided with a supportive and nonjudgmental approach towards the girls and women who have undergone this procedure.

Risks

The immediate risks after the procedure are hemorrhage (excessive bleeding), severe pain, and infection (including abscesses, tetanus, and gangrene). The most severe consequence is death due to excessive blood loss. Long term complications include scarring, interference with the drainage of urine and menstrual blood, chronic urinary tract infections, pelvic and back pain, and infertility. Sexual intercourse can be painful. Complications of childbirth are also a risk. It is unclear whether it is related to the procedure itself, or related to the general condition of medical practice, but infant and maternal death rates are generally higher in those communities where female circumcision is practiced.