Female genital mutilation (FGM) is a procedure involving the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons. This practice is a global issue, affecting millions of girls and women worldwide. This article provides factual information on the methods and context of how FGM is performed, along with its immediate risks.
Understanding Female Genital Mutilation
Female genital mutilation is internationally recognized as a violation of human rights. The World Health Organization (WHO) classifies FGM into four main types, which helps categorize the varying degrees of the procedure.
Type I, known as clitoridectomy, involves the partial or total removal of the clitoral glans and/or the prepuce, which is the clitoral hood. Type II, or excision, includes the partial or total removal of the clitoral glans and the labia minora, with or without the removal of the labia majora. Type III, referred to as infibulation, is the narrowing of the vaginal opening through the creation of a covering seal. This seal is formed by cutting and repositioning the labia minora or labia majora. Finally, Type IV encompasses all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping, or cauterizing the genital area.
The Procedures: Methods of Performance
The performance of Female Genital Mutilation involves specific anatomical alterations depending on the type. Type I, or clitoridectomy, involves the removal of only the clitoral hood, also known as the prepuce, or the partial or total removal of the clitoral glans itself. The clitoral glans is the external, visible part of the clitoris.
Type II, known as excision, involves more extensive tissue removal. This procedure includes the partial or total removal of the clitoral glans and the labia minora, which are the inner folds of the vulva. In some instances, the labia majora, the outer folds of skin, may also be partially or totally removed during this procedure.
Type III, or infibulation, is a more severe form that narrows the vaginal opening by creating a covering seal. This is achieved by cutting and repositioning the labia minora and/or the labia majora. The cut edges are then stitched together, or held in apposition, to form a seal, leaving only a small opening for the passage of urine and menstrual blood. This process may or may not include the removal of the clitoral glans or prepuce.
Type IV procedures encompass a range of other harmful interventions that do not fit into the first three categories. These can involve actions like pricking, piercing, or incising the clitoris and/or labia. Other methods include scraping the vaginal orifice, cutting the vagina, or cauterizing the genital area. Some practices categorized under Type IV also involve introducing corrosive substances or herbs into the vagina to induce bleeding or to tighten and narrow it.
Context of the Practice
Female genital mutilation is predominantly performed by traditional circumcisers, who are often older women within the community, or by traditional birth attendants. However, a concerning trend shows an increasing number of procedures being carried out by health workers, including doctors, nurses, and midwives. This “medicalization” of FGM occurs despite strong opposition from organizations like the WHO, which emphasizes that even medically performed FGM still lacks health benefits and violates human rights.
The tools used for FGM are typically unsterile and rudimentary, contributing to significant risks. Common instruments include razor blades, knives, scissors, pieces of glass, or even sharpened stones. These tools are often not sterilized between procedures, increasing the risk of infection. In some practices, a single instrument may be used on multiple girls.
Procedures are usually conducted in non-medical and unhygienic environments, such as homes, rather than clinical settings. Anesthesia is generally not administered, and antiseptic precautions are typically absent. The age at which FGM is performed varies, but it is most commonly carried out on young girls between infancy and 15 years of age. In some regions, procedures occur days after birth, while in others, they might take place during childhood, adolescence, or even around the time of marriage or first pregnancy.
Immediate Risks During the Procedure
The performance of female genital mutilation carries severe immediate risks that manifest during or directly following the procedure. Girls experience intense pain, as the majority of these procedures are performed without anesthesia. Even if local anesthesia is used, multiple injections are often required, adding to the distress.
Excessive bleeding, or hemorrhage, is a frequent and serious complication, sometimes leading to life-threatening blood loss. Cutting across blood vessels, particularly the clitoral artery, can result in significant bleeding that is difficult to control. The combination of severe pain, fear, and blood loss can induce shock, which can be fatal.
Acute infections are common due to the unsterile tools and unhygienic environments. These can range from localized wound infections to more systemic conditions like tetanus or sepsis, which can be life-threatening. Injury to adjacent tissues, such as the urethra, bladder, or rectum, can occur due to the crude instruments used and the struggles of the girl during the procedure. Additionally, urinary retention, an inability to pass urine, is a common immediate consequence, often caused by pain, swelling, or injury to the urethra.