Female genital cutting (FGC), female genital mutilation (FGM), female circumcision (FC), is the excision or tissue removal of any part of the female genitalia for religious, cultural or other non-medical reasons. It is not the same as the procedures used in gender reassignment surgery or the genital modification of intersexuals. FGC is practiced throughout the world, but the practice is concentrated more heavily in Africa, Indonesia, and the Middle East.
The World Health Organization (WHO) separates FGC procedures into four categories: Type I, II, III, and IV. There is much controversy surrounding Type III (Infibulation) due to concerns regarding the safety and consequences of the procedure. In the past several decades, there have been pushes by global health organizations, such as the WHO, to end the practice of FGC. However, due to its importance in traditional and religious life, the practice remains in many societies.
The World Health Organization (WHO) separates FGC procedures into four categories: Type I, II, III, and IV. There is much controversy surrounding Type III (Infibulation) due to concerns regarding the safety and consequences of the procedure. In the past several decades, there have been pushes by global health organizations, such as the WHO, to end the practice of FGC. However, due to its importance in traditional and religious life, the practice remains in many societies.
World Health Organization Categorization
Type I
The WHO defines Type I female genital mutilation as the removal or splitting of the clitoral hood, termed "hoodectomy" (or "clitorodotomy"), with or without excision of the clitoris, see Diagram 1B. The clitoral hood is homologous to the foreskin of the penis which is removed during circumcision.
Although labeled Sunna by Islamic advocates of the practice, most Muslim clergy oppose all forms of female genital cutting as it is viewed as a social custom, rather than a religious practice. According to Dr. Sami A. Aldeeb Abu-Salieh at the Swiss Institute of Comparative Law:
Islamic juridical logic cannot acknowledge the distinction between female and male circumcision, both being the mutilation of healthy organs which is damaging to the physical integrity of the child, whatever the underlying religious motivations. Furthermore, both practices violate the
Type II: Excision
Excision refers to clitoridectomy (removal of the prepuce and the clitoris) plus the partial or total removal of the labia minora, the inner lips of the vulva, see Diagram 1C. Type II circumcision is a more extensive form of FGC compared to Type I and due to the sewing together of the leftover labia minora epidermis, which contains sweat glands, a buildup of sweat and urine in the closed off space beneath this closure can lead to local or urinary infection, septicemia, hemorrhaging and cyst formation.This type of FGC is also called khafd, meaning reduction in Arabic.
Type III: Infibulation
Type III is the most severe form of FGC and is called infibulation or pharaonic circumcision (referring to the Pharaohs who were thought to practice this form). It accounts for 15% of all FGM procedures. Infibulation 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 must be opened completely and 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. Despite claims that infibulation eliminates sexual pleasure, 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.
In some areas of Africa, women see infibulation as a form of female empowerment. A study by Anthropologist Rogaia M. Abusharaf, found that "circumcision is seen as 'the machinery which liberates the female body from its masculine properties' and for the women she interviewed, it is a source of empowerment and strength"
Type IV: Other types
There are other forms that are collectively referred to as Type IV and may not involve any tissue removal at all. This includes a diverse range of practices, including pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina or introducing herbs into the vagina to cause bleeding and a narrowed vaginal opening. Type IV is found primarily among isolated ethnic groups as well as in combination with other types.