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Female Genital Mutilation

Introduction

The partial/complete removal or alteration of female genital organs for non- medical reasons is referred to as Female genital mutilation (FGM). This practice is usually associated with traditional and societal norms in Africa,the Middle East and South East Asia. It is predominantly carried out on young girls under the age of 15. FGM is illegal in most of the countries where it is prevalent and has been declared a human rights violation by the UN.

Risk factors

FGM is mostly carried out on prepubescent girls but has also been seen in infants and adult women. While most affected women live in Africa as well as parts of the Middle East and Asia, FGM is also seen in developed countries among migrants associated with these countries. Therefore, patients most at risk of FGM are those belonging to communities where FGM is prevalent. A patient with a family member already having undergone FGM is also considered high risk.

Cause

A mix of cultural, social and religious factors underlies the reasons behind FGM.

In certain countries, FGM is considered to be a form of social convention that is culturally acceptable and that needs to be followed by women under the threat of social exclusion. For this reason, it is not unusual for FGM practices to be supported by women.

Patriarchal notions regarding female sexuality such as preservation of virginity and low female libido also motivate FGM practices.

In many cultures, FGM is thought to enhance male sexual pleasure.

While most religious texts do not advocate FGM, it is not uncommon for communities to believe that FGM has religious sanction because of the focus on female chastity and purity by most religions.

Classification:

There are four types of FGM classified on the basis of the genital tissue excised.

  1. Type 1 is aclitoridectomy, which can involve removing all or part of the clitoris.
  2. Type 2 involves excision of the inner labia along with all or part of the clitoris.
  3. Type 3 istermed infibulation where the external genitalia are removed. Thereafter, the labia are cut and sewed together leaving an opening for the release of urine and menstrual blood. The scar is then opened during sexual intercourse with a knife or by penile penetration.
  4. Type 4 covers all other uncategorized procedures such as pricking, piercing, scraping, cutting and burning, which can cause harm to female genitalia.

 

Clinical presentation

FGM has no known health benefits. In most cases it is carried out by women with no medical training in an unsterile environment using knives, scissors and blades with no anesthetic administration. It is associated with harmful short and long-term effects.

Immediate complications include hemorrhage, anemia, tetanus, sepsis, urine retention,urinary infection, open sores in the genital region, injury to nearby genital areas, gangrene, severe pain and shock.

Long-term effects include infertility, recurrent urinary and bladder infections, cysts, painful menstruation, complications during pregnancy, newborn deaths, painful sexual intercourse, lack of pleasure during sex and blood-borne viral infections such as HIV and hepatitis. In addition, there may be a need for later surgical procedures to widen the vaginal opening for sexual intercourse and childbirth.

FGM patients can also suffer from psychological consequences such as posttraumatic stress disorder (PTSD), lower libido, depression, anxiety and feelings of shame.

Treatment

Treatment for FGM includes a two-pronged approach.

Firstly, medical help for the patient needs to be provided to tackle physicalhealth complications from FGM such as vaginal infections, inflammatory reactions, bleeding and urinary infections. Specialist clinics are also capable of partially reversing type 3 FGM through a process called de-infibulation. This involves opening of the vaginal scar and stitching of the skin on either side and is done under local anesthesia. Innovative clitoral restoration surgeries can also have a profound impact on the lives of FGM patients.

Secondly, counseling of FGM patients by experienced psychologists can help them to manage their lives better, achieve sexual satisfaction and deal with other associated emotional and mental issues.

Prevention

Raising awareness in communities where FGM is prevalent is the need of the hour. This can be done through education of young men and women as well as community elders.Training school teachers and counselors who regularly interact with young girls can help them to identify those at risk of FGM.

It is also important to help women understand the health complications caused by FGM, so as to try and lessen support for it.

While FGM is a crime in most countries, it is rarely prosecuted. The police, health care professionals and social workers will need to work together to successfully identify and prosecute those involved in this practice.

Accurate reporting of FGM incidents by hospitals and clinics will help track and monitor cases of mutilations and possibly prevent further instances within families.

Since FGM has deep-rooted cultural and traditional roots, tackling the problem will require that all parties including doctors, nurses, social workers and law enforcement professionals are also provided with cultural sensitivity training. This is especially important in migrant communities in developed nations and can help prevent feelings of alienation and resentment.