She went first. All four of us went through it on the same day. I was given a 'Sunna' circumcision, which meant skin was cut from around my clitoris, and the tip of my clitoris was removed. It's widely practised in the Somali region of Ethiopia where I come from and was done in a medical centre.
It took three days to heal and I felt a lot of pain. My friends however, were given infibulation, which is the most severe form of FGM — which means the girl's vagina is cut and sewn up, to leave a tiny gap. They said it was agonising. With this method, the pain lasts throughout a girl's life — when they have a period, when they have sex and when they give birth. When a girl has experienced infibulation, the stitches are opened up just before the marriage — sometimes by the husband.
My friend was taken to hospital just before she was married to unstitch her there. It's incredibly painful. I'm in school now and run a club there — and on weekends too. The victims are usually approached in the health sector and by authorities in an inadequate way, ignorance prevails. FGM is in hardly any European country a regular part of the vocational training of doctors, midwives and social workers.
Female genital mutilation has serious health physical and mental! In addition to the psychological trauma and the loss of sexual sensation, the victims often complain of long-term pain when urinating and during menstruation.
Sitting or even walking can bruise and even re-open the scar tissue due to the constant rubbing of clothing. Cysts, abscesses, bladder infections and incontinence may occur. Infertility is one of the possible long-term consequences.
Sexual intercourse is often painful. Giving birth to a child can increase bleeding and tissue cracks. The birth may take longer than usual and caesarean sections are common. An estimated 55 million girls under the age of 15 in 28 African countries have experienced or are at risk of experiencing FGM, which remains prevalent in parts of West, East, Central, and Northern Africa. This, despite the fact that laws against FGM are most common in the African continent where 28 countries have specific anti-FGM laws or legal provisions.
The move to end FGM in Africa has over the years gained traction on the continent with state and non-state actors at the international, regional, and national levels coalescing around actions designed to address this harmful practice.
The World Health Organization WHO classifies the mutilation of the female genital into four distinct categories [ 5 ]. Three of the four categories are further broken down into subcategories that classify the specific type of mutilation that was performed. Type Ia is the removal of the clitoris hood or prepuce only while Type Ib includes the removal of both the clitoris and the prepuce [ 6 ]. Type II, or excision, is the partial or total removal of the labia minora unrelated to any mutilation performed on the labia majora.
Type IIa includes the removal of the labia minora only. Type IIb is the removal of the labia minora and the partial or total removal of the clitoris [ 6 ]. Type IIc involves the removal or the clitoris, labia minora, and labia majora. Infibulation, or Type III, is the third category of mutilation procedures defined as the narrowing of the vaginal orifice with the sealing of the perineum by cutting and repositioning the labia minora and labia majora with or without the excision of the clitoris.
Type IIIa references specifically procedures done with the removal and apposition of the labia minora, while Type IIIb includes procedures done with only the labia majora [ 6 ].
Type IV is a broad category that includes all other harmful procedures done without medical purpose to the female genitals. Female circumcision is practiced in many regions throughout Africa, Asia, and the Middle East. However, the highest prevalence rates are found within the Horn of Africa, the region containing the countries of Djibouti, Eritrea, Ethiopia, and Somalia [ 21 ].
Worldwide, it is estimated that more than million women have been cut and approximately 6, girls are circumcised every day [ 23 ]. More than 3 million girls are at risk for circumcision on the continent of Africa [ 21 ]. The prevalence trends have shown mixed results over the past two decades with little, if any, decline [ 25 ].
Figure 1 displays data collected by the Population Reference Bureau PBR in which varied trends are seen for the years , , and [ 25 ]. In some instances, prevalence rates have dropped only to return to their previous levels. Although intervention programs have been introduced in Africa, Egypt, and much of Asia, the prevalence rates have not been significantly lowered [ 25 ].
Several countries, specifically the ones with more stabilized governments who have taken stances against mutilation, have begun to see a slight decline with the younger population indicating a possibility of eradication.
As most girls undergo mutilation between the ages of 6 and 12, looking at the prevalence of girls currently aged between 15 and 19 and comparing them to those of women aged between 45 and 49 allow us to see a declining trend taking hold in some countries.
Figure 2 compares trends of both age groups with substantial differences [ 25 ]. This indicates a preliminary decline in the circumcision in younger women in these countries. The consequences of FGM have both physiological and psychological complications [ 26 ], including short- and long-term complications [ 26 ].
The method in which the procedure is performed may determine the extent of the short-term complications [ 13 ]. If the process was completed using unsterile equipment, no antiseptics, and no antibiotics, the victim may have increased risk of complications. Primary infections include staphylococcus infections, urinary tract infections, excessive and uncontrollable pain, and hemorrhaging [ 27 ]. Infections such as human immunodeficiency virus HIV , Chlamydia trachomatis , Clostridium tetani , herpes simplex virus HSV 2 are significantly more common among women who underwent Type 3 mutilation compared with other categories [ 27 ].
As the short-term complications manifest, mortality risk increases because of the limited health care available in low-income economies. While data on the mortality of girls who underwent FGM are unknown and hard to procure, it is estimated that 1 in every circumcisions results in death [ 21 ].
The belief that the procedure produces protective factors against sexually transmitted infections STIs , much like male circumcision, was disproved in a case-control study conducted in Sudan [ 27 ]. After the area heals, victims suffer the long-term consequences of the abuse through both physiological and psychological complications and substantial complications during childbirth [ 28 , 29 ].
One of the most common long-term complications is the development of keloid scar tissue over the area that has been cut [ 30 ]. This disfiguring scar can be a source of anxiety and shame to the women who had FGM [ 30 ]. Neuromas may develop because of entrapped nerves within the scar leading to severe pain especially during intercourse [ 31 ].
First sexual intercourse can only take place after gradual and painful dilation of the opening left after mutilation. Other side complications include cysts, haematocolpos, dysuria and recurrent urinary infections, and possible infertility [ 31 ]. Childbirth for infibulated women presents the greatest challenge, as maternal mortality rates are significantly higher because of complications that arise during labor.
During delivery, infibulated women i. Posttraumatic stress disorder PTSD , anxiety, depression, neuroses, and psychoses are common delayed complications that are associated with FGM [ 32 — 34 ]. In developing countries, these conditions regularly go unrecognized and if left untreated, may lead to mental concerns later in life.
The implications of FGM include both psychological and social factors. Prior literature reported the association between female circumcision and maternal morbidity and birth outcomes [ 26 ]. Studies have shown maternal prolonged maternal hospitalization, low birth weight, prolonged labor, obstructed labor, and increased frequency of cesarean sections as outcome variables in order to determine the consequences of FGM.
These outcomes coincide with the existing literature that depicts the relationship between FGM and a host of negative health effects including obstetrical, gynecological, and fetal sequelae [ 26 ]. Nevertheless, several limitations exist within the study may explain large confidence intervals and insignificant results in the outcomes analyzed. The inclusion criterion for FGM patients was very broad and included any marking or change that was performed on the female genital organs.
This allowed confounding variables such as self-impairment that had no impact on the vaginal orifice i. Moreover, patients with FGM were given preferential treatment i. In addition to the obstetrical, gynecological, and neonatal impacts of FGM, other long-term health consequences include psychological and psychosexual disorders.
The questionnaire captured the sociodemographic aspects of respondents and included an array of questions regarding the practice, belief, and eradication of FGM [ 35 ]. Additionally, Christianity The most common perception on the commonality and acceptance of circumcision was cultural significance Furthermore, respondents indicated that the reduction of female sexuality Only 7. In addition,
0コメント