FGM stands for Female Genital Mutilation, and is
defined as all procedures that involve the partial or total removal of the
external female genitalia, or other injury to the female genital organs for
There are four types of FGM, as classified by World Health Organisation (WHO) in 1997 and subdivided in 2008, and they are:
I: partial or total removal of the clitoris and/or the prepuce
Subdivisions of FGM Type I are: FGM Type Ia,
removal of the clitoral hood or prepuce only and FGM Type Ib, removal of the
clitoris with the prepuce.
II: partial or total removal of the clitoris and the labia minora, with or
without excision of the labia majora (excision).
of FGM Type II are: IIa, removal of the labia minora only; IIb, partial or
total removal of the clitoris and labia minora; and IIc, partial or total
removal of the clitoris, labia minora and labia majora.
III: narrowing of the vaginal orifice with creation of a covering seal by
cutting and appositioning the labia minora and/or the labia majora, with or
without excision of the clitoris (infibulation).
Subdivisions of FGM Type III are: FGM Type IIIa,
removal and apposition of the labia minora; and FGM Type IIIb, removal and
apposition of the labia majora.
Reinfibulation is covered under this definition.
This is a procedure to recreate an infibulation, for example after childbirth
when defibulation is necessary.
Type IV: unclassified – All other harmful
procedures to the female genitalia for non-medical purposes, for example:
pricking, pulling, piercing, incising, scraping and cauterization.
is estimated that over 200 million girls and women worldwide are living with or
at risk of suffering the associated negative health consequences of FGM
year 3 million girls and women are at risk of FGM and are therefore exposed to
the potential negative health consequences of this harmful practice. FGM has no
known health benefits, and those girls and women who have undergone the
procedure are at great risk of suffering from its complications throughout
procedure of FGM is painful and traumatic, and is often performed under
unsterile conditions by a traditional practitioner who has little knowledge of
female anatomy or how to manage possible adverse events. The removal of, or damage, to healthy genital
tissue interferes with the natural functioning of the body and may cause severe
immediate and long-term negative health consequences.
practice of FGM is prevalent in 30 countries in Africa and in a few countries
in Asia and the Middle East, but also present across the globe due to
international migration. FGM practice is deeply rooted in a strong cultural/social
framework. It is endorsed by the practicing community & supported by loving
parents who believe that undergoing FGM is in the best interest of their
beliefs sustaining the practice of FGM vary greatly from one community to
another, although there are many common themes such ascending promiscuity or
the maintaining culture tradition of the community.
its cultural importance, we need to acknowledge the fact that FGM is a harmful
traditional practice that violates the rights or girls and women. Therefore, FGM has to be eliminated.
Now let us talk about “The negative health
consequences associated with FGM and medical interventions available for FGM
survivors in Nigeria”
FGM it interferes with healthy genital tissue and can lead to severe
consequences for a girl’s and women physical, mental and sexual health. In our conference today we dwell more on the negative
health consequences of FGM. These health
consequences are, broadly, grouped into Immediate & short-term physical
complications as well as long-term complications (Gynaecological &
urogynaecological, etc). @WHO
First, let us discuss the “Immediate & Short term complications of
FGM (severe pain and injury to tissues; haemorrhage (bleeding); haemorrhagic
shock; infection and septicaemia; genital tissue swelling; acute urine
retention and fracture of bones.
Severe pain and injury to tissues; the
clitoris and surrounding genital tissues have a dense nerve supply and so are
very sensitive. FGM is usually performed without anaesthetic and therefore
causes very severe pain.
Haemorrhage (bleeding): Cutting the
clitoris may involve cutting the clitoral artery, which contains blood flowing
under high pressure. Cutting the labia also damages some blood vessels.
Bleeding usually occurs during or immediately after the procedure.
Haemorrhagic shock; this occurs when
there is a reduced volume of blood circulating in the body due to severe
bleeding. Due to excessive blood loss,
from FGM, death can occur within a short time if the patient fails to receive
Infection and septicaemia; Infection may
occur when FGM is conducted in unhygienic surroundings and with dirty
instruments, and if there is a lack of proper wound care after FGM. This will
lead to an elevated body temperature and a dirty, inflamed wound.
Genital tissue swelling; Cutting and
damaging the genital tissues cause a local inflammatory response. Genital
swelling may also be caused by an acute local infection.
Acute urine retention; Urine retention
may be the result of injury, pain and fear of passing urine, or occlusion of
the urethra during infibulation. Acute retention of urine usually occurs due to
genital tissue swelling and inflammation around the wound.
