Female genital mutilation

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Road sign near Kapchorwa, Uganda, 2004
Definition Defined in 1997 by the WHO, UNICEF and UNFPA as the "partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons."[1]
Areas Estimated in 2013 to be most common in 27 countries in Africa, as well as in Yemen and Iraqi Kurdistan[2]
Numbers 133 million in those countries as of 2014[3]
Age Days after birth to puberty[4]

Female genital mutilation (FGM) is cutting off part or all of the female genitals that are outside of the body. FGM is also called female genital cutting and female circumcision. It is done for cultural reasons, as part of a ritual, not for medical reasons.

FGM is most common in 27 African countries, as well as Yemen and Iraqi Kurdistan. However, it also happens in other countries in Asia, the Middle East, and around the world.[5] Usually, FGM is not done by a doctor or in a hospital.[6] It is often done with a razor blade, sometimes without anesthesia.

Different ethnic groups do different kinds of FGM. They also do FGM at different ages. Some groups do FGM when infants are only a few days old. Others do it when girls reach puberty, or are older. In about half the countries where FGM happens, most girls have FGM before they are five years old.[4]

FGM can cause serious health problems, like infections, chronic pain, trouble getting pregnant and giving birth, bleeding so bad that it can kill.[7] FGM does not make a person's health better in any way.[8]

FGM is illegal in most of the countries where it happens.[9] However, these laws are often ignored.[10] Since the 1970s, many countries have tried to stop FGM. In 2012, the United Nations General Assembly said that FGM is a human rights problem, and voted to try harder to stop it.[11] The World Health Organization and the "Maputo Protocol" to the African Charter on Human and Peoples' Rights also say that FGM must be stopped.

Types of female genital mutilation[change | change source]

There are many different types of female genital mutilation. The World Health Organization (WHO) has created four basic categories of FGM, called Types 1-IV.[12]

Type I[change | change source]

In Type I FGM, part or all of the clitoris is cut off. The clitoris is the organ that makes sex feel good for women. Without it, a woman usually cannot have an orgasm.[13]

Diagram showing types of female genital mutilation

Type II[change | change source]

There are a few forms of Type II FGM. All of them involve cutting off part or all of the inner labia, the two flaps of skin on the sides of the vagina. The forms of Type II FGM are:[14]

  • Type IIa: The inner labia are cut off.
  • Type IIb: The inner labia and part of the clitoris are cut off.
  • Type IIc: The inner labia and part of the clitoris are cut off. So is the outer labia, the folds of skin that protect the genitals.

Type III[change | change source]

Type III FGM is usually called infibulation. It is the most severe form of FGM. The genitals outside a woman's body are cut off and the wound is sewn shut with thread and thorns.[15] The different types of infibulation are:[14]

  • Type IIIa: The inner labia are cut off and sewn closed.
  • Type IIIb: The outer labia are cut away and seen closed.

When the labia are sewn shut, one small hole is left open so the girl can urinate and menstruate. The hole is kept open by putting something like a twig into the wound.[16][17]To help the wound close, the girl's legs are tied together, often from hip to ankle, for up to six weeks.[18][19]

After the woman gets married, her vagina is cut open so she can have sex. A midwife might cut open the vagina with a knife, or the woman's husband might tear it open with his penis.[20] If the woman gets pregnant, the vagina is opened more for childbirth, and then often sewn back up afterward (this is called re-infibulation).[21]

Type IV[change | change source]

Type IV FGM is anything else that is done to hurt the genitals, like scraping, burning, scarring, or cutting the genitals without cutting them off.[1][22]

Prevalence[change | change source]

In many countries where FGM is common, almost every woman and girl in the country has had FGM. In other countries, millions of women and girls have had FGM over many years.

In 25 countries in Africa and the Middle East, over 125 million women and girls have had FGM. This includes:[6]

In some of these same 25 countries, FGM is very common. It is most common in these countries:[6]

However, in other countries, FGM is not as common. For example, of the 25 countries where FGM happens most often, it is least common in these countries:[6]

Complications[change | change source]

FGM can hurt women's physical and mental health throughout their lives.[23][24]

The type of complications that people might have from FGM depend on many things, like:[7]

  • The type of FGM
  • Whether the FGM was done by someone with medical training
  • Whether antibiotic medicine]]s were used
  • Whether sterile (clean and safe) tools were used

Short-term complications[change | change source]

"Short-term complications" are problems caused by FGM soon after the FGM happened. Common short-term complications include:[25]

More serious short-term complications can cause symptoms that can kill a woman. They include:[24][26][7]

Nobody knows how many girls and women die from FGM.[27][28]

Late complications[change | change source]

Late complications happen later on after FGM is done. For example:[29][30][7][31][29]

Painful periods are common because it is very difficult for blood to get out of the tiny hole left by infibulation. Blood can fill the vagina and uterus, and stay there without moving. If the vagina gets completely blocked, the vagina and uterus can fill up completely with menstrual blood.[7] Because women with this problem do not menstruate, and blood builds up in their abdomen (making it swell), it can be confused with pregnancy.

