What is Female Genital Mutilation?

Female Genital Mutilation (FGM) is internationally recognized as a gross human rights violation, a form of violence against women and girls deeply rooted in gender equality and discrimination.

FGM affects over 200 million women and girls around the world and can cause life-long physical and psychological trauma. It occurs in many cultural, religious and socio-economic groups and is most often carried out on girls between infancy and age 15, although adult women are also subjected.

It is happening in far more countries around the world than widely acknowledged, and the number of women and girls who are affected is being woefully underestimated. Research by international women’s rights organisation Equality Now found evidence of FGM in at least 92 countries, but only 51 (55%) have specific legislation against the practice, leaving millions without adequate legal protection.

FGM has no medical benefits and is performed for a range of complex cultural, religious, and social reasons. Underpinning all this is deeply entrenched gender inequality and discrimination, and the desire to control women’s sexuality and bodily autonomy.

FGM goes in tandem with cultural ideals relating to femininity, modesty, and “appropriate” female sexual behavior, and it is believed to help avert sex before marriage, prevent wives from being unfaithful, and reduce uncertainty relating to paternity. It is often viewed as an essential part of preparing a girl for marriage and adulthood, and those who are cut are thought to have better marriage prospects.

Justifications for FGM are closely tied to set gender roles and the positioning of women and girls as gatekeepers of family honor. Myths prevail about how girls’ sexual desires must be moderated early to preserve their virginity and “purity,” and therefore the honor of the family.

“When I was cut, I didn’t realize it would be the end of my schooling. It took around two months for me to heal and my mother said she had no money for me to pay for my education so instead I had to take care of the cows. Then my mother told me that because she had no income it was time to get someone to take me as their wife.

“At first, I didn’t realize but then I made the connection between the two things. Thinking about it still pains me — my mother cut me so I could be married to an old man.” Caroline, 13

Women who have not undergone FGM can be viewed as dishonourable, and if a daughter remains uncut and her family is unable to arrange her marriage, she may be cast out without support or means of survival. Alternatively, girls who resist are sometimes cut by force.

What are the types of FGM?

The WHO has classified FGM into four categories:

TYPE I — CLITORIDECTOMY: the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and/or the prepuce (the fold of skin surrounding the clitoris).

TYPE II — EXCISION: the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva).

TYPE III — INFIBULATION: the narrowing of the vaginal opening through the creation of a covering seal by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy).

TYPE IV — OTHER: all other harmful procedures to the female genitalia for non-medical purposes, including: pricking; piercing; incising; scraping; and cauterizing the genital area (burning the skin or flesh).

In the past, FGM was viewed as a cultural practice that happened in private and was taboo to discuss openly.

“I didn’t know about FGM before I was cut, I had never heard about it. Nobody explained anything to us, I didn’t understand the reasons, they just did the cutting and left.

“When I came to realize what I had been through, I hated myself, my family and those who had done it to me. I regretted that I didn’t know about cutting before because if I had known then maybe I would have run away. If I had a choice, I would like my body to be the way it was.” Beatrice, 14

Immediate complications include:

excessive bleeding; pain; genital tissue swelling; problems with wound healing; urine retention and other urinary problems; infections; and psychological trauma. In some instances, FGM can result in death.

Longer term effects can include:

• Chronic repeated infections, particularly when the urethra and/or vaginal opening has been blocked through FGM Types II and III. Immediate complications and infections in the reproductive system can occur but often are not medically treated. Such untreated infections can occur in the bladder and kidneys, and can ascend to the uterus and fallopian tubes causing scarring, inflammation, and infertility.
• Urinary problems affecting the bladder, uterus, and kidneys. Partial blockage to the vagina and urethra means the normal flow of urine is deflected and the area remains constantly wet and susceptible to bacterial growth, making infections more common. This can make urination painful, cause recurrent and chronic urinary tract infections, and lead to urinary incontinence. If not treated, such infections can spread to the kidneys, potentially resulting in renal failure, septicaemia, and death.
• Abscesses, cysts, and ulcers. Abscesses typically originate as simple infections that develop in the vulvar skin or tissues underneath the skin. Neurinoma can develop when the dorsal nerve of the clitoris is cut or trapped in a stitch or in scar tissue. The surrounding area becomes hypersensitive and unbearably painful. Cysts vary in size, can be extremely painful, and can prevent sexual intercourse.
• Excessive and painful scar tissue. Keloid scars are the result of excess scar tissue at the site of the cut and are caused by slow and incomplete healing of the wound. These scars can obstruct the vaginal opening and in some cases, can be so extensive that they prevent penile penetration.
• Sexual health problems. FGM involves damaging or removing parts of the body that are directly involved in female sexual function, such as the clitoris and highly sensitive genital tissue. This may impact sexual sensitivity and cause sexual problems, including pain during intercourse; difficulties with penetration; decreased lubrication during sex; reduced sexual pleasure and desire; less frequent or no orgasm. Scar formation, pain, and trauma associated with being cut can also result in such problems. It is important to note that while many FGM survivors experience discomfort during intercourse, some are able to enjoy sexual activity despite having undergone FGM.
• Mental health problems. FGM can result in posttraumatic stress disorder, depression, and anxiety.
• Vaginal infections, including vaginosis and other infections, cause discharge, itching, and discomfort.
• Back and pelvic pain, including from chronic pelvic inflammation and chronic pelvic disease, which is caused by infection of the female upper genital track.
• Menstrual problems caused by obstruction of the vaginal opening or by partial or total blockage or closing of a blood vessel. This can cause painful menstruation (dysmenorrhea), irregular periods, and difficulty in passing menstrual blood, including amenorrhea, which is the absence of menstruation or missed menstrual periods.
• Infertility arising from chronic, long term infections, including damage caused to the fallopian tubes.
• Complications during childbirth. FGM is associated with a greater risk of complications during labor, some of which are life-threatening. Problems including prolonged and difficult labor; caesarean section; obstetric tearing and lacerations; obstetric fistula; and postpartum hemorrhage (bleeding). For Type III FGM, deinfibulation may be required. This is the practice of cutting open the sealed vaginal opening of a woman who has been infibulated, which is often necessary for facilitating childbirth.
• Infant and maternal mortality. FGM related obstetric complications are linked to increased risk of infants requiring resuscitation at delivery, stillbirth, and neonatal death.

“In my community, women and girls are not allowed to make decisions. If your father or husband decides something is good or bad you must accept it, you have no voice.

“I was mutilated when I was 12. Shortly after, my father arranged for me to marry a man who was around 40, and I had a baby when I was 13. I cried a lot but there was nobody to help.

“When you are cut you are not allowed to complain, you are not allowed to cry, you must bear the pain. Before it happened, I wanted it because if you were not mutilated you would be isolated from society. We were blinded by our parents, now we know what they told us is not true. The most important thing is education, to teach young girls to stand up for their rights, to educate parents and teach the cutters the problems of FGM.” Esta, 61

Equality Now is an international women’s rights organisation that focuses on using the law to protect and promote women and girls rights around the world. Find out more about FGM around the world and what Equality Now is doing to end this harmful practice.