FGM/C (female gender mutilation/cutting) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. It compromises all procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.
The procedure has no health benefits to women or girls, on the contrary it has many consequences. It is a direct violation of human rights- both sexual and reproductive rights. It can be traced back to the pharaonic era in ancient Egypt and also in certain ethnic groups in sub-Saharan Africa.
There are 4 types of FGM/C.
• Type 1- excision of the clitoris or the prepuce with or without excision of part or all of the clitoris (in Sudan and Arabian countries it represents religious backgrounds and beliefs)
• Type 2- excision of the clitoris with partial or total excision of the labia minora
• Type 3- excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation; the colloquial name is pharaonic type)
• Type 4- includes pricking, piercing or incision of the clitoris and/or labia; cauterisation by burning of the clitoris and surrounding tissues; scraping of the vaginal orifice (anguyrya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding, into the vagina or for the purposes of tightening or narrowing it; and any other procedure that falls under the definition of FGM given above.
The practice is mostly carried out by traditional circumcisers who often play other central roles in communities, such as attending child births. In many settings health care providers perform FGM due to erroneous belief that the procedure is safer when medicalised. Midwives and the elderly in the family may also perform the FGM.
The age FGM is performed depends on the ethnic and geographical distribution. The age is flexible within the communities, either because it is not tied to any particular ceremony, or because people’s belief in its ceremonial significance has died away. The procedure may be carried out on infant girls, during childhood or adolescence, at the time of marriage (preparing for the marriage), at a woman’s first pregnancy, or even whilst in labour (this is a form of fixing the woman and making the vaginal opening as small as it used to be).
Such an extensive procedure involves many complications and risks that are not only medical but psychological too. Severe pain is inflicted due to the operation being performed with crude instruments and without anaesthetic and many women writhe in pain and this can bring injury to the adjacent parts such as the vagina, tissue of urethra, perineum, rectum and some obtain broken limbs from being held down. These complications can also be due to the operator being ignorant in anatomy and physiology of the female external genitalia, has poor eyesight or a careless technique (no prior education in surgery) or just because the operation was done in poor light. Infection is also very common because of an unhygienic non-sterile operating environment which can cause it to fail to heal. Rupture of urethra can result in incontinence. Acute urine retention is another complication and so are keloids scars (shown in picture below), obstructed labour, infertility, shock due to haemorrhage (because of sudden loss of blood) and neurogenic shock due to severe pain and trauma. The women may also experience apareunia (impossibility of sexual intercourse), superficial dyspareunia (pain during intercourse), sexual dysfunction, anorgasmia (lack or orgasms), post-traumatic stress disorder (PTSD), obstructed mensuration, insecurity and trust violation by closest family, relatives and peers.
FGM is such a horrendous act that you are probably asking yourself, why? Why would anyone do that to themselves or to another human being? There are many reasons for this vile act. Some cultures do so as a means of controlling women’s sexuality and to ensure virginity until marriage and fidelity in marriage (women who have had FGM don’t enjoy sex so they won’t have multiple sexual partners). But is this not counter intuitive? Sex is described as one of the basic needs together with water, shelter and food and in essence they are associating it with something not pleasurable. So in short they have turned water into gasoline and are now depriving women of their needs. Some men say that the FGM increases sexual pleasure for them and hence they request for their brides to undergo FGM before they are married. FGM also makes girls more acceptable in certain communities and increases their eligibility for marriage and can also be used as a traditional rite of passage into adulthood (this rite is often surrounded by various myths). FGM is associated with notions of being “feminine,” “modest,” “clean” and/or “beautiful” and these are things many females strive to be as the tradition brings honour to the family. Some types of FGM are done when one is sick to cure them e.g. if one has mass on the vaginal opening such as a cancer or any chronic disease which they have never come across or don’t know how to treat FGM is performed to remove the mass and the women is “cured” from the unknown disease. There is also FGM for the afterlife- it is done on the dead body of the female so that they are considered new again and ready for their next life. It is also believed that an unmodified clitoris leads to masturbation and lesbianism which is unacceptable behaviour.
The real reason is power and control over women and this instils fear. This is why it is mostly concentrated in patriarchal societies where fear is confused for respect. In such patriarchal societies women have little or no say and do not voice their opinions which is a demoralisation of integrity and a robbing of personality. Although it is illegal it is a social norm, a tradition, a culture that’s deeply rooted in the communities and the pressure keeps this mal-practice on going. Women are not at liberty to speak about their sex life and hence whether it is enjoyable or even durable is not a concern. Lack of sexual pleasure is a norm- even the wise elderly women who the women consult have never had such experiences hence the women do not know what they are losing or that they are they are losing anything at all. Women in such communities are also afraid of being alone and divorced if they do not consent to the procedure. There is a stigma of being unclean if the procedure is not done and this serves as a platform for bullying for girls at school hence they would rather have the procedure than endure the bullying. Some women go as far as asking for the procedure again after traumatic child births that may “undo” the procedure.
Hence empowering women and educating them is paramount. The elimination of FGM cannot be done overnight but is instead a painstakingly long process that requires long term commitment and the laying of a strong foundation that will support successful behaviour change. A hands-on approach of working in the community and also embracing the emotional aspects of it is needed- FGM is dressed to be the key to beauty and honour (things which women strive for) and hence by this virtue make the harmful procedure “appealing” to women. Fighting against FGM will require strong and capable anti-FGM programmes at national, regional and local levels. FGM prevention should be integrated into all relevant government programmes and health care workers should be trained to manage the complications of it whilst advocating for the practice to be stopped. Continuous campaigns are in order because they are convinced the procedure is right and has many benefits. Playing on the physical and traumatic harm towards women and girls is a starting block in eliminating such practices. Education shouldn’t only be targeted at the women but at the men too- maybe if they don’t find it attractive women may not feel pressured into it. The practice is very embedded in the culture and social norms and sadly women do not know their rights.
Remember that FGM is stealing the sexual rights of a woman (women’s genitals are cut off unnecessarily like rags), while male circumcision is for medical reasons. This is why we all need to advocate and raise awareness, to empower women and change the society’s mentality!
Chipo a medical student at the University of Zimbabwe. She is a member of the Zimbabwe Medical Students’ Association (ZiMSA).health
