Written By: Dr Victor Ayodeji Omolona | Gynecology and Obstetrics, LUTH, Lagos
Female genital mutilation (FGM) is globally recognised as a violation of the human rights of girls and women. Female genital mutilation comprises all surgical procedures involving partial or total removal of the external genitalia or other injuries to the female genital organs for cultural or other non-therapeutic reasons.
FGM is also referred to as ‘female genital cutting’ or ‘female circumcision’ or ‘circumcision of girls’.
FGM has been categorised into four types by the World Health Organization.
Type 1
Excision/cutting away of the prepuce (the fold of skin above the clitoris) with or without excision of part or the entire clitoris. This is referred to as ‘sunna’.
Type 2
Excision of the prepuce and clitoris together with partial or total excision the labia minora (the inner lip of the female genital).
Type 3
Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening. This is referred to as infibulation or ‘Pharaonic circumcision’.
Type 4
Unclassified: This includes pricking, piercing or incision of the clitoris and /or labial cauterization by burning of the clitoris and surrounding tissue; scraping of tissues surrounding the vagina orifice or cutting of the interior and sometimes posterior vaginal wall(gishiri cuts); introduction of corrosive substances into the vagina wall to cause bleeding, or herbs into the vagina to tighten or narrow it; and any other procedure that falls under the definition of FGM given above.
It should be noted that female genital cutting or FGM is irreversible and its effects last a lifetime.
According to World Health Organization statistics, 100-140 million girls and women worldwide are living with the consequences of FGM. Approximately 3.3 million girls are at risk of FGM every year. FGM is practised in 27 African countries with national prevalence among women aged 15years and older ranging between 0.6% -97.9%.
The practise of FGM is widespread in Nigeria and varies from one cultural setting to another. It is carried out at infancy, or at childhood as a rite of passage to adulthood. FGM practise is founded in traditional beliefs and societal pressure to conform. It is carried out based on beliefs that it attenuates sexual desire in the female; for identification with cultural heritage; maintenance of social cohesion and social acceptance; hygiene and aesthetics as some culture believe the external female genital is unclean and unsightly and perception that it enhances fertility and helps delivery of babies. There has been no scientific evidence or backing to justify these erroneous beliefs and perception.
FGM has no health benefits. Health consequences of FGM can be immediate or long-term. It has serious implications on the reproductive, physical and emotional health of girls and women. Immediate health consequences include severe pain, injury to adjacent structures- urethra, vagina, rectum and the perineum. Others include heavy bleeding, shock, acute urinary retention, fracture or dislocation due to restraints, failure to heal, risk of contracting infections such as HIV and Hepatitis B and ultimately death. Long term consequences include difficulty in passing urine, recurrent urinary tract infection, difficulty in menstruation, fistula formation (vesicovaginal fistula or rectovaginal fistula), painful intercourse, infertility, problems in vaginal birth.
The eradication of FGM calls for urgent attention due to increased susceptibility to HIV/AIDS as the use of an infected instrument in the operation could be an important mode of transmission. FGM often get done for many women at the same time, with same instruments that are unsterilized which is a great risk for HIV/ Hepatitis B and C transmission. The risks are evidenced from the fact that the operation is mainly carried out by practitioners of traditional medicine and by traditional birth attendants using unsanitary knives and other instruments in generally unhygienic conditions. The transmission of these viral diseases (HIV1 &2 / Hepatitis B/Hepatitis C) is an obvious danger alongside the usual gynaecological and psychological problems associated with the practice. The multiple risks associated with FGM are compounded in the case of infibulations by the need to cut open the infibulated area for childbirth (vaginal delivery) resulting in infection and heavy bleeding during childbirth.
FGM is an infringement on the physical and psychosexual integrity of women and girls. It is discriminatory and violates the rights to equal opportunities in life, the right to the highest attainable standard of health, the right to make decisions concerning reproduction, the right to be protected from traditional practices prejudicial to women’s and children health.
Female genital mutilation can be eliminated or attenuated to the least by enacting legislative provisions and stern measures to prohibit the practice; development of alternative sources of income for the traditional practitioners involved in circumcision; and strong advocacy campaigns against the practice which include engaging major stakeholders in the community, use of the mass media on information, education and communication campaigns that have an impact on the public understanding of and societal attitudes to FGM.
Say NO TO FGM anywhere it is practised among our people. It is crude, dangerous and wicked. FGM is not required by any religion and there is no scientific evidence that women who have had genital cutting/mutilation are more faithful or better wives than those who have not. It is absolutely evident that there is no single derivable benefit from female circumcision.