women’s rights

As gynecologist with own office I am regularly if not very often confronted with this practice. Due to immigration from countries practicing FGM we see this phenomenon increasingly also in European countries.
It is important to be sensitized to this topic and to know more about it to treat affected women adequately and to prevent further damage caused by lack of experience, repudiation and judgment of FGM.

Here is some important background information:

FGM (or female circumcision as described by some authors) comprises the partial or total removal or other injury to the external female genitalia executed for cultural or other, non-medical purposes.

The World Health Organization (WHO) estimates that worldwide at least 200 million women are affected by FGM. The annual number of new cases amounts to two million – most of them being infants, toddlers and young girls.

History

Even though often religious motifs are used to justify the practice, no religion explicitly demands FGM. The practice is older than Christianity and Islam. In the areas concerned Muslims, Catholics, Protestants, animists and atheists practice FGM.

Social and cultural reasons do have an important imfluence :

• Tradition, rite of passage
• Purity requirements
• Aesthetic reasons
• Preservation of virginity
• Assure  fidelity in married women
• Increase in fertility
• Group membership

These are just a few examples, the list could be extended indefinitely.

Geography

FGM is practiced predominantly in 28 African countries south of the Sahara and more rarely in some Asian regions. Egypt is the only north-African country where the practice is used.

Types of FGM

There are four types of FGM

Type 1 Sunna circumcision – removal of prepuce and partial or total removal of the clitoris.
Type 2 Removal of the clitoris plus part or all of the labia minora.
Type 3 Infibulation – removal of part or all of the labia minora, with the labia majora sewn together, covering the uretha and vagina and leaving a small hole for urine and menstrual fluid. The scar has to be opened for sexual intercourse and birth which provokes additional pain. This is the worst type of FGM.
Type 4 All other procedures to the female genitalia for non-medical purposes including pricking, piercing, incising, scraping and cauterization.

The majority of all (80%) comprise types 1 and 2. Infibulation represents 15% of all cases.

Procedure of FGM

Generally the procedures are performed by traditional circumcisers. In most cases the intervention takes place without anaesthesia and non-sterile devices. Devices include knives, scissors, razors, glass and scalpels.
In 70% of the cases FMG is undertaken during childhood. In some regions it is done shortly after birth, in others prior to a wedding or during puberty .

Consequences of FGM

FGM harms women’s physical and emotional health dramatically. Immediately after the FGM the complications can be hemorrhages, inflammations, tetanus, bladder paralysis or septicemia, which frequently are fatal. The use of non-steril devices can also provoke an infection with the HIV virus.

In the long term victims often complain of pain while urinating or during period. Infections of the bladder and incontinence may occur as well as pain during sexual intercourse and infertility.

Interestingly, affected women very often do not realize that these complications are consequences of the FGM. Usually the FGM is an event far in the past and they share these problems with most of the women around them («The typical life of a woman»).

Women concerned who live in the West very often are struggling more with the psychological problems and FGM can provoke severe psychological trauma. Very often it is perceived as a breach of confidentiality of their parents and grandparents. Anxiety, depression, couple problems or psychosis may be the results.

Legal situation

FGM is considered an aggravated assault which represents a punishable act in Switzerland . This applies also when the procedure is executed according to the patient’s desire.

Finally, I would like to emphasize the necessity to also take into account the legal, cultural and ethical problems as well as the medical ones when dealing with women affected by FGM. When confronted with the consequences of a tradition which most of us condemn vehemently, we may show reactions that are humiliating the women even more. Consequently, the topic has to be addressed with the utmost sensibility – even though it has to be addressed – because we have to protect their daughters from having to go through the same ordeal.

Dr. med. Elisabeth Lebeda
FMH Gynäkologie und Geburtshilfe
Dorfstrasse 5
8700 Küsnacht