CAGeM

Campaign Against Genital Mutilation
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CLASSIFICATION
 
 
 
TYPES DESCRIPTION
TYPE 1

Partial or total removal of the clitoris and/or
the prepuce (clitoridectomy).
When it is important to distinguish between the
major variations of Type I mutilation, the following
subdivisions are proposed:

 

Type Ia, removal of the
clitoral hood or prepuce only;

 

Type Ib, removal of the
clitoris with the prepuce.

TYPE 2

 Partial or total removal of the clitoris and the
labia minora, with or without excision of the labia
majora (excision).
When it is important to distinguish between the major
variations that have been documented, the following
subdivisions are proposed:

 

Type IIa, removal of the
labia minora only;

 

Type IIb, partial or total removal of
the clitoris and the labia minora;

 

Type IIc, partial or
total removal of the clitoris, the labia minora and the
labia majora.


Note also that, in French, the term "excision" is often
used as a general term covering all types of female
genital mutilation.

TYPE 3

 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).
When it is important to distinguish between variations
in infibulations, the following subdivisions are
proposed:

 

Type IIIa: removal and apposition of the
labia minora;

 

Type IIIb: removal and apposition of the
labia majora.

TYPE 4 Unclassified: All other harmful procedures
to the female genitalia for non-medical purposes, for
example, pricking, piercing, incising, scraping and
cauterization.
 
De-infibulation

Infibulation creates a physical barrier to sexual intercourse and childbirth. An infibulated woman therefore has to undergo gradual dilation of the vaginal opening before sexual intercourse can take place. Often, infibulated women are cut open on the first night of marriage (by the husband, or a circumciser), in order to enable the husband to be intimate with his wife. At childbirth, many women also have to be cut again, because the vaginal opening is too small to allow for the passage of a baby. Attempts at forcible penetration may cause rupture of scars and sometimes perineal tears, dyspareunia, and vaginismus. Excessive penile force during first intercourse can cause severe bleeding, shock and infection.
 
Re-infibulation
In some communities, the raw edges of the wound are sutured again after childbirth, recreating a small vaginal opening. Re-infibulation is the sewing up of a circumcised woman’s vaginal opening after childbirth or periodically during her life when she feels as though her opening has gotten too big or loose.


 
Type I

Type I FGM is the partial or total removal of the clitoris (clitoridectomy),and/or the prepuce removal (clitoral hood), see Diagram 1B. When it is important to distinguish between the major variations of Type I mutilation, the following subdivisions are proposed.
 
Type Ia, removal of the clitoral hood or prepuce only.
 
Type Ib, removal of the clitoris with the prepuce. In the context of women who seek out labiaplasty, Stern opposes removal of the clitoral hood and points to potential scarring and nerve damage.

Type II

Type II FGM is "partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed:
 
Type IIa, removal of the labia minora only
 
Type IIb, partial or total removal of the clitoris and the labia minora
Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora. Note also that, in French, the term ‘excision’ is often used as a general term covering all types of female genital mutilation.

Type III: Infibulation with excision

Type III FGC is 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)." It is the most extensive form of FGM, and accounts for about 10% of all FGM procedures described from Africa. Infibulation is also known as "pharaonic circumcision."

In a study of infibulation in the Horn of Africa, Pieters observed that the procedure involves extensive tissue removal of the external genitalia, including all of the labia minora and the inside of the labia majora. The labia majora are then held together using thorns or stitching. In some cases the girl's legs have been tied together for two to six weeks, to prevent her from moving and to allow the healing of the two sides of the vulva. Nothing remains but the walls of flesh from the pubis down to the anus, with the exception of an opening at the inferior portion of the vulva to allow urine and menstrual blood to pass through, see Diagram 1D. Generally, a practitioner deemed to have the necessary skill carries out this procedure, and a local anesthetic is used. However, when carried out "in the bush," infibulation is often performed by an elderly matron or midwife of the village, with no anesthesia used.

A reverse infibulation can be performed to allow for sexual intercourse or when undergoing labor, or by female relatives, whose responsibility it is to inspect the wound every few weeks and open it some more if necessary. During childbirth, the enlargement is too small to allow vaginal delivery, and so the infibulation is opened completely and may be restored after delivery. Again, the legs are sometimes tied together to allow the wound to heal. When childbirth takes place in a hospital, the surgeons may preserve the infibulation by enlarging the vagina with deep episiotomies. Afterwards, the patient may insist that her vulva be closed again.

This practice increases the occurrence of medical complications due to a lack of modern medicine and surgical practices.

A five-year study of 300 women and 100 men in Sudan found that "sexual desire, pleasure, and orgasm are experienced by the majority of women who have been subjected to this extreme sexual mutilation, in spite of their being culturally bound to hide these experiences."

Most advocates of the practice continue to perform the procedure in adherence to standards of beauty that are very different from those in the west. Many infibulated women will contend that the pleasure their partners receive due to this procedure is a definitive part of a successful marriage and enjoyable sex life.

Type IV: Other types

There are other forms of FGM, collectively referred to as Type IV, that may not involve tissue removal. Type IV FGC as "all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization." This includes a diverse range of practices, such as pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina. Type IV is found primarily among isolated ethnic groups as well as in combination with other types.