Female Genital Mutilation: No such thing as perfect Vagina

Despite the campaign against FGM, there seem to be a group of women who wants to change their genitalia.Well from breast surgery to lip surgery what else would be left untouched by the knife, but surely one’s genitalia, that is crazy

Lately it seems like everyone is obsessed with a topic which most women have probably wondered or even worried about at some stage in their lives: The appearance of the vagina.

I am sure that all women have experienced that moment when you catch a glimpse of your bits in a mirror and think “I wonder if this is what a vagina is supposed to look like”. Maybe not but if one has, it is actually a completely irrational thought. First of all, genitalia are odd looking. Whether it’s a penis or a vagina, they are proof that God has a sense of humour and he used it when creating our nether regions.

Secondly, there is no such thing as the perfect vagina. I can’t even imagine how you would go about deciding what the criteria for the ideal vagina would be. A discussion about the appropriate amount of pubic hair alone would probably take months. Not to mention the proportions of all the other bits and pieces.

 A friend told me she only recently made her peace with the way her lady garden looks. She used to want to have it as smooth as a baby’s bum and an unfortunate incident involving some poorly applied hair removal cream led to her first full-on confrontation with her vagina as an adult.
She said she was completely horrified. She was convinced that her labia minora was way too big and the labia majora not plump enough. Needless to say, she avoided looking at it until the hair grew back and did not allow anyone else to see it either.

These days, however, after a chat on the Female Genital mutilation issue, my friend frequently go for full bikini waxes and love how it looks. For her now it’s not about modifying her vagina, but rather a celebration of it. She no longer try to hide it behind hair the way you would try to hide an odd-looking house behind a pretty garden. It has helped her to accept a very intimate part of her anatomy. Ladies no vaginal mutilation for a man to like the way you look. Why go through the pain and expense?

That being said, I do believe that people who would resort to cosmetic surgery to permanently alter the way their bits look are out of their damn minds. Why would you allow someone to operate on you unless it is necessary? Sure, some women have real vaginal health issues like obstetric fistula that needs to be fixed, but trying to nip and tuck your way to the supposed ultimate vagina? Please.

Vaginas come in different shapes, sizes and colours. And thank goodness they do, because being a woman would be a lot less interesting if we all looked the same down below.

 

Circumcision: The other side

What is Male Circumcision?

Male circumcision is the surgical removal of some or all of the foreskin (or prepuce) from the penis.

Male Circumcision and Risk for HIV Acquisition by Heterosexual Men

Several types of research have documented that male circumcision significantly reduces the risk of men contracting HIV through penile-vaginal sex.

Biologic Plausibility

Compared with the dry external skin surface of the glans penis and penile shaft, the inner mucosa of the foreskin has less keratinization (deposition of fibrous protein) and a higher density of target cells for HIV infection. Some laboratory studies have shown the foreskin is more susceptible to HIV infection than other penile tissue, although others have failed to show any difference in the ability of HIV to penetrate inner compared with outer foreskin surface. The foreskin may also have greater susceptibility to traumatic epithelial disruptions (tears) during intercourse, providing a portal of entry for pathogens, including HIV. In addition, the microenvironment in the preputial sac between the unretracted foreskin and the glands penis may be conducive to viral survival. Finally, the presence of other sexually transmitted diseases (STDs), which independently may be more common in uncircumcised men, increase the risk for HIV acquisition.

International Observational Studies for Prevention of HIV Acquisition by Heterosexual Men

A systematic review and meta-analysis that focused on male circumcision and heterosexual transmission of HIV in Africa was published in 2000. It included 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study. A substantial protective effect of male circumcision on risk for HIV infection was noted, along with a reduced risk for genital ulcer disease. After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at STD clinics, for whom the adjusted relative risk was 71% lower for circumcised men.

Another review that included stringent assessment of 10 potential confounding factors and that was stratified by study type or study population was published in 2003. Most of the studies were from Africa. Of the 35 observational studies in the review, the 16 in the general population had inconsistent results. The one large prospective cohort study in this group showed a significant protective effect: The odds of infection were 42% lower for circumcised men. The remaining 19 studies were conducted in populations at high risk. These studies found a consistent, substantial protective effect, which increased with adjustment for confounding. Each of the four cohort studies included in the review demonstrated a protective effect, and two were statistically significant.

