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Female genital mutilation FGM , also known as female genital cutting and female circumcision , [a] is the ritual cutting or removal of some or all of the external female genitalia. Typically carried out by a traditional circumciser using a blade, FGM is conducted from days after birth to puberty and beyond. In half of the countries for which national figures are available, most girls are cut before the age of five. They include removal of the clitoral hood and clitoral glans ; removal of the inner labia ; and removal of the inner and outer labia and closure of the vulva. In this last procedure, known as infibulation , a small hole is left for the passage of urine and menstrual fluid ; the vagina is opened for intercourse and opened further for childbirth. The practice is rooted in gender inequality , attempts to control women's sexuality , and ideas about purity, modesty and beauty. It is usually initiated and carried out by women, who see it as a source of honour and fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion. There have been international efforts since the s to persuade practitioners to abandon FGM, and it has been outlawed or restricted in most of the countries in which it occurs, although the laws are poorly enforced. Since , the United Nations has called upon healthcare providers to stop performing all forms of the procedure, including reinfibulation after childbirth and symbolic "nicking" of the clitoral hood. Until the s, FGM was widely known in English as female circumcision, implying an equivalence in severity with male circumcision.
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Female genital mutilation FGM , also known as female genital cutting and female circumcision , [a] is the ritual cutting or removal of some or all of the external female genitalia. Typically carried out by a traditional circumciser using a blade, FGM is conducted from days after birth to puberty and beyond. In half of the countries for which national figures are available, most girls are cut before the age of five.

They include removal of the clitoral hood and clitoral glans ; removal of the inner labia ; and removal of the inner and outer labia and closure of the vulva. In this last procedure, known as infibulation , a small hole is left for the passage of urine and menstrual fluid ; the vagina is opened for intercourse and opened further for childbirth.

The practice is rooted in gender inequality , attempts to control women's sexuality , and ideas about purity, modesty and beauty. It is usually initiated and carried out by women, who see it as a source of honour and fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion. There have been international efforts since the s to persuade practitioners to abandon FGM, and it has been outlawed or restricted in most of the countries in which it occurs, although the laws are poorly enforced.

Since , the United Nations has called upon healthcare providers to stop performing all forms of the procedure, including reinfibulation after childbirth and symbolic "nicking" of the clitoral hood. Until the s, FGM was widely known in English as female circumcision, implying an equivalence in severity with male circumcision.

In countries where FGM is common, the practice's many variants are reflected in dozens of terms, often alluding to purification. The surgical infibulation of women came to be known as pharaonic circumcision in Sudan, and as Sudanese circumcision in Egypt. The procedures are generally performed by a traditional circumciser cutter or exciseuse in the girls' homes, with or without anaesthesia. The cutter is usually an older woman, but in communities where the male barber has assumed the role of health worker he will also perform FGM.

A study in Ghana found that in four percent said they had not undergone FGM, but in said they had, while 11 percent switched in the other direction. Type Ia [e] involves removal of the clitoral hood only. This is rarely performed alone. Type II excision is the complete or partial removal of the inner labia , with or without removal of the clitoral glans and outer labia. Type IIa is removal of the inner labia; Type IIb, removal of the clitoral glans and inner labia; and Type IIc, removal of the clitoral glans, inner and outer labia.

Excision in French can refer to any form of FGM. Type III infibulation or pharaonic circumcision , the "sewn closed" category, is the removal of the external genitalia and fusion of the wound. The element of speed and surprise is vital and the circumciser immediately grabs the clitoris by pinching it between her nails aiming to amputate it with a slash. The organ is then shown to the senior female relatives of the child who will decide whether the amount that has been removed is satisfactory or whether more is to be cut off.

After the clitoris has been satisfactorily amputated Since the entire skin on the inner walls of the labia majora has to be removed all the way down to the perineum, this becomes a messy business. By now, the child is screaming, struggling, and bleeding profusely, which makes it difficult for the circumciser to hold with bare fingers and nails the slippery skin and parts that are to be cut or sutured together.

Having ensured that sufficient tissue has been removed to allow the desired fusion of the skin, the circumciser pulls together the opposite sides of the labia majora, ensuring that the raw edges where the skin has been removed are well approximated.

The wound is now ready to be stitched or for thorns to be applied. If a needle and thread are being used, close tight sutures will be placed to ensure that a flap of skin covers the vulva and extends from the mons veneris to the perineum, and which, after the wound heals, will form a bridge of scar tissue that will totally occlude the vaginal introitus.

The amputated parts might be placed in a pouch for the girl to wear. To help the tissue bond, the girl's legs are tied together, often from hip to ankle; the bindings are usually loosened after a week and removed after two to six weeks. The vagina is opened for sexual intercourse, for the first time either by a midwife with a knife or by the woman's husband with his penis. Reinfibulation can involve cutting the vagina again to restore the pinhole size of the first infibulation. This might be performed before marriage, and after childbirth, divorce and widowhood.

The penetration of the bride's infibulation takes anywhere from 3 or 4 days to several months. Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation, and the woman's vaginal passage is then cut open to allow birth to take place. Those men who do manage to penetrate their wives do so often, or perhaps always, with the help of the "little knife". This creates a tear which they gradually rip more and more until the opening is sufficient to admit the penis.

Type IV is "[a]ll other harmful procedures to the female genitalia for non-medical purposes", including pricking, piercing, incising, scraping and cauterization. From the age of eight, girls are encouraged to stretch their inner labia using sticks and massage. Girls in Uganda are told they may have difficulty giving birth without stretched labia.