Pregnancy and childbirth[change | change source]

FGM may increase a woman's risk of having problems during pregnancy and childbirth.[7] For example, women who had infibulations are more likely to:[7][32]

FGM also raises the risk that a woman's baby will die soon after it is born. In 2008, the WHO estimated that 10–20 babies out of every 1,000 die because their mothers had FGM. All types of FGM were found to raise babies' risk of death, which was:[33][34]

  • 15 percent higher for Type I FGM;
  • 32 percent higher for Type II; and
  • 55 percent for Type III.

Effects on mental health & sexual function[change | change source]

There is not much information about the effects of FGM on women's and girls' mental health. However, a few small studies have found that women with FGM often have anxiety, depression, and post-traumatic stress disorder.[28]

Studies on how FGM affects women's ability to have sex have also been small.[28] In total, in 2013, there had been 15 studies involving 12,671 women from seven countries. When all the information from these studies was put together, researchers found that:[35]

  • Women with FGM were twice as likely than other women to say they never felt like having sex
  • Women with FGM were 52% more likely than other women to have dyspareunia (pain during sex)
  • One third of women with FGM had less sexual feelings than before their FGM.

References[change | change source]

  1. 1.0 1.1 "Classification of female genital mutilation". The World Health Organization. 2016.
  2. Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of Change, New York: United Nations Children's Fund, July 2013 (hereafter UNICEF 2013), pp. 5, 26–27.
  3. Female Genital Mutilation/Cutting: What Might the Future Hold?, New York: UNICEF, 22 July 2014 (hereafter UNICEF 2014), pp. 3, 6.
  4. 4.0 4.1 UNICEF 2013, p. 50.
  5. UNICEF 2013, pp. 2, 26-27
  6. 6.0 6.1 6.2 6.3 UNICEF 2013, pp. 2, 44–46
  7. 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Jasmine Abdulcadira, et al, "Care of women with female genital mutilation/cutting", Swiss Medical Weekly, 6(14), January 2011. doi:10.4414/smw.2011.13137 PMID 21213149
  8. "Female genital mutilation", New York: World Health Organization, February 2014.
  9. UNICEF 2013, p. 8
  10. UNFPA–UNICEF 2012, p. 48.
  11. "67/146. Intensifying global efforts for the elimination of female genital mutilation", United Nations General Assembly, adopted 20 December 2012.
  12. WHO 2014; WHO 2008
  13. Kammerer-Doak D; Rogers RG 2008. "Female Sexual Function and Dysfunction". Obstetrics and Gynecology Clinics of North America 35 (2): 169–183. doi:10.1016/j.ogc.2008.03.006. PMID 18486835.
  14. 14.0 14.1 WHO 2014.
  15. Kelly and Hillard 2005, p. 491
  16. Abdulcadira et al. 2011.
  17. Momoh, Comfort (2005). Female Genital Mutilation. Radcliffe Publishing Ltd. p. 7. ISBN 1-85775-693-2.
  18. Kelly and Hillard 2005, p. 491
  19. Ismail 2009, p. 14.
  20. Abdalla 2007, pp. 191, 198
  21. Kelly and Hillard 2005, p. 491.
  22. WHO 2008, p. 24; UNICEF 2013, p. 7.
  23. Rigmor C. Berg, et al., "Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis", BMJ Open, 4(11), 2014: e006316. PubMed doi:10.1136/bmjopen-2014-006316
  24. 24.0 24.1 Dan Reisel, Sarah M. Creighton, "Long term health consequences of Female Genital Mutilation (FGM)", Maturitas, 80(1), January 2015 (pp. 48–51), p. 49. PubMed doi:10.1016/j.maturitas.2014.10.009
  25. Rigmor C. Berg, Vigdis Underland, "Immediate health consequences of female genital mutilation/cutting (FGM/C)", Kunnskapssenteret (Norwegian Knowledge Centre for the Health Services), systematic review no. 8, 2014, pp. 4–5 (full text). ISBN 978-82-8121-856-7
  26. Christos Iavazzo, Thalia A. Sardi, Ioannis D. Gkegkes, "Female genital mutilation and infections: a systematic review of the clinical evidence", Archives of Gynecology and Obstetrics, 287(6), June 2013, pp. 1137–1149. PubMed doi:10.1007/s00404-012-2708-5
  27. UNICEF 2005, p. 16.
  28. 28.0 28.1 28.2 Reisel and Creighton 2015, p. 50.
  29. 29.0 29.1 Kelly and Hillard 2005, pp. 491–492
  30. 30.0 30.1 Amish J. Dave, Aisha Sethi, Aldo Morrone, "Female Genital Mutilation: What Every American Dermatologist Needs to Know", Dermatologic Clinics, 29(1), January 2011, pp. 103–109. PubMed doi:10.1016/j.det.2010.09.002
  31. Hamid Rushwan, "Female genital mutilation: A tragedy for women's reproductive health", African Journal of Urology, 19(3), September 2013, pp. 130–133. doi:10.1016/j.afju.2013.03.002
  32. Rashid and Rashid 2007, p. 97.
  33. Emily Banks, et al, "Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries", The Lancet, 367(9525), 3 June 2006, pp. 1835–1841. PubMed doi:10.1016/S0140-6736(06)68805-3
  34. "New study shows female genital mutilation exposes women and babies to significant risk at childbirth", World Health Organization, 2 June 2006.
  35. Rigmor C. Berg, Eva Denison, "A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systematic Review", Health Care for Women International, 34(10), March 2013. PubMed Template:PMC doi:10.1080/07399332.2012.721417