Ecologic studies also indicate a strong association between lack of male circumcision and HIV infection at the population level. Although links among circumcision, culture, religion, and risk behaviour may account for some of the differences in HIV infection prevalence, the countries in Africa and Asia with prevalence of male circumcision of less than 20% have HIV infection prevalences several times higher than those in countries in these regions where more than 80% of men are circumcised.

International Clinical Trials for Prevention of HIV Acquisition by Heterosexual Men

Three randomized controlled clinical trials (RCTs) were conducted in Africa to determine whether circumcision of adult males reduces their risk for HIV infection. The controlled follow-up period in all three studies was stopped early, and the control group offered circumcision when interim analyses found that medical circumcision significantly reduced male participants' HIV infection risk. The controlled follow-up period in the study in South Africa was stopped in 2005, and the controlled follow-up periods for the studies in Kenya and Uganda were stopped in 2006.

In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a small number of men who had been assigned to be circumcised did not undergo the procedure; likewise, a small number of men assigned to the control groups did undergo circumcision. When the data were reanalysed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised.

A 2008 meta-analysis, which examined data from the three RCTs, as well as from cohort and case-control studies, found that HIV risk was reduced 58% in circumcised men (overall risk ratio [RR], 0.42; 95% confidence interval .The authors concluded that the studies provided enough evidence to conclude that circumcision causes a reduction in transmission of HIV-1 infection.

Male Circumcision and Other Health Conditions

Carcinogenic subtypes of human papillomavirus (HPV)—which are believed to cause 100% of cervical cancers, 90% of anal cancers, and 40% of cancers of the penis, vulva, and vagina —have also been associated with lack of circumcision in men. A Ugandan RCT found a lower prevalence of high-risk HPV subtypes among men in the circumcised group. In a South African trial, circumcision was also associated with a lower prevalence of high-risk HPV subtypes. These prevalence associations may result from an effect of circumcision on HPV acquisition by men, its persistence, or both.  The Ugandan RCT also found incidence of high-risk HPV infection among women to be lower among those with circumcised male partners.

The lifetime risk for a U.S. male of ever being diagnosed with penile cancer is 1 in 1,437. In a retrospective analysis of 89 cases of invasive penile cancer diagnosed from 1954 through 1997, 98% were in uncircumcised men; of 118 cases of carcinoma in situ, 84% were in uncircumcised men. Schoen published a retrospective review of 5 studies with 592 cases of invasive penile cancer in the United States; none of the cases were in men who had been circumcised in infancy.

In a meta-analysis of male circumcision status and cervical cancer in female partners, data from 7 case-control studies were pooled. Circumcision was associated with significantly less HPV infection in men. In an analysis restricted to monogamous women, there was a nonsignificant reduction in the odds of having cervical cancer among women with circumcised partners. When the couples with men with 5 or fewer lifetime partners (40% of the study population) were excluded, there was a significantly reduced odds of cervical cancer in female partners of circumcised men compared with the female partners of uncircumcised men.

Studies have consistently demonstrated decreased incidence of urinary tract infections (UTIs) among circumcised compared with uncircumcised boys. A meta-analysis including 18 studies found a pooled UTI prevalence of 20.1% among febrile uncircumcised boys <3 months of age and a prevalence of 2.4% among febrile circumcised boys <3 months of age. Another systematic review included 12 studies and over 400,000 children and concluded that male circumcision was associated with a significantly reduced risk of UTI.

Overall, UTIs are not common among male infants, with estimates of the annual rate of UTI in uncircumcised infants being 0.70% versus 0.18% for circumcised infants.

 

Data from clinical trials also provides evidence that circumcision is significantly associated with decreased incidence of herpes simplex virus type 2 (HSV-2). The Ugandan trial also found that male circumcision may reduce self-reported genital ulcer disease in men. In female partners of circumcised men, evidence from the trials showed a significant reduction of female genital ulceration, bacterial vaginosis, and trichomoniasis.

