Every year more than 2 million girls and women are forced to undergo female genital mutilation (FGM.) Although the specific rationale behind the practice varies from country to country and culture to culture, the general reason remains the same – to deny women the ability to have pleasurable sexual intercourse and in so doing cause them to reserve their sexuality for their husbands. It may also be a religious rite of initiation into womanhood, a way to cleanse an ugly body part, required by god, or simply a way to increase male pleasure. FGM, also known as genital cutting or female circumcision, is practiced in more than 30 countries, mostly in a belt stretching across Africa north of the equator.
Although evidence suggests that FGM does not necessarily increase a woman’s risk for sexually transmitted diseases, it is certainly not protective. In most countries where FGM is practiced, women who have undergone mutilation have similar rates of sexually transmitted diseases to those whose bodies remain intact. Female genital mutilation does, however, put women at increased risk of HIV and AIDS when unhygienic surgical methods are used in the procedure.
Female genital mutilation is not a uniform practice. It ranges from a symbolic cutting of the genitals to complete removal of the clitoris and the external genitalia with stitching of the two sides of the open wound together with just enough of an opening to allow the escape of menstrual blood and urine. The World Health Organization has actually developed a classification system for FGM that divides it into categories as follows: Type I: Excision of the prepuce (clitoral hood) and part or all of the clitoris; Type II: Excision of the prepuce and clitoris together with partial or total excision of the labia minora; Type III: Infibulation. Excision of part or all of the external genitalia and stitching of the two cut sides together to varying degrees; and Type IV: Pricking, piercing, incision, stretching, scraping, or other harmful procedures performed on the clitoris, labia, or both. The actual experience of FGM does not always fall into one of these categories. The extent of surgery varies between local practitioners as well as between cultural groups, and their practices may include aspects of one or more types of mutilation.
It is extremely generous to refer to FGM as a surgical procedure. These mutilations are most frequently performed by traditional practitioners without anesthesia using whatever instruments they can find – from sharpened sticks and rocks to scissors and penknives – and devices are not generally sterilized between women. In cases of infibulation a girl’s legs may be left tied together for 2-6 weeks in order to promote healing of the wound. Once it heals she is left with an un-breached layer of scarred skin between her legs, with only a small opening at the bottom for release of urine and menstrual fluid. This opening is sometimes so small that a man may be unable to penetrate her successfully, at which point it can be enlarged with a knife or other instrument at hand. Where infibulation is a common practice, if the opening becomes too large after vaginal delivery or other circumstances, a woman may actually be reinfibulated to restore the small size of the original opening.
Genital mutilation is most commonly performed when women are between 4 and 10 years of age, although it can occur as early as infancy and as late as during a first pregnancy. Depending on the extent of the mutilation it can have serious psychological and physical side effects. Unintended physical effects of FGM include uncontrolled bleeding, damage to the urethra and bladder, urinary infection and retention, broken bones in the pelvis and legs from where women were restrained while struggling, systemic infection, infertility, and even death. Psychologically, women can show symptoms of post traumatic stress disorder, anxiety, depression, and – as intended – a fear of sexual intercourse.
As world travel becomes more straightforward and migration patterns change, FGM has changed from a primarily African problem to one that affects countries worldwide. Western nations, in general, have two types of legal experience with FGM – refugees who are seeking asylum to escape it and migrants who are seeking legal protection to perform it. Although most countries do their best to respect the cultural and religious beliefs of immigrants, there is a growing consensus that FGM is an unacceptable violation of human rights. Countries are increasingly deciding that respecting this type of cultural rite… is wrong. The United States outlawed the practice in 1997, and several European nations have prosecuted medical professionals for performing FGM, which has led to an interesting debate. If parents are going to find a way for their daughters to be mutilated anyway, possibly sending them on a holiday to their home countries to have the procedure done, would it be better to allow the practice to occur in the safety of a modern medical facility which would at least reduce the risk of unintended complications and infection?
Some physicians have found that a symbolic pricking of the clitoris, or small cut upon the genitals, is an acceptable substitute for more extensive FGM in certain communities. Where bloodletting is the only requirement, a procedure performed by a physician can be done under anesthesia and repaired immediately without lasting physical or psychological damage to the child. However, most Western medical societies forbid their practitioners to engage in any such an unnecessary procedure on the genitals. Although the reasons for such regulations are clear, some people have argued that in this case Western morals and ethics actually get in the way of the well-being of the child… particularly since the symbolic procedures are far less extensive than male circumcision.