WHAT IS FGM?

Female Genital Mutilation is basically physically altering the external female organ: the labia majora, the labia minora, the clitoris and the prepuce, urethra, vaginal opening and the perinum. Each of these organs are very sensitive to touch and protect the internal reproductive organs. The labia majora (the big or outer lip) is thick fatty folds of fleshy tissue covering and protecting softer and delicate tissue of the inner lip, the labia minora, which in turn protects and covers the urine tube and the vaginal opening. The clitoris is an organ covered with foreskin (prepuce) and supplied blood vessels and nerves and is very sensitive. The vaginal opening and the urethra are openings leading to the womb and the urinary bludder respectively. The perinum is the stretchable skin between the anus and the genitalia.

The World Health Organization defines FGM as follows:
“Female genital mutilation constitutes all procedures which involve partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or any other non-therapeutic reasons”. (WHO 1996)

Another definition given by the Inter-African Committee is “Female genital mutilation designates the fact of meddling with body integrity and with normal functioning of female genital organs mainly, by total or partial cutting, excision, infibulation or by other means.” (IAC 1999)

The term FGM covers many varieties of genital mutilation. The various mutilations consist of the removal of the external and sometime internal, female sexual organs varying from an incision in the foreskin of the clitoris, up to and including the total amputation of the clitoris with the accompanying skin and the labia majora (Smith 1995). The main classification of this ritual include:

  1. Type I.
    Circumcision (also known among the Moslems as ‘Sunna’ meaning tradition). This type of excision consists of cutting of the clitoral prepuce (foreskin) and or the tip of the clitoris. Relatively, this is the mildest form of genital mutilation.

  2. Type II.
    Excision also referred to as clitoridectomy is the removal of the entire clitoris and of all or part of the adjacent labia minora (small lips). The amount of flesh removed depends on local customs and experience of operators.

  3. Type III.
    Infibulation also referred to as Pharaonic circumcision (in some instances as Sudanese Circumcision).

    This is the most extreme form of genital mutilation. Infibulation consists of the removal of the clitoris, labia majora and labia minora. After the removal of these parts, the scraped sides (the two labias) of the vulva are then sewed together with thorns, silk or cutgut sutures to form a closure of the whole vulva region including the vaginal and urinary openings. A small opening is left for the flow of urine and menustral blood. Infibulated women have to be cut open to allow intercourse and more cut for child delivery. The girls legs are bound together from thigh to ankle for several weeks to help form scar tissues over the wound.

  4. Type IV.
    The fourth classification is “intermediate”. This consists of the cutting of the clitoris and labia minora and also stitiching of the labia majora after cutting. In some cases the clitoris and the labia minora are cut away and stitched to each other (Smith 1995).

    WHO refers to this classification as “unclassified” (WHO 1996). This includes: piercing or incision of clitoris and/or labia; cauterzation by burning of clitoris and surrounding tissues; scraping (angurya cuts) of the vaginal orifice or cutting (gishiri cuts) of the vagina; introduction of corrosive substances into the vagina to cause bleeding or herbs into the vagina with the aim of tightening or narrowing the vagina.

Toubia defines intermediate circumcision as more severe than clitordectomy and only slightly less damaging than infibulation. This is practised where infibulation is banned and/or its health impact condemned (Toubia 1993).

Circumcision (Type I) and excision (Type II) are the most common forms of genital mutilation and accounts for nearly 85% of all the cases (Toubia 1993, WHO 1996). Infibulation, the most extreme form of FGM causing the worst damage accounts for nearly 15% of the cases and is mainly practised on all females in all of Somalia and Somalians living in neighbouring countries (and abroad?), 80% to 90% in Sudan and Egypt. It is also practised on a smaller scale in parts of Ethiopia and Eritrea along the Red Sea Coast, Mali and Gambia (WHO 1996; Toubia 1993).

Procedure

The operation is usually performed by old women or traditional birth attendants, also known as cirumcisers or excisors. They are mostly women except in some places such as Nigeria where barbers do the operation. Mothers never circumcise their own daughters but assist the excisors by holding the hand or feet of their daughter. Men are rarely present at the operation of their daughters.

The circumcisers use special knives, scissors, razor blades, kitchen knives or pieces of glass for the operation. For example, a survey of 300 women in western Sierra Leone showed that in 81 of the cases razor blades were used, traditional knives in 166, surgical scalpel 6, broken bottles 4, and others 12 (Statistical Record of women worldwide). In most cases anaesthetics and antiseptics are generally not used. Physical force is used when necessary to control a struggling girl during the operation which in most cases will make the operator miss the target and cut also the surrounding parts of the clitoris. The operations are done under unhygenic condition with the instrument of operation being used over and over without cleaning which could be a reason for the transmission of HIV and other infections.

In cases of initation, where a group of similar age-groups under go the operation, it is usually performed under a special tree or a site selected for the occasion ouside the village, and inside a hut or backyard in individual cases. Individual operations may take place either at the home or work place of the excisor or the home of the individual to be excised. In the latter case, the excisor will have the privilege of taking part in the festivity following the operation. The places where the operations take place are usually unhygenic for any form of operation and help to spread a variety of bacterial viruses and infections. In some urban areas the operation is done in hospitals or clinics.

Age of Operation

The age at which the operation is performed varies from community to community and ranges from new born babies aged 7 or 8 days, as in Ethiopia and partly Nigeria, to puberty. Traditionally, in Africa as a puberty rite it was performed at the age of 12 to 15 years, just before the onset of menustration. Recent studies have shown that most parents have their children operated when they are within the 4 to 10 years age. For example, in the case of Senegal 84.5% of the children are circumcised before they reach their 10th birthday (Diallo 1998). Now the age for operation had gradually been reduced so that the children are in a position not to complain or rebel.