Fractured bones; FGM operation can lead to dislocation
or fracture of bones especially in older girls and women as they are pinned
down with much force during the process of cutting. This usually occurs while
the girl/woman is struggling with the cutters.
Second, let us discuss the “long-term complications of FGM” chronic
vulvar pain; clitoral neuroma; reproductive tract infections; menstrual
problems; urinary tract infections; painful or difficult urination; epidermal
inclusion cysts and keloids.
chronic vulvar pain; duringFGM, the clitoral glans and
surrounding genital tissues are injured leading to the formation of inelastic
scar tissue. This causes some women to experience pain in the vulvar area
during sexual intercourse or daily activities.
clitoral neuroma; occurs when the dorsal clitoral nerve is
damaged. It can be asymptomatic or cause sensations of electric discharge, or
chronic pain. With this condition, sitting, sexual intercourse, or even the
friction of underpants, can cause pain.
reproductive tract infections (RTIs); women who have undergone FGM
have an increased risk of RTIs, which can be painful. They can be recurrent
and, if left untreated, may become persistent and lead to pelvic inflammatory
problems; Girls and women who have undergone FGM often
report dysmenorrhoea (pain) with or without menstrual irregularity. Possible causes include tight infibulation or
severe scarring leading to narrowing of the vaginal opening.
infections(UTIs); FGM survivors, esp. type III FGM, have
an increased risk of developing UTI, due to obstruction. This causes the urine
to stagnate, making it susceptible to bacterial growth that can lead to a UTI,
which can become recurrent.
painful or difficult urination; this may be
caused by a UTI or partial obstruction of the urethral opening. Obstruction makes it difficult to empty the
bladder; urine can only exit drop by drop and may continue leaking after
urination has stopped.
epidermal inclusion cysts. Cutting the genital area leads to a wound that may heal to leave a
scar. Sometimes this leads to epidermal inclusion cysts that can gradually increase
in size, may become inflamed or infected, causing pain and tenderness.
Keloids; Due to impaired wound healing and
healing by scar tissue formation, an abnormal sized and continuous growing scar
tissue (keloid) can form at the vagina area.
health issues; Removal or damage to highly sensitive
genital tissues e.g. clitoris affects sexuality of FGM survivors leading to decreased
sexual desires and pleasure, pain during sex, difficulty at penetration,
decreased lubrication, etc.
complications; FGM has increase risk of Caesarean Section
(CS) due to inability of the vagina tissue (which has lost there elasticity due
to FGM) to expand to allow a vaginal birth of the baby leaving the women with
CS as the option. Most women do not want
the option of Caesarean Section (CS) because some Nigerian communities see a
woman who is unable to give birth vaginally as a weakling and thus stigmatize
women who give birth via CS.
Obstetric fistula; to avoid being stigmatized for delivering
via Caesarean Section (CS), some women visit Traditional Birth Attendants where
they may labour for days to deliver through a vagina opening that is too small leading
to obstructed labour.
The consequence would be a uterine rupture, Vesico vaginal fistula(
leaking of urine), Recto Vaginal Fistula (leaking of faces from the vagina) and
excessive bleeding leaving the woman with health and social challenges if she
survives the experience.
Psychological consequences; FGM survivors battle with post-traumatic
stress disorder(PTSD), anxiety disorders
depressions, insomnia, etc.
Having gone through the health consequences of FGM, let’s look at the
Medical intervention available to FGM survivors in Nigeria. Girls and women suffering immediate and
short-term consequences (bleeding, pain, infection, etc.) should visit the
nearest health facility for immediate medical attention.
Fistula repair surgeries; Currently in Nigeria, there are 12 -13
National Obstetric and Fistula centres. Women with obstetric fistula like
mentioned in tweet 26b receive free fistula repair surgeries. The patients with
Fistula can also receive psychotherapy sessions before re-integration into the
society. One of such centres is the National Obstetric and Fistula centre
Abakaliki, Ebonyi State, one of the five focus States for the Joint Programme
Women with infertility issues from FGM can have their babies via
Artificial reproductive techniques in some tertiary hospitals in Nigeria but at
an expensive cost.
Deinfibulation surgeries are available for FGM survivors who had
undergone FGM Type III. It involves re-opening the infibulated genitalia. This surgery
is performed by plastic surgeons in Tertiary hospitals here in Nigeria.
Vagina reconstruction surgeries are available at some Tertiary
hospitals in Nigeria performed by plastic surgeons.
for joining me, @mbamonyii, in the discussion on “Disseminating
the 2018 World Health Organisation (WHO) guideline: “Care of women and girls
living with FGM: a clinical handbook”. @WHO