Female genital mutation (FMG) is the partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.
FGM is also known as female genital cutting, female genital mutilation/cutting and female circumcision.
It is the ritual cutting or removal of some or all of the vulva.
Areas of involvement: Africa, Southeast Asia, Middle East, and within communities from these areas.
Numbers Over 200 million women and girls in 27 African countries; Indonesia; Iraqi Kurdistan; and Yemen.
Occurs days after birth to puberty.
As of 2023, UNICEF estimates that at least 200 million girls in 31 countries including Indonesia, Iraq, Yemen, and 27 African countries including Egypt—had been subjected to one or more types of female genital mutilation.
Using a blade, FGM is conducted from days after birth to puberty and beyond.
Most girls undergo FGM do so before the age of five.
Procedures differ by country or ethnic group.
Procedures include:
removal of the clitoral hood (type 1-a) and clitoral glans (1-b); removal of the inner labia (2-a); and removal of the inner and outer labia and closure of the vulva (type 3).
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.
FGM is rooted in gender inequality, attempts to control women’s sexuality, and ideas about purity, modesty, and beauty.
FGM is usually initiated and carried out by women, who see it as a source of honour, and who fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion.
FGM adverse health effects depend on the type of procedure and include: recurrent infections, difficulty urinating and passing menstrual flow, chronic pain, the development of cysts, an inability to get pregnant, complications during childbirth, and fatal bleeding.
No known health benefits accrue from FGM.
While it is outlawed in many countries, laws are often poorly enforced.
The procedures are generally performed in the girls’ homes, with or without anaesthesia.
The cutter is usually an older woman, but where male barbers has assumed the role of health worker, he will also perform FGM.
Non-sterile devices are commonly used: knives, razors, scissors, glass, sharpened rocks, and fingernails.
In several countries, health professionals are involved.
Classification:
Type I-partial or total removal of the clitoral glans, the external and visible part of the clitoris, which is a sensitive part of the female genitals, and/or the prepuce/clitoral hood, the fold of skin surrounding the clitoral glans.
Type Ia involves removal of the clitoral hood only, but this is rarely performed alone.
Type Ib (clitoridectomy), the complete or partial removal of the clitoral glans and clitoral hood.
Type II
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
Type IIc, removal of the clitoral glans, inner and outer labia.
Type III (infibulation) the sewn closed category, is the removal of the external genitalia and fusion of the wound.
The inner and/or outer labia are cut away, with or without removal of the clitoral glans.
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.
A single hole of 2–3 mm is left for the passage of urine and menstrual fluid.
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.
The woman is opened further for childbirth (defibulation or deinfibulation), and closed again afterwards (reinfibulation).
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 men (15%) are unable to penetrate their wives at all and the task is often accomplished by a midwife under conditions of great secrecy, since this reflects negatively on the man’s potency.
Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation.
The woman’s vaginal passage is then cut open to allow birth to take place.
Type IV is other harmful procedures to the female genitalia for non-medical purposes: pricking, piercing, incising, scraping and cauterization, nicking of the clitoris (symbolic circumcision), burning or scarring the genitals, and introducing substances into the vagina to tighten it, and labia stretching.
FGM harms women’s physical and emotional health throughout their lives.
FGM has no known health benefits.
Complications of FGM depend on the type of FGM, whether the practitioner has had medical training, and whether they used antibiotics and sterilized or single-use surgical instruments, how small a hole was left for the passage of urine and menstrual blood in type III, and whether the procedure was performed more than once.
Common short-term complications include swelling, excessive bleeding, pain, urine retention, and healing problems/wound infection.
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.
Other short-term complications include fatal bleeding, anemia, urinary infection, septicemia, tetanus, gangrene, necrotizing fasciitis and endometritis.
It is not known how many girls and women die as a result of FGM.
Late complications of FGM include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation involving nerves that supplied the clitoris.
An infibulated girl an opening as small as 2–3 mm, which can cause prolonged urination, pain while urinating, and a feeling of needing to urinate all the time, and 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 usually 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.
Damage to the urethra and bladder can lead to infections and incontinence, pain during sexual intercourse and infertility.
Painful periods are common because of the obstruction to the menstrual flow, and blood can stagnate in the vagina and uterus.
Complete obstruction of the vagina can result in vagina and uterus being filled with menstrual blood.
Pregnancy, childbirth
FGM may place women at higher risk of problems during pregnancy and childbirth.
Pregnancy and childbirth problems are more common with the more extensive FGM procedures.
Infibulated women may try to make childbirth easier by eating less during pregnancy to reduce the baby’s size.
Cervical evaluation during labor may be impeded and prolonged or obstructed.
Third-degree tears anal-sphincter damage and emergency caesarean section are more common in infibulated women.
The WHO estimated in 2006 that an additional 10–20 babies die per 1,000 deliveries as a result of FGM.
All types of FGM pose an increased risk of death to the baby: 15 percent higher for Type I, 32 percent for Type II, and 55 percent for Type III, which may be connected to genital and urinary tract infections and the presence of scar tissue.
FGM is associated with an increased risk to the mother of damage to the perineum and excessive blood loss, newborn resuscitation, stillbirth, perhaps because of a long second stage of labor.
Studies show that women with FGM develop anxiety, depression, and post-traumatic stress disorder.
Women with FGM were twice as likely to report no sexual desire and 52 percent more likely to report dyspareunia, and one-third reported reduced sexual feelings.
Over 200 million women and girls are thought to be living with FGM in 30 countries.
As of 2023, UNICEF reported that there highest levels of FGM can be found in Mali, Sierra Leone, Guinea, the Gambia, Somalia, and Egypt, where more than half of the female population thinks the practice should continue.
FGM is more common in rural areas, less common in most countries among girls from the wealthiest homes, and generally less common in girls whose mothers had access to primary or secondary/higher education.
In Somalia and Sudan the situation is reversed: in Somalia, the mothers’ access to secondary/higher education was accompanied by a rise in prevalence of FGM in their daughters, and in Sudan, access to any education was accompanied by a rise.
Girls are most commonly cut shortly after birth to age 15.
A country’s national prevalence often reflects a high prevalence among certain ethnicities, rather than a widespread practice.
It is women who organize all forms of FGM.
FGM practitioners see the procedures as marking not only ethnic boundaries but also gender differences: circumcision defeminizes men while FGM demasculinizes women.
Common reasons for FGM cited by women in surveys are social acceptance, religion, hygiene, preservation of virginity, marriageability and enhancement of male sexual pleasure.
Religious views on female genital mutilation have shown a widespread belief that FGM is a religious requirement.
It is distinguish between religion, tradition, and chastity.
The practice became associated with Islam because of that religion’s focus on female chastity and seclusion, but there is no mention of the practice in the Quran.
Christian communities in Africa do practise as in 2013 UNICEF identified 19 African countries in which at least 10 percent of Christian women and girls aged 15 to 49 had undergone FGM.