Results from observational studies have been mixed but have found lower risk for some STDs in circumcised men. A 2006 meta-analysis included 26 studies that assessed the association between male circumcision and risk for male genital ulcer disease. The analysis concluded that, overall, there was a significantly lower risk for syphilis (however, an RCT showed that syphilis was not reduced) and chancroid among circumcised men, whereas the reduced risk of herpes simplex virus type 2 infection had a borderline statistical significance .

Risks Associated with Male Circumcision

Reported complication rates depend on the type of study (e.g., chart review vs. prospective study), setting (medical vs. nonmedical facility), person operating (traditional vs. medical practitioner), patient age (infant vs. adult), and surgical technique or instrument used.

In large studies of infant circumcision in the United States, reported inpatient complication rates are approximately 0.2%. The most common complications are bleeding and infection, which are usually minor and easily managed.

A recent meta-analysis of 16 prospective studies from diverse settings worldwide that evaluated complications following neonatal, infant, and child male circumcision found that median frequency of severe adverse events was 0% (range, 0%-2%). The median frequency of any complication was 1.5% (range, 0%-16%). Male circumcision by medical providers on children tended to be associated with more complications (median frequency, 6%; range, 2%-14%) than for neonates and infants.

In the three African trials of adult circumcision, complication rates for adult male circumcision ranged from 2% to 8%. The most commonly reported complications were pain, bleeding, infection, and unsatisfactory appearance. There were no reported deaths or long-term effects documented.

Minimizing pain is an important consideration for male circumcision. Appropriate use of analgesia is considered standard of care for the procedure at all ages and can substantially control pain. One study found that 93.5% of neonates circumcised in the first week of life using analgesia gave no indication of pain on an objective, standardized neonatal pain rating system.

Effects of Male Circumcision on Penile Sensation and Sexual Function

Well-designed studies of sexual sensation and function in relation to male circumcision are few, and the results present a mixed picture. Taken as a whole, the studies suggest that some decrease in sensitivity of the glans to fine touch can occur following circumcision. However, several studies conducted among men after adult circumcision suggest that few men report their sexual functioning is worse after circumcision; most report either improvement or no change. The three African trials found high levels of satisfaction among the men after circumcision.

HIV Infection and Male Circumcision in the United States

The United States has a much lower population prevalence of HIV infection (0.4%) than sub-Saharan Africa [53], and an epidemic that is concentrated among men who have sex with men, rather than men who have sex with women. In 2006, it is estimated that approximately 56,300 new HIV infections occurred, of which 73% were in males. Of all new infections, 53% were in MSM, 31% in heterosexuals with reported high risk of exposure, 12% in injection drug users (IDUs), and 4% in MSM-IDUs. Among men, 72% of estimated new infections occurred in the male-to-male sexual contact transmission category, while heterosexual transmission accounted for 13%.

In one prospective study of heterosexual men attending an urban STD clinic, when other risk factors were controlled, uncircumcised men had a 3.5-fold higher risk for HIV infection than men who were circumcised. However, this association was not statistically significant due to small sample size. And in an analysis of clinic records for African American men attending an STD clinic, circumcision was not associated with HIV status overall, but among heterosexual men with known HIV exposure, circumcision was associated with a statistically significant 58% reduction in risk for HIV infection.

Summary

Male circumcision reduces the risk that a man will acquire HIV from an infected female partner, and also lowers the risk of other STDs, penile cancer, and infant urinary tract infection. Although male circumcision has risks including pain, bleeding, and infection, more serious complications are rare.

Of late health ministers in Zimbabwe, South Africa, and Botswana where HIV/AIDS is most prevalent have been encouraging adult men to go for circumcision because  there is evidence  it reduces the risk of the disease. The same could not be said of FGM.

 

                                                                                               

Female Genital Mutilation: Common complications

 

I thought I should add this following my article on the risk of HIV/AIDS on female genitally mutilated women which was attacked by a reader who thinks male circumcision carries more risk of HIV/AIDS.  On the contrary more women are HIV infected than men around the world. I am still surprised at how some people jump to compare male circumcision (based on a small figure of US males) and female genital mutilation without thinking of the people in the African interior where FGM is practised with no chance of anaesthesia except the powdered poultice from the cutters.  In my articles I never say male circumcision is good but my platform is for the girls and women who are genitally mutilated and live with the scars for the rest of their lives. Here is why:-

Complications following FGM, especially if the girl is infibulated, are common and many are well documented. These may be immediate or late. The major immediate complications are, of course, haemorrhage from the dorsal artery, shock and then infection, urinary retention and tetanus, which can lead to mortality.

Some late and long-term complications seen are urinary incontinence, cysts, urogenital tract infections; severe dyspareunia, pelvic inflammatory disease, infertility, and obstetrical problems such as delayed or obstructed second stage labour, trauma, and haemorrhage. Haemorrhage was also seen as a late complication especially in the newly married girl who was tightly infibulated and was subjected to forcible sex by the husband or who the husband defibulated using various instruments such as scissors, blades or knives.

 

In the research done by Dirie and Lindmark in Somalia on 290 women (mean age 22 years, range 18 to 54), 88% of research subjects had excision and infibulation, the remainder fell into the less mutilating categories. Sixty-nine percent had this procedure performed at home and 52% of these were performed by an untrained person. The immediate main complication reported by 112 women in the study was hemorrhage, infection, urinary retention, and septicaemia. Five women reported severe schock and two of them required blood transfusions. Those women with urinary retention were treated by splitting the infibulation scar and were reinfibulated a few weeks later. The late complication of which 108 women complained, were as follows: 36 with clitoral cysts, 29 requiring excision; 57 with pain on micturition; and 15 subjects had poor urinary flow.

Hemorrhage is an immediate as well as a late complication. For hemostasis the girl's legs are tied together and sometimes a poultice of crushed medicinal herbs is applied.

The urinary retention reported by the women in the Dirie/Lindmark study occurred within the first 3 days after the operation and the reason given by the authors was that the girls tried to avoid passing urine because of the pain that urine causes when it irritates the raw surfaces. The retention was also due to skin flaps, blood clots or, in several cases the urinary meatus was sutured while closing the vulva.

Recurrent urinary tract infections and urinary problems were numerous, and according to Dirie/Lindmark, these were caused because the meatus was covered by the infibulation, causing vaginal discharge to accumulate and favor the growth of bacteria. The women reported that they were given antibiotics by their doctor and this helped. DeSilva reported that urinary tract infection with Escherichia coli was common in these women.

The most common late complication of FGM that was reported by Dirie and several other authors was vulvar swelling, which was due to epidermal cyst formation that develops along the scar tissue and in the excised clitoral region.

Hanly discusses 10 patients that attended the hospital in Tabuk, Saudia Arabia. All patients were immigrants into the Kingdom from Africa. Six patients presented with a large painless mass in the infibulation scar. Two complained of pain, one gave a history of a white continuous secretion for the scar site, and one complained of severe dyspareunia and had a cyst measuring 5.5 X 5 cm. The pathological finding in eight patients was of an implantation dermoid, in the other two patients the cyst had ruptured.

Mayad discusses the fibrous connective tissue tumours called fibromata. These form in the same areas as the dermoid cysts and also can grow to be large and pedunculated.

Sexually Transmitted Diseases, Pelvic Inflammatory Disease and Infertility

Pelvic inflammatory disease (PID), a common complication of sexually transmitted disease (STD) is accompanied by abdominal pain, infertility, and ectopic pregnancy. Research indicates that PID is a major problem worldwide and in some African countries, 22 to 44% of women admitted to the hospital for gynaecological problems had PID. In women 20-29 years old, 7 to 25% of them were childless.

The most prevalent organisms were Neisseria gonnorrhoeae and Chlamydia trachomatis. However, it is now believed that FGM plays a significant role in the development of PID. For the woman who has been infibulated there are added risks of infection and resulting infertility. It has been reported by Sami and El Dareer that chronic pelvic disease was three times more prevalent in the infibulated women. Chronic retention of urine, menstrual flow, and repeated urinary tract infections with E. coli are the consequences of poor drainage, which results from a space formed behind the vulva skin. This then becomes an excellent reservoir for the growth of pathogenic organisms such as the E. coli.

Shandall and DeSilva  reported a high incidence of candiasis, which was more frequent with infibulation, and urine cultures showed the presence of mixed organisms, specifically E. coli.

 Shandall has suggested three main causes of PID in the infibulated woman, namely:

 (1) infection at the time of infibulation,

 (2) interference with drainage and

(3) infection from spliting the infibulation and resulting in resuture after labor. The infections then spread to the inner reproductive organs causing infertility.

Rushwan states that FGM should be recognized as an important etiological factor for PID.

 Another reason for infertility is acquired gynetresia which according to Ozumba, is directly related to infibulation. In a study done by Ozumba in Eastern Nigeria on 78 women 59 patients (76%) had acquired gynetresia caused by infibulation. Sexual intercourse is generally difficult and the process of deinfibulation painful and can take 2-12 weeks to complete or even up to 2 years during which time the women seeks medical help for infertility.

It is estimated that 2-25% of the cases of infertility in the Sudan are due to infibulations, either as a result of chronic pelvic infection or because of difficulty in having sexual intercourse and lack of penetration. In this society the psychological and social impact of being sterile are profound because a woman's worth is frequently measured by her fertility, and being sterile can be cause for a divorce.

Women who have had FGM (especially infibulations) done have a small opening, just large enough for the passage of urine and blood. Penetration or intercourse is difficult, often resulting in tissue damage, lesions, and postcoital bleeding. These tears would tend to make the squamous vaginal epithelium similar in permeability to the columnar mucosa of the rectum, thus facilitaing the possible transmission of HIV. The vaginal introitus is narrowed to increase the man's sexual enjoyment and ensure fidelity and virginity. However, because of this many women experience severe dyspareunia. Other common reasons for the dyspareunia are epidermal or dermoid cysts, which form along the incisional site. These can be a small as a pea or as large as a football.

These often become infected, painful, and a common reason for the woman seeking medical help. Dyspareunia can also be a result of neuromata that are formed when the dorsal nerve ending is trapped in scar tissue, resulting in immense pain and severe dyspareunia.

So when Dr al- Ghawaabi and all the accomdationist talks of benefits of FGM one wonders which planet they are from. FGM has no medical benefits. Who would chop a head off to cure a headache?

 

Female Genital Mutilation v Male Circumcission 2

There is always a problem when people do compare things that should not be compared. In this case I mean FGM and MGM and I am realising each time I say FGM must end, then someone would say how about MGM. I never said MGM is good but comparing the two, FGM mutilation is the worst and here is why.

Frankly, the commonly performed version of male circumcision isn’t as serious as many of the widely performed FGM practices. Yes, removal of the foreskin causes harm and, despite claims to the contrary, has no detectable medical benefits, but FGM often goes far further. Leaving aside the horrible pain that the severe mutilation of a structure as sensitive as the clitoris causes (to have anything approaching a point of comparison, don’t think of removal of the foreskin, think instead of someone cutting a chunk out of your glans) The scarring of the woman’s genital tract can easily result in Obstetric fistula and complications in pregnancy or birth, assuming that the victim does not die soon after the initial mutilation occurs due to blood-loss or secondary infection.

In some forms of FGM, the entire clitoris and most of the labia are excised in their entirety, and the vaginal opening sewn shut except for a small aperture left for urine and other bodily secretion, until the victims wedding night, when the stitching is either cut or ripped open. The level of physical and emotional trauma the victims suffer is hard to imagine.

Then there is the social context of the respective behaviours. Removal of the male prepuce, while painful, disturbing and entirely unnecessary, is viewed primarily as a form of rite of passage – a means of identifying the victim as part of the in group. While these elements also feature in FGM, the symbolism goes far further. The labia and clitoris are removed in a bid to destroy the victim’s ability to experience sexual pleasure, as an expression of the utter contempt that the cultures and religions that perform this horrific abuse hold women and female sexuality in. It is believed that by removing these structures, women will not be ‘tempted’ to take charge of their own sexuality. Further, some cultures believe that by excising the seat of female sexual pleasure you also remove a component of the woman’s free will, thus rendering her more biddable. It is a twisted attempt at sympathetic-magic-based mind-control.

Finally, there is in some ways the most horrific and repugnantly misogynist component of all – in no small degree FGM is performed in pursuit of the aesthetic preferences and perceived convenience of the men of these cultures. It is a concrete expression of