These were removed from the WHO's definition because of insufficient information about prevalence and consequences. Gishiri cutting involves cutting the vagina's front or back wall with a blade or penknife, performed in response to infertility, obstructed labour and other conditions. In a study by Nigerian physician Mairo Usman Mandara, over 30 percent of women with gishiri cuts were found to have vesicovaginal fistulae holes that allow urine to seep into the vagina.

FGM harms women's physical and emotional health throughout their lives. In the case of Type III, other factors include how small a hole was left for the passage of urine and menstrual blood, whether surgical thread was used instead of agave or acacia thorns, and whether the procedure was performed more than once for example, to close an opening regarded as too wide or re-open one too small.

A systematic review of 56 studies suggested that over one in ten girls and women undergoing any form of FGM, including symbolic nicking of the clitoris Type IV , experience immediate complications, although the risks increased with Type III.

The review also suggested that there was under-reporting. The practitioners' use of shared instruments is thought to aid the transmission of hepatitis B , hepatitis C and HIV , although no epidemiological studies have shown this. Late complications vary depending on the type of FGM. Urine may collect underneath the scar, leaving the area under the skin constantly wet, which can lead to infection and the formation of small stones.

The opening is larger in women who are sexually active or have given birth by vaginal delivery, but the urethra opening may still be obstructed by scar tissue. Vesicovaginal or rectovaginal fistulae can develop holes that allow urine or faeces to seep into the vagina. Complete obstruction of the vagina can result in hematocolpos and hematometra where the vagina and uterus fill with menstrual blood. FGM may place women at higher risk of problems during pregnancy and childbirth, which are more common with the more extensive FGM procedures.

Third-degree laceration tears , anal-sphincter damage and emergency caesarean section are more common in infibulated women. Neonatal mortality is increased. The estimate was based on a study conducted on 28, women attending delivery wards at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. The reasons for this were unclear, but may be connected to genital and urinary tract infections and the presence of scar tissue.

According to the study, FGM was associated with an increased risk to the mother of damage to the perineum and excessive blood loss , as well as a need to resuscitate the baby, and stillbirth , perhaps because of a long second stage of labour. According to a systematic review there is little high-quality information available on the psychological effects of FGM.

Several small studies have concluded that women with FGM suffer from anxiety, depression and post-traumatic stress disorder. One third reported reduced sexual feelings. Aid agencies define the prevalence of FGM as the percentage of the 15—49 age group that has experienced it. Was any flesh or something removed from the genital area? Was your genital area sewn? Type I is the most common form in Egypt, [74] and in the southern parts of Nigeria. In Eritrea, for example, a survey in found that all Hedareb girls had been infibulated, compared with two percent of the Tigrinya , most of whom fell into the "cut, no flesh removed" category.

FGM is mostly found in what Gerry Mackie called an "intriguingly contiguous" zone in Africa—east to west from Somalia to Senegal, and north to south from Egypt to Tanzania. Over million women and girls are thought to be living with FGM in those 30 countries. The highest concentrations among the 15—49 age group are in Somalia 98 percent , Guinea 97 percent , Djibouti 93 percent , Egypt 91 percent and Sierra Leone 90 percent.

The prevalence rate for the 0—11 group in Indonesia is 49 percent Prevalence figures for the 15—19 age group and younger show a downward trend. FGM is not invariably a rite of passage between childhood and adulthood, but is often performed on much younger children. In half the countries for which national figures were available in —, most girls had been cut by age five. In Kenya, for example, the Kisi cut around age 10 and the Kamba at A country's national prevalence often reflects a high sub-national prevalence among certain ethnicities, rather than a widespread practice.

For example, in the northeastern regions of Ethiopia and Kenya, which share a border with Somalia, the Somali people practise FGM at around the same rate as they do in Somalia. Dahabo Musa, a Somali woman, described infibulation in a poem as the "three feminine sorrows": the procedure itself, the wedding night when the woman is cut open, then childbirth when she is cut again. Like FGM, footbinding was carried out on young girls, nearly universal where practised, tied to ideas about honour, chastity and appropriate marriage, and "supported and transmitted" by women.

FGM practitioners see the procedures as marking not only ethnic boundaries but also gender difference. According to this view, male circumcision defeminizes men while FGM demasculinizes women. African female symbolism revolves instead around the concept of the womb. In communities where infibulation is common, there is a preference for women's genitals to be smooth, dry and without odour, and both women and men may find the natural vulva repulsive.

Common reasons for FGM cited by women in surveys are social acceptance, religion, hygiene, preservation of virginity, marriageability and enhancement of male sexual pleasure. In Sudan in , 42 percent of women who had heard of FGM said the practice should continue. Against the argument that women willingly choose FGM for their daughters, UNICEF calls the practice a "self-enforcing social convention" to which families feel they must conform to avoid uncut daughters facing social exclusion.

The Zabarma girls would respond Ya, mutmura! A mutmara was a storage pit for grain that was continually opened and closed, like an infibulated woman. But despite throwing the insult back, the Zabarma girls would ask their mothers, "What's the matter? Don't we have razor blades like the Arabs? Because of poor access to information, and because circumcisers downplay the causal connection, women may not associate the health consequences with the procedure. When informed of the causal relationship between FGM and ill health, Mackie wrote, the women broke down and wept.

He argued that surveys taken before and after this sharing of information would show very different levels of support for FGM. There is no mention of FGM in the Bible. In UNICEF identified 19 African countries in which at least 10 percent of Christian women and girls aged 15 to 49 had undergone FGM; [y] in Niger, 55 percent of Christian women and girls had experienced it, compared with two percent of their Muslim counterparts.

Judaism requires male circumcision but does not allow FGM. The practice's origins are unknown. Gerry Mackie has suggested that, because FGM's east-west, north-south distribution in Africa meets in Sudan, infibulation may have begun there with the Meroite civilization c.



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