UNIT 6.0

TOPIC - FEMALE GENITAL MUTILATION (FGM)

Instructional Materials

• White board and maker

• Projector/ Laptop

• Pictures 

• Anatomic models

Teaching methods

• Lecture 

• Discussion

• Brainstorming  

Type of Assessment

• MCQ

• Assignments

• Essay 

Learning Objectives: At the end of the lesson, learners will be able to

• Define Female Genital Cutting/Mutilation (FGC/M)

• Identify the types of FGC/M

• List the complications of FGC/M

• State the Strategy for Eradication of  FGC/M

• Identify the reasons for the practice of FGC/M

• Identify other harmful practices

6.0 Introduction

It is also called female circumcision or female genital cutting, surgical alteration or modification. It is typically carried out on girls from a few days old to puberty and occasionally adult women. It may take place in a hospital, but is usually performed without anesthesia by a traditional circumciser using a knife, razor or scissors. According to WHO, it is practiced in 28 Countries in Western, Eastern and Northern Africa, and some part of the Middle East and Asia. In Africa about 3 million girls are at risk for FGM annually.

6.1 Definition

It is defined as all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non- medical reasons (WHO, 1991).

6.2 Classification and Types of FGC/M

1. TYPE I (clitoridectomy): It is the removal of the clitoral hood or total removal of clitoris itself. When only the clitoral hood is removed, it is referred to as the Sunni circumcision.

2. TYPE II (Excision): - It is the partial or total removal of the clitoris and labia minora with or without excision of the labia majora.

3. TYPE III (Infibulations): - It is the removal of all part of the labia minora and majora and usually the clitoris and the fusion of the wound leaving a small hole for the passage of urine and menstrual flow. The wound is opened for intercourse and child birth. The area is stitch up and child legs are bound for up to 40 days. It is also referred to as the pharaonic circumcision. 

A reserve infibulations can be performed to allow for sexual intercourse or when undergoing labour.

4. TYPE IV (Others): It range from a symbolic pricking or piercing of the clitoris or labia, to cauterization (burning of the tissue) of the clitoris, cutting into the vagina to widen it (gishiri cutting) and introducing corrosive substance to tighten it. It involve all other harmful procedures to the female genital not necessarily tissue removal. Nicking the clitoris is a form of type IV practiced in Indonesia

• 85% 0f Women who experienced FGM, experiences, Type I and II. While

• 15% experience Type III. (This is commonly practiced in Sudan, Somalia and Djibouti)

6.3 Consequences or Complications of FGC/M

1. Severe pain

2. Shock

3. Hemorrhage

4. Infection like Tetanus or Sepsis

5. Urine retention.

6. Open sores in the genital region

7. Injury to nearby genital tissue.

8. Dysperunia.

9. Genital lacerations during birth.

6.3.1 Long Time Consequences

10. Recurrent bladder and urinary tracts infections

11. Cysts.

12.  Infertility

13.  Increased risk of childbirth complications and new born deaths e.g. obstructed labour leading to VVF or RVF.

14. Scarring and keloid formation.

15.  The need for later surgeries e.g. in type III, the procedures that seals or tighten the vaginal orifice needs to be cut open for sex or childbirth. Sometimes it is sutured back after childbirth and so on and on.

6.4 Strategy for Eradication of FGC/M

The cause of FGM includes a mixture of cultural, religious and social factors within families and communities, thus the eradication of FGM is dependent upon handling these factors;

1. Advocacy to traditional and religious leaders for full involvement toward eradication.

2. Health education to communities practicing FGM, to enlighten the consequence to the reproductive health of women.

3. The involvement of health workers in counseling and treatment of women who have undergone the procedures.

4. Involvement of political leaders and CBO/NGO’s in the fight against FGM.

5. Enacting laws that rule against FGM practice in the Countries where they are practiced.

 6.5 Causes/Reasons for FGC/M

1. Traditional/cultural practice:-

• FGM is a social convention in some areas, hence the social pressure to confirm to what others do and have been doing for long.

• In some societies, FGM is practiced as a result of burying a neighboring cultural practice. 

• In some societies FGM is considered a cultural traditions, hence a practice to be preserved.

2. Initiation rite into adulthood: - It is often considered a Necessary part of raising a girl properly and a way of preparing her for adulthood and marriage.

3. Prevent promiscuity and safeguard virginity:- 

• It is practiced to preserve proper sexual behavior in girls, by preserving virginity and marital fidelity e.g. in type III, the pain of opening it and the fear that this will be found out discourage any sexual act before marriage.

• Unmodified clitoris can lead to masturbation and lesbianism.

• Intact clitoris affects general sexual arousal and older men may not satisfy their wives during intercourse which may lead to infidelity.

4. Attenuate sexual desire: - It is believed to reduce a woman’s libido, hence reducing the chance of sex before marriage, thereby preserving the family honor.

5. Purification:-

• FGM is associated with cultural ideals of feminity and modesty, which includes the idea that girls are “clean and beautiful” after removal of body parts that are considered male or unclean. The clitoris and labias are considered as parts of a male on a female.

• Bad genital odors can only be eliminated by removing the clitoris and labia minora.

6. Though no religious script prescribe it, some people often believed that it has religious support. Religious leaders have different positions with regards to FGM practice.

7. In some societies it is believed that if the clitoris touches the penis, the man will die likewise during childbirth, if it touches the baby’s head it will die.