Does female genital mutilation have any health benefits?

by Curswell Tshihwela

Female circumcision has always been seen as an inappropriate ritual or law by many cultures compared to male circumcision. This practice of partially or totally removing the external genitalia of girls and young women for nonmedical reasons is regarded as an important stage that forms part of traditional practices or rituals in some cultures. However, it is illegal in many countries. The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths.

FGM ( Female Genital Mutilation ) is recognised internationally as a violation of the human rights of girls and women. It reflects how deeply-rooted inequality between the two sexes is, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors who are undergoing puberty stage 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. The procedures differ according to the country or ethnic group. They include removal of the clitoral hood and clitoral glans; removal of the inner labia; and removal of the inner and outer labia and closure of the vulva. The practice is rooted in gender inequality, attempts to control women’s sexuality, and ideas about purity, modesty, and beauty.

It is usually initiated and carried out by women, who see it as a source of honor and fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion. The harmful health effects depend on the type of procedure; they can include recurrent infections, difficulty urinating and passing menstrual flow, chronic pain, the development of cysts, an inability to get pregnant, complications during childbirth, and fatal bleeding. Female genital mutilation is classified in four types and these procedures are generally performed by a traditional circumciser (cutter) in the girls’ homes, with or without any anesthesia. The cutter is usually an older woman, but in communities where the male barber has assumed the role of health worker, he will also perform FGM. When traditional cutters are involved, non-sterile devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks and fingernails to multiple individuals.

According to a nurse in Uganda, quoted in 2007 in The Lancet, a cutter would use one knife on up to 30 girls at a time. Health professionals are often involved in Egypt, Kenya, Indonesia, and Sudan. In Egypt, 77 percent of FGM procedures, and in Indonesia over 50 percent, were performed by medical professionals as of 2008 and 2016. Women in Egypt reported in 1995 that a local anesthetic had been used on their daughters in 60 percent of cases, a general anesthetic in 13 percent, and neither in 25 percent (two percent were missing/don’t know).

Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).

Type 3: Often referred to 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 clitoris (clitoridectomy).

Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area. FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue. It interferes with the natural functions of girls and women’s bodies which leads to immediate complications such as, severe pain, excessive bleeding (hemorrhage), genital tissue swelling, fever-infections e.g., urinary problems, wound healing problems, injury to surrounding genital tissue, shock, death and long term consequences such as, (discharge, itching, bacterial vaginosis and other infections); menstrual problems including 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 FGM procedure that seals or narrows a vaginal opening (type 3) needs to be cut open later to allow for sexual intercourse and childbirth.

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.) These procedures are 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.
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.

The practice is most common 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. Since 1997, great efforts have been made to counteract FGM, through research, work within communities, and changes in public policy. Progress at international, national and sub-national levels includes: wider international involvement to stop FGM; international monitoring bodies and resolutions that condemn the practice; revised legal frameworks and growing political support to end FGM (this includes a law against FGM in 26 countries in Africa and the Middle East, as well as in 33 other countries with migrant populations from FGM practicing countries); the prevalence of FGM has decreased in most countries and an increasing number of women and men in practicing communities support ending its practice.

Research shows that, if practicing communities themselves decide to abandon FGM, the practice can be eliminated very rapidly. WHO (World Health Organization) put efforts to eliminate female genital mutilation that focus mostly on strengthening the health sector response, guidelines, tools, training, and policy to ensure that health professionals can provide medical care and counseling to girls-
and women living with FGM, building evidence, generating knowledge about the causes and consequences of the practice, including why health care professionals carry out procedures, how to eliminate it, and how to care for those who have experienced FGM; increasing advocacy: developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation.

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