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 non-medical reasons.
There are four types of FGM, as classified by World Health Organisation (WHO) in 1997 and subdivided in 2008, and they are:
Type I: partial or total removal of the clitoris and/or the prepuce (Clitoridectomy).
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.
Type II: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
Subdivisions 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.
Type 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.
It 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
Every 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 their lives.
The 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.
The 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 daughter.
The 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.
Despite 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.
For more information about FGM you can visit http://www.who.int andwww.endcuttinggirls.org or watch https://www.youtube.com/watch?v=f0-dYD9cYKo&t=80s
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 adequate treatment.
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 disease (PID).
menstrual 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.
urinary tract 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.
Female sexual 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.
Obstetric 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 (UNJP).
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.
Thank you 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
For more information please download the “Care of women and girls living with FGM: a clinical handbook (WHO 2018), http://apps.who.int/iris/bitstream/handle/10665/272429/9789241513913-eng.pdf?ua=1
To learn more about the Social Media Campaign to end FGM, please visit endcuttinggirls.org and follow our social media handles on Facebook, Twitter, Instagram and YouTube, using
At this point, I will end the presentation to give room for questions and contributions from participants. Thank you all for reading our tweets
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