Female Genital Mutilation (FGM) or Clitoridectomy

Hewlett Foundation Grantees in Kenya
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Every year more than 2 million girls and women are forced to undergo female genital mutilation (FGM.) The specific rationale behind the practice varies from country to country and culture to culture. However, the general reason for genital mutilation remains the same. The goal is to deny women the ability to have pleasurable sexual intercourse and in so doing cause them to reserve their sexuality for their husbands.

From the perspective of the culture where the practice is employed, genital mutilation 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. Most of these countries are in a belt stretching across Africa north of the equator. However, women have been the victims of FGM around the world.

Evidence suggests that FGM does not necessarily increase a woman’s risk for sexually transmitted diseases. It is also 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.

WHO Classification System

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. Removal of the clitoris is known as clitoridectomy or clitorectomy.

The World Health Organization has actually developed a classification system for FGM that divides it into categories as follows.

  • Type I is excision of the prepuce (clitoral hood) and part or all of the clitoris.
  • Type II is excision of the prepuce and clitoris together with partial or total excision of the labia minora.
  • Type III is infibulation. Infibulation is excision of part or all of the external genitalia and stitching of the two cut sides together to varying degrees.
  • Type IV is 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. Furthermore, practices may include aspects of one or more types of mutilation.

What Happens During FGM?

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. This ranges from sharpened sticks and rocks to scissors and penknives. Devices are not generally sterilized between women. This increases the risk of transmitting infection alongside other harmful effects.

In cases of infibulation, a girl’s legs may be left tied together for 2 to 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. There is only a small opening at the bottom for the release of urine and menstrual fluid. This opening is sometimes so small that a man may be unable to penetrate her successfully. At that point, the man may enlarge the opening with a knife or other instrument he has at hand.

Where infibulation is a common practice, if the opening becomes too large after vaginal delivery or other circumstances, that is considered to be a problem. A woman may actually be reinfibulated to restore the small size of the original opening.

Physical and Psychological Effects

Genital mutilation is most commonly performed when women are between 4 and 10 years of age. However, 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
  • Death

Psychological effects of FGM include:

  • Post traumatic stress disorder
  • Anxiety
  • Depression
  • Fear of sexual intercourse (as intended)

FGM Outside of Africa

As world travel becomes more straightforward and migration patterns change, FGM has changed. It used to be a primarily African problem. Now it is one that affects countries worldwide. Western nations, in general, have two types of legal experience with FGM. There are refugees who are seeking asylum to escape it and migrants who are seeking legal protection to perform it. Most countries do their best to respect the cultural and religious beliefs of immigrants. However, 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.

Ethical and Moral Considerations

The United States outlawed the practice of FGM in 1997. Several European nations have prosecuted medical professionals for performing FGM. This 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? That 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.The reasons for such regulations are clear. However, some people have argued that in this case Western morals and ethics actually get in the way of the well-being of the child. This is particularly true since the symbolic procedures are far less extensive than male circumcision. Male circumcision is a legal and, in many places standard, practice. It is even proposed as a method to reduce the spread of STDs.

Voluntary Genital Reconstruction

Even as the controversies surrounding female genital mutilation grow, and the practice becomes less acceptable, voluntary genital reconstruction is becoming increasingly more common. Women want to reshape their external genitalia to give them a ‘clean’ appearance, with hidden inner labia and outer labia that could appear in a magazine. In fact, it’s girly magazines that have caused women to be concerned about their genital appearance. Women are told that the airbrushed symmetry and lack of variation is what men consider beautiful and want to change their bodies to match. Research suggests that most women undergoing this surgery have been talked into it by their partners, who want the look of a Playboy model lying next to them in bed.

Genital plastic surgery can also involve tightening of the vaginal opening, either after childbirth or to accommodate a partner with small penis size. Data is controversial, however, on whether this actually increases the woman’s own sexual pleasure since the surgical procedure damages nerves and muscle and can also cause local scarring. This vaginal rejuvenation is not a new procedure. Women have been having tucks to tighten their vaginas after childbirth for many years. It is primarily done for the pleasure of men and is sometimes referred to as the "husband stitch."

Virginity has always a been a cultural asset for women, and even in the 21st century little has changed. Surgical recreation of the hymen, for example, is growing in popularity as an elective procedure throughout the world. This procedure was once the domain of women in the Middle East who risked serious repercussions if they did not appear virginal in their marriage bed. (Since the hymen can be damaged in non-sexual ways, hymenoplasty could prevent women from being wrongly penalized for a lack of virginity.). Now hymen restoration is becoming a fashion trend. Women choose them as a gift to their husbands, or to mislead a future spouse. Apparently, the appearance of purity is worth not only major surgery but also the re-association of sex with a not insignificant amount of pain.

What do these voluntary procedures have to do with the horrors of female genital mutilation? In Sweden, legislation designed to prevent the second had the unintended consequences of also criminalizing the first. The superficial similarities of the procedures have also led some scientists to question whether the paternalistic protection of poor African women while allowing rich Western women to choose a similar procedure is actually institutionalized racism.

This may seem extreme, but it is reasonable to ask if when women consent to the practice of FGM it should still be disallowed. With FGM, the argument is usually made that women are conditioned by their cultures to think that the procedure is necessary for them, or their daughters. The vast majority of women who choose to undergo labioplasty are also responding to societal pressures. Women undergoing voluntary surgery may be trying to enhance their sexual lives rather than inhibit them, but women undergoing FGM are strengthening their familial ties. That is something which they may, quite reasonably, consider to be far more important.

There are more than 130 million women in the world whose lives have been irreversibly damaged by FGM, who experience unnecessary physical and emotional pain. It is a shame that vanity has made it possible to question the condemnation of a practice that is so hazardous to women. Governments around the world have denounced FGM with good reason, in order to protect the girls and women who are their most vulnerable citizens, and outreach groups continue to try and find ways to help individuals who believe in the practice find a less dangerous alternative. It remains the responsibility of individuals and governments to determine how to draw the line between respect and protection, even if it may turn out to be at the expense of choice.

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