Female genital mutilation (FGM) consists of procedures that deliberately modify or harm female genitalia for nonmedical purposes, including partial or total removal of external genital organs or other intentional injuries. According to the World Health Organization and the United Nations Population Fund, an estimated 200 million living girls and women have been subjected to FGM. One may believe that instances of FGM is limited to regions of Africa and Asia; however, the practice spans across all six inhabited continents and even has documented cases in Western Nations such as the United States.
The four major Types of FGM and Associated Health Risks:
FGM is typically conducted in developing nations by designated elderly community leaders , or by traditional health practitioners or birth attendants. Others who may carry out the practice may include members of secret societies, herbalists, female relatives, or male barbers. Practitioners of FGM utilize a variety of often crude instruments, including scissors, scalpels, razor blades, ceremonial knives, or even shards of glass. The types of FGM are classified into four main categories:
- Type 1 (Clitoridectomy): the partial or full removal of the clitoris. In rare cases, only the prepuce (the clitoral hood) is removed.
- Type 2 (Excision): the partial or full removal of the clitoris and labia minora (inner labia) with or without removal of the labia majora (outer labia).
- Type 3 (Infibulation): the narrowing of the vaginal opening with the intention of forming a seal. This is achieved through the cutting repositioning of the labia and can include the partial or full removal of the clitoris as well.
- Type 4 (Other Harmful Procedures): Any other injurious procedure done to the female genitalia for non-health related purposes. Some common forms of Type 4 FGM include pricking, piercing, cutting, scraping, and burning.
There is no evidence that FGM provides any health benefit to those who receive it, and the procedure in fact puts women at risk for serious physical and psychological damage. Immediate complications include severe pain, hemorrhaging, infections, shock, and death. Long-term effects can include urinary and vaginal complications, sexual complications, scar tissue, and complications during childbirth. In addition, those who have undergone FGM have an increased risk of HIV infections. When a single tool is shared between communities to conduct a large amount of same-day rituals, the risk of HIV transmission increases. Damage to genitalia can also lead to the formation of scar tissue that can lacerate during intercourse. Genital lacerations greatly increases the risk of HIV transmission during sexual intercourse. In conjunction with the physical trauma, a victim of FGM may also suffer from a variety of psychological effects: post-traumatic stress disorder, depression, anxiety, low confidence, or trust issues. Those who are most at risk of FGM include girls ranging from infancy to 15 years of age.
Difference Between FGM and Circumcision:
Female genital mutilation is often compared to male circumcision (the removal or the foreskin from the penis). While the two practices may seem similar, they are quite different. FGM is an extreme form of sexual discrimination. Often rooted in religious tradition, FGM is predominantly conducted to conform with cultural standards of femininity and acceptable sexual practices. Ideals of modesty and social pressures are a large motivators for FGM, and the practice is done in order to improve social image and increase marriageability. Many of the procedures have the purpose of lowering sexual pleasure in order to deter the individual from sexual activity. There are no health benefits to FGM and the incentives for the procedure stem from the inequality of the sexes. Although traditionally circumcision is also done for religious reasons, it’s been empirically shown to provide health benefits through preventative medicine and personal hygiene that FGM does not. Male circumcision can lower the risk of penile cancer, prevent penile problems, and decrease the risk of urinary tract infections and sexually transmitted infections. In addition circumcision does not affect fertility nor does it detract from sexual pleasure.
Difference Between FGM and Cosmetic Genital Procedures:
It is important to understand the difference between FGM and cosmetic or medically indicated surgical procedures involving female genitalia. According to Dr. Brian M. Slomovitz, M.D., a specialist in gynecology and gynecologic oncology at The Miller School of Medicine, FGM is a social issue that is not recognized as a viable medical option. Surgeons like Dr. Slomovitz solely perform “medically indicated procedures” on “problems that need to be fixed.” As physicians, Dr. Slomovitz and other members of the medical community are here to serve their patients. FGM is antithetical to medicine’s guiding principle of “primum no nocere” – first do no harm – as it is done solely to restrict female sexuality and is a violation of human rights. In cases of FGM, nerve endings are destroyed and victims can never regain full function of their mutilated organs. Medical procedures, however, are done for the general improvement of patient wellbeing. Plastic surgery involving female genitalia can be for both cosmetic and reconstructive purposes. While cosmetic procedures may not have any medical indication, they differ from FGM because they do not inhibit or restrict female sexuality and are done for aesthetic purposes at the discretion of the surgeon and the patient’s preference. FGM is a practice that is not comparable to modern medical techniques; it is an “unethical [practice] and is not acceptable in U.S. healthcare”.
Female Genital Mutilation in the First World:
Despite being a common practice in many portions of Africa and the Middle East, FGM is not limited to those areas. According to the United Kingdom organization the National Society for the Prevention of Cruelty to Children (NSPCC), there are an estimated 137,000 women and girls affected by FGM in England and Wales alone. Other documented cases have arisen in Australia and the United States as well. In 2016, three individuals were convicted of illegally performing FGM in Australia on six and seven year old sisters. Two of the individuals were deemed accessories and were sentenced to serve 11 months of home detention. The third individual was sentenced to a minimum of 11 months jail time, making him the first person to be imprisoned over FGM charges in Australia. More recently in 2017, two Michigan doctors have been charged with performing FGM on two seven year old girls. This is the first federal genital mutilation case in the United States and will set an important precedent for the legal proceedings of similar future cases.
Future Prevention and Support:
FGM can be performed at any age. Those who are most at risk lie within the 0-15 age range. Future prevention is key for the decrease and elimination of FGM. In the United States, the FBI has a tip line for information on suspected activity and for victims of FGM. Information can also be given to local police departments and authorities. Support organizations, such as Daughter of Eve, have several resources for those who are have been affected by FGM, those wanting to learn more about FGM, and those interested in helping stop the practice. FGM is a violation of rights and is completely preventable. In order to eradicate it, the taboo surrounding it must be eliminated. This can begin once silence is broken.