Consequences of FGM
Women suffer from FGM as young children from the operation, at the time of their marriage as adults and later during their child delivery. Female genital mutilation has detrimental effects on the physical and psychological health of the infants, girl-children and women operated. The degree of complications depend on various factors including the nature of the mutilation (excision or infibulation), the types of tools used, the physical environment of the operation, the skill of the operator and the physical response of the operated individual at the time of the operation.
The consequences which begin immediately at the time of the operation can be grouped into long- and short-term. The latter manifests itself within a very short period extending from a few hours of the operation to some ten days. Long-term complications are life-long, irreversable and require medical attentions to mitigate their effects. One study, for example, found out that 83% of women whose genitals have been mutilated required medical attention at some time in their lives for problems related to the procedure they went under (African Env’t 1999). Lack of access to health facilities and ignorance of the cause of their suffering prevents most of the women to look for medical attention. Of all of the forms of FGM, excision and infibulation lead to severe complications.
- Immediate complications and consequences
- Shock from bleeding, pain and stress resulting from cutting very sensitive and delicate area of the genitalia without the use of anaesthetic.
- Bleeding or hemorrhage: the cutting of the blood vessels in the vulva (clitoral artery) during the operation leads to bleeding. Serious bleeding can also cause shock. Protracted bleeding can lead to anaemia and even death.
- Urinary retention from fear of pain, tissue swelling or injury of the urethra cause pain and discomfort which could easily lead to bladder and urinary tract infections.
- Infection caused by the use of unsterilized instruments in unhygienic environment may lead to other complications and even to death. Infections can also cause pelvic inflammation. It could result directly in blood poisoning and in having tetanus, and if untreated finally death may follow. There is also high risk of HIV transmission through the use of one instrument for multiple operations.
- Damage to organs such as the anus, urethra and the bladder from unexperienced circumcisers.
In the case of infibulation, the consequences are compounded by frequent cutting and stitching. Thus, bleeding and the risk of hemorrhage, pain, risk of infection and urine retention are much severe and serious.
Infibulation and excision cause long-term complications of gynecological, obsterics and urinary tracts. The main ones are the following (MGR 1992/3; African Env’t 1999; Toubia 1993; Smith 1995; Leye 1998; WHO)
- Repeated urinary infection because of the narrowing of the urinary outlet which prevents the complete emptying of urine from the bladder.
- Extremely painful menustration due to the build up of urine and blood in the uterus leading to inflammation of the bladder and internal sexual organs.
- Formation of scars and keloid on the vulva wound. The growth of dermoid cysts which may result in abscesses.
- Formation of fistula – the rupture of the vagina and/or uterus.
- Vulval abscesses.
- Severe pain during intercourse which may consist of physical discomfort and psychological traumatization.
- Difficult child birth which in case of long and obstructed labour may lead to foetal death and brain damage of the infant.
- In the case of infibulation acute and chronic pelvic infection leading to infertility and/or tubal pregnancy.
- Accumulation of blood and blood clots in the uterus and/or vagina.
A study of the physical effects of FGM leading to genital malformation in 269 cases in western Sierra Leone shows that 168 had keloid scars, fistula 1, prolapse 82, cysts 8, abscesses 4, and none 86. Another study of 100 girls between the ages of 8-12 in the same country 10 had vaginal bleeding, 8-10 pain, 8 acute urine retention, 5 tetanus, 50 vaginal discharge and 15 dysuria [difficult urine discharge] (Statistical Record of Women World Wide). Another study by Population Council in Mali among 3590 women attending health centers, 7% of the women had complications, the most common being blood clots and tears in the perineum (35%), hemorrhage (33%), vaginal adhesions (8%) and keloids (4%) (Population Council Programme briefs).
FGM is the mutilation of the sexually sensitive organ of women, resulting in the loss of woman’s natural sexual sensitivity. This can affect martial relationship, child birth and create fear and suppression of interest and feelings during sexual intercourse. The nerve endings of the clitoris is sensitive and serves the purpose of pleasure. Toubia describes the removal of the clitoris through excision or infibulation as follows “In effect, the delicate area where female genital once existed is turned into tough scar tissue that bears more resemblance to cured hide than to human tissue. Women ... have no perception or experience of soft, tender female genitals on adult women.” In cases that the clitoris has been replaced by scar tissues, orgasm is difficult to achieve (Toubia 1993). The presence of the scar makes penetration difficult and the intercourse itself a painful ordeal for the woman. Women face fear during the first weeks of marriage from sexual intercourse and defibulation. Penetration in the case of infibulated women may take weeks, may even require the use of the “knife” to open her up.
The effect of FGM operation on the vaginal opening, narrow in the case of infibulation or too scarred by excision, will make vaginal intercourse difficult and painful. In the case of infibulation where the cutting and stitching of the vaginal opening are repeated frequently, all the complications associated with the initial operation will repeat themselves.
The other sexual problem related to FGM is the difficulty experienced during child birth in particular with infibulated women. The vaginal canal loses its elasticity due to excision and the vaginal opening is closed in cases of infibulation. This needs a cut to get the child out of a wall of flesh, which if done improperly will lead to bleeding, infection, fistula formation (inability to control urine). If the vaginal opening is narrow, the mother’s labour will be prolonged and delayed which may be fatal to both mother and foetus. In the obstructed delivery the head is forced to press on the scar which may lead to arrest labour, rupture of the scar or uterine rupture, tearing of the vulva and perineum.
Of all aspects of FGM, the psychological or the emotional aspect is a less known area. Toubia (1993) cites three psychological cases: “anxiety state” originating from lack of sleep and hallucinations; “reaction depression” from delayed healing, and “psychotic excitement” from childlessness and divorce. Other problems include traumatic experience, sense of being betrayed by family members, elders, and joining peer groups by force through the FGM operation.