Female genital mutilation

What is female genital mutilation (FGM)?

Female genital mutilation (sometimes referred to as female circumcision) refers to procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. FGM is illegal in the UK and causes significant physical, mental and emotional harm.

FGM is carried out for cultural, religious and social reasons within families and communities. It’s usually carried out on young girls between infancy and the age of 15, and usually before puberty starts.

It is often considered a necessary part of raising a girl properly, and as a way to prepare her for adulthood and marriage. It is often motivated by the belief that it has benefits for the girl or woman. Many communities believe it will reduce a woman’s libido (sex drive) and discourage sexual activity before marriage.

The procedure is traditionally performed by a woman with no medical training. Anaesthetics and antiseptic treatments are not generally used, and the practice is usually carried out using knives, scissors, scalpels, pieces of glass or razor blades. Girls may have to be forcibly restrained.

It is estimated that more than 20,000 girls under the age of 15 are at risk of FGM in the UK each year, and that 66,000 women in the UK are living with its consequences. However, the true extent is unknown, due to the “hidden” nature of the crime.

Girls may be taken to their countries of origin so that FGM can be carried out during the summer holidays, allowing them time to “heal” before they return to school. It’s prevalent in parts of Africa, the Middle East and Asia. Some girls may have FGM performed in the UK.

In the UK, female genital mutilation tends to occur in areas with larger populations of communities who practise FGM, such as first-generation immigrants, refugees and asylum seekers.

Forms of FGM

There are four main types of FGM:

1. Clitoridectomy – removing part or all of the clitoris
2. Excision – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips)
3. Infibulation – narrowing of the vaginal opening by creating a seal, formed by cutting and repositioning the labia
4. Other harmful procedures to the female genitals, which include pricking, piercing, cutting, scraping and burning the area

Effects

There are no health benefits to FGM. Removing and damaging healthy and normal female genital tissue interferes with the natural functions of girls’ and women’s bodies.

Immediate effects include:

• severe pain
• shock
• bleeding
• wound infections, including tetanus and gangrene, as well as blood-borne viruses such as HIV, hepatitis B and hepatitis C
• inability to urinate
• injury to vulval tissues surrounding the entrance to the vagina
• damage to other organs nearby, such as the urethra (where urine passes) and the bowel

Long-term consequences include:

• chronic vaginal and pelvic infections
• abnormal menstruation (periods)
• difficulty passing urine, and persistent urine infections
• kidney impairment and possible kidney failure
• damage to the reproductive system, including infertility
• cysts and scar tissue
• complications in pregnancy, and newborn deaths
• pain during sex and lack of pleasurable sensation
• mental health issues, including low libido (sex drive), depression and anxiety
• flashbacks during pregnancy and childbirth
• the need for later surgery to open the lower vagina for sexual intercourse and childbirth

FGM can sometimes cause death.

Case histories and personal accounts show that FGM is an extremely traumatic experience for girls and women, which stays with them for the rest of their lives.

Young women receiving counselling in the UK report feelings of betrayal by parents, as well as regret and anger.

The law

Female genital mutilation is illegal in the UK. It is also illegal to allow or arrange for a child to be taken abroad for FGM. If caught, offenders face a large fine and a prison sentence of up to 14 years.

If you are worried about someone who is at risk of FGM, you must share this information with the police. It is their responsibility to investigate and protect any girls or women involved.

If someone under the age of 18 has already experienced FGM, this should also be reported.

Surgical “reversal”

Surgery can be performed to open up the lower vagina. This is sometimes called “reversal”, although it cannot restore sensitive tissue that has been removed.

Surgery may be necessary for women who are unable to have sex because the vagina is too narrow. In addition, some pregnant women who have had FGM will need to have their lower vagina opened up before labour, to allow a safer birth.

Female genital mutilation increases the risk of the vagina tearing during delivery, which causes damage and can lead to heavy bleeding. It can also increase the risk of the baby dying during or just after birth.

Surgery is best performed before pregnancy, or at least within the second trimester of pregnancy (between about 13 and 28 weeks).

Some women may be reluctant to undergo reversal until labour starts, because this may be normal practice in their country of origin.

Surgery involves making a careful incision along the scar tissue that has closed up the entrance to the vagina.

Adequate pain relief is essential. The procedure is usually performed under local anaesthetic in an outpatient clinic. A small number of women will need either a general or spinal anaesthetic (injection in the back), which would normally involve a one-day stay in hospital.

If you have experienced female genital mutilation, you are not alone and support is available.

Birmingham and Solihull Women’s Aid (BSWA) has a specialist FGM worker. Please call the helpline on 0808 800 0028 for more information, or to refer yourself to this service.