CAGeM

Campaign Against Genital Mutilation
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Harmful Effects of FGM 
 
Female genital mutilation is associated with a series of health risks and consequences. Almostall those who have undergone female genital mutilation experience pain and bleeding as a
consequence of the procedure. The intervention itself is traumatic as girls are usually physically held down during the procedure. Those who are infibulated often have their legs bound together for several days or weeks thereafter. Other physical and psychological health problems occur with varying frequency. Generally, the risks and complications associated with Types I, II and III are similar, but they tend to be significantly more severe and prevalent the more extensive the procedure. Immediate consequences, such as infections, are usually only documented when women seek hospital treatment. Therefore, the true extent of immediate complications is unknown. CAGeM is currently conducting research on the immediate consequences. Long-term consequences can include chronic pain, infections, decreased sexual enjoyment, and psychological consequences, such as post-traumatic stress disorder.
Dangers for Childbirth
 
A study in which more than 28,000 women participated, confirms that women who had undergone genital mutilation had significantly increased risks for adverse events during childbirth. Higher incidences of caesarean section and post-partum haemorrhage were found in the women with Type I, II and III
genital mutilation compared to those who had
not undergone genital mutilation, and the risk
increased with the severity of the procedure.
 
A striking new finding from the study is that genital mutilation of mothers has negative effects on their newborn babies. Most seriously, death rates among babies during and immediately after birth were higher for those born to mothers who had undergone genital mutilation compared to those who had not: 15% higher for those whose mothers had Type I, 32% higher for those with Type II and 55% higher for those with Type III genital mutilation. It was estimated that, at the study sites, an additional one to two babies per 100 deliveries die as a result of female genital mutilation.
 
The consequences of genital mutilation for most
women who deliver outside the hospital setting
are expected to be even more severe.  The high incidence of postpartum haemorrhage, a life-threatening condition, is of particular concern where health services are weak or women cannot easily access them.
 
 
Long-term consequences
 
  • Anemia
  • Intermittent bleeding
  • Urinary tract infections
  • Kidney damage
  • Incontinence
  • Reproductive tract infections
  • Chronic pelvic infections
  • Infertility
  • Cysts
  • Scars
  • Permanent pain
  • Painful sexual intercourse (dyspareunia)
  • Problems in pregnancy and childbirth
  • Increased risk of maternal or fetus death during childbirth
  • Easier transmission of HIV during sexual intercourse
  • Abscesses
  • Keloid scar formation
  • Damage to the urethra, resulting in urinary incontinence
  • Sexual dysfunction
  • Hypersensitivity of the genital area.

Other serious long term health effects are also common. These include urinary and reproductive tract infections, caused by obstructed flow of urine and menstrual blood, various forms of scarring and infertility. The first time having sexual intercourse will often be extremely painful, and infibulated women will need the labia majora to be opened, to allow their husband access to the vagina. This second cut, sometimes performed by the husband with a knife, can cause other complications to arise.

 

Infibulation can cause severe scar formation, difficulty in urinating, menstrual disorders, recurrent bladder and urinary tract infection, fistulae, prolonged and obstructed labour (sometimes resulting in fetal death and vesico-vaginal fistulae and/or vesico-rectal fistulae), and infertility (as a consequence of earlier infections).

Cutting of the scar tissue is sometimes necessary to facilitate sexual intercourse and/or childbirth. Almost complete vaginal obstruction may occur, resulting in accumulation of menstrual flow in the vagina and uterus. During childbirth the risk of haemorrhage and infection is greatly increased.

 
 
Immediate Risks
 
  • Death
  • Severe pain
  • Shock
  • Haemorrhage
  • Tetanus or sepsis
  • Urine retention
  • Ulceration of the genital region
  • Injury to adjacent tissue
  • Wound infection
  • Urinary infection
  • Fever
  • Septicaemia
  • Potential spread of HIV
 
Immediate risks of health complications from Types I, II and III

Severe pain: Cutting the nerve ends and sensitive genital tissue causes extreme pain. Proper anaesthesia is rarely used and, when used, not always effective. The healing period is also painful. Type III female genital mutilation is a more extensive procedure of longer duration (15–20 minutes), hence the intensity and duration of pain are more extensive. The healing period is extended and intensified accordingly.
 
Shock can be caused by pain and/or
haemorrhage.

Excessive bleeding (haemorrhage) and septic
shock have been documented. 

Difficulty in passing urine, and also passing of
faeces, can occur due to swelling, oedema and
pain.

Infections may spread after the use of
contaminated instruments (e.g. use of same
instruments in multiple genital mutilation
operations), and during the healing period.
 
Human immunodeficiency virus (HIV)
Use of the same surgical instrument without sterilization could increase the risk for transmission of HIV between girls who undergo female genital mutilation together.6 In one study an indirect association was found,7 but no direct association has been documented,8 perhaps because of the rarity of mass genital cutting with the same instrument, and the low HIV prevalence among girls of the age at which the procedure is performed.
 
Death
Death can be caused by haemorrhage or infections, including tetanus and shock.
 
Psychological consequences
The pain, shock and the use of physical force by those performing the procedure are mentioned as reasons why many women describe female genital mutilation as a traumatic event.  Genital mutilation/cutting may leave a lasting mark on the life and mind of the woman who has undergone the procedure. The psychological stress may trigger behavioural disturbances in children, closely linked to the loss of trust and confidence in care-givers. In the longer term, women may suffer feelings of anxiety, depression, and frigidity. Sexual dysfunction may also be the cause for marital conflicts and eventual divorce.
 
Unintended labia fusion
Several studies have found that, in some cases, what was intended as a Type II female genital mutilation may, due to labia adhesion, result in a Type III female genital mutilation.

Repeated female genital mutilation appears to be quite frequent in Type III female genital mutilation, usually due to unsuccessful healing.