Female circumcision/female genital mutilation (FC/FGM) is the collective description of the traditional practice that involves the cutting or removing of female genital organs. FGM is most often performed on girls between the ages of 4 and 10, however in some cultures, the procedure may be practiced as early as a few days after birth, postponed until just prior to marriage or subsequent to the first pregnancy.

FGM is viewed as a necessary rite of passage to womanhood and women who have not had the procedure are subject to ridicule, humiliation and being unwed outcasts in the community. In most third world villages, the local practitioner (buankisas), a layperson or parent performs the procedure without the use of anesthesia while the girl is physically immobilized on the ground. Instruments such as knives, razors, tin lids, scissors or broken glass may be the items of choice to do the cutting (American Academy of Pediatrics 1998). Antiseptic powder or pastes containing various herbs, milk, eggs, ashes or animal dung may be applied afterwards which are believed to facilitate healing. The girl may then be taken to a specially designated location in which to heal and recover.

Type I- V

FGM may be categorized into four types based on their severity (American Academy of Pediatrics 1998). “Surgeries” may further be described as major or minor. Type I or clitoridectomy, is the excision of the prepuce or skin (hood) surrounding the clitoris with or without the excision of the clitoris. It is believed to have been practiced even before written records existed. Type II or excision, is the removal of the entire prepuce and clitoris and all or part of the labia minor. Crude stitches of catgut or thorns are then applied to control bleeding from the clitoral artery and any exposed tissues.

In the type II procedure, the vaginal opening is not covered with skin tissue. Type III or infibulation is the excision of the entire clitoris and some or all of the labia minora and is the most severe and barbaric form of FGM. It is also referred to as pharonic circumcision. Raw labial surfaces are created and are then stitched together to cover the urethra and vaginal openings. Merely a small posterior opening is left remaining to permit urinary and menstrual flow.

Infibulation

In cases of infibulation, the legs may be bound together for up to 40 days before the thorns are removed and the wound of the vulva has healed and formed a scab. Inserting a splinter of wood or bamboo is usually employed to create the small opening. Infibulation is performed to make sexual intercourse impossible and to guarantee that a bride is intact. A girl is typically inspected by the female relatives of the husband-to-be and it is common practice that the smaller the opening, the higher the bride’s price. Type IV involves all other practices related to female external genitalia for cultural reasons such as piercing, pricking, stretching of the clitoris or labia, and the scraping or introduction of corrosive substances into the vagina.

Consequences

The practice of FGM often results in serious and life-long health consequences. At the time of the operation, immediate outcomes may include severe pain, shock and extensive bleeding that may lead to hemorrhaging and death. Many girls do die after the procedure secondary to blood loss yet the tribe often views it as God’s will and not the direct result of the operation. The girls may be viewed as witches for whom the community is glad of their removal. The use of the same instrument among girls without proper sterilization techniques can also cause the spread of HIV and other blood borne illnesses.

Long-term effects often consist of chronic infections of the bladder and urinary tract, infertility, problems with sexual intercourse and pregnancy and psychological disturbances including feelings of anxiety, terror and betrayal. It is also possible that the women who did not receive mutilation also experience psychological trauma as the result of mass rejection from the community. The first sexual intercourse after the procedure is only able to take place after gradual and painful dilation of the remaining opening usually by means of unskillful cutting by the family or being savagely “unfastened” by the new husband.