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The types and health risks of female genital mutilation

Received 2011 Jul 18; Accepted 2011 Oct 3.

  • Excision of part or all of the external genitalia and stitching together of the two cut sides, to varying degrees;
  • FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male;
  • The procedure is routinely carried out between the ages of six and eight with a few cultures preferring to cut at birth, menarche, or before marriage [ 8 ].

This article has been cited by other articles in PMC. It is recognized internationally as a violation of the human rights of girls and women and constitutes an extreme form of discrimination against women due to the severe health consequences and the pain and risks involved. In many societies it is a rite of passage to womanhood with strong, ancestral sociocultural roots.

  • The risk of bias was assessed in all studies by three independent review authors;
  • Childbirth for infibulated women presents the greatest challenge, as maternal mortality rates are significantly higher because of complications that arise during labor;
  • Type IV is a broad category that includes all other harmful procedures done without medical purpose to the female genitals;
  • More than 3 million girls are at risk for circumcision on the continent of Africa [ 21 ].

Excision of the prepuce and part or all of the clitoris. Excision of the prepuce and clitoris together with partial or total excision of the labia minora.

Excision of part or all of the external genitalia and stitching together of the two cut sides, to varying degrees. Pricking, piercing, incision, stretching, scraping, or other procedures harming the clitoris or labia, or both. The immediate health complications include shock, haemorrhage, infections and psychological consequences [ 11 - 13 ].

Health consequences of female genital mutilation/cutting in the Gambia, evidence into action

The long term health risks consist of chronic pain, infections, cheloids formation, primary infertility, birth complications, danger to the new born and psychological consequences [ 13 - 18 ].

For example, they have been reported to provoke unequivocal complications like shock, haemorrhage, urogenital complications [ 12 ], obstetric complications [ 18 ] and sexual dysfunction [ 15 ]. In 1999, Morison et al. This issue has political and religious implications since the government of The Gambia asked for medical proofs on the harmfulness of the practice in order to permit making an informed statement based on local evidence and taking further steps.

Sexual and reproductive health

The specific objectives are to: The data has been collected during 4 months December 2008 to March 2009 in hospitals and major health centres throughout the country, achieving a total of 871 cases of women and girls that have undergone the practice. As there is no national health register, it was impossible to determine the total number of medical consultations during study period, consequently making it impossible to calculate morbidity and mortality indices.

Health risks of female genital mutilation (FGM)

Data collection The data has been collected by Cuban doctors, specialized in General Comprehensive Medicine and Gynaecologists, working in The Gambia on a humanitarian mission.

The data analyzed here are obtained from secondary data as a result of patients' spontaneous demand and consequently the use of the data no required previous information to the patient.

Furthermore, the research team, in agreement with the Gambian health authorities, collected data anonymously. After the doctors visited the patients, the information was collected in a clinical form specially designed for the study.

Obstetrics and Gynecology International

They could not guarantee that the data was recorded exhaustively due to the inadequate conditions of the health facilities and the over demand of medical services. This survey provides a "raw" picture and is the preliminary step to conducting a more complete clinical survey, covering complications during delivery and foetal suffering.

The review took place only in medical facilities consultations and delivery rooms. The clinical examination only was done if the patient reported a medical problem requiring a medical gynaecological examination. Demographic Variables - Registration place: Patient's region of residence.

All six regions in The Gambia: Clinical variables qualitative variables - Type of cutting ordinal. Categories of this variable were those defined by WHO in 1995.

What is female genital mutilation?

Type IV was not included in the study. Complications were also classified, according to the time when they appeared, into: Patients in who cutting was recent, with signs of complication appearing in the next few hours and up to 10 days after cutting was performed. Complications appeared more than 10 days later, and were more related with pregnancy affectations during labour or childbirth Obstetrics complications.

Depending on aetiology, the complications can be: Excessive bleeding from genitalia because of this cause. Considered in this study if the patient presented symptomatology suggesting anaemia, as a consequence of haemorrhage due to the cutting.

Invasion and spreading of pathogenic micro organisms, divided into: Presence of fits or convulsions, opistotonous position. Colonization of the blood by bacteria with a lethal systemic infectious stage. Acute inflammation of the vaginal mucus characterized by burnings, itching, redness and excoriation due to rash with or without leucorrhoea. Pathologic formation of fibrous tissue in the genitalia due to an abnormal scarring or cicatrisation of cuts, i.

Excessive growth of scar tissue at the site of a skin lesion that has just healed. Characterized by an abnormal growth of the tissue over the place of the cutting.

  1. No date restrictions were imposed, and all study types were explored including systematic reviews, cohort studies, case-control studies, case series, cross-sectional studies, case reports, and randomized controlled studies to encompass qualitative research and the qualitative element of diversified methods.
  2. If not treated, such infections can ascend to the kidneys, potentially resulting in renal failure, septicaemia and death.
  3. If the people with power and authority in a place believe and agree that FGM should prevail, it is difficult to prevent it. Discussion and Interpretation The current review demonstrates that the practice of FGM remains prevalent in certain countries, even though there may exist laws against FGM.
  4. Worldwide banning of FGM In 2012, the United Nations adopted a resolution banning FGM worldwide , stating that "All necessary measures, including enacting and enforcing legislation to prohibit FGM and to protect women and girls from this form of violence, and to end impunity. Prior literature reported the association between female circumcision and maternal morbidity and birth outcomes [ 26 ].

Adherence and abnormal fusion which may be partial or total, of the major or minor labia. Due to the tissue lost with abnormal scarring and retraction of anatomical zones.

  • As the short-term complications manifest, mortality risk increases because of the limited health care available in low-income economies;
  • WHO efforts to eliminate female genital mutilation focus on;
  • The eradication of FGM as a public health initiative is imperative to ensuring that newborn females and youth do not undergo this traumatic ordeal.

Gynaecological complication characterized by pain during intercourse due to the cutting. Chi square tests of association were calculated and partial binomial and multinomial distributions are compared. Ethical aspects This survey was done at the request of the Gambian government. The clinical register was kept under the custody of the medical personnel in charge of that issue, and under rigorous confidentiality.

Results Data was collected on a total of 871 cases, throughout the country. Type III had a much lower prevalence, 7. Complications, whether immediate or late, were present in 23. The most common immediate complication, for all types, was infection, associated in some cases with haemorrhage and anaemia. The late complications were observed in 189 patients out of 871 patients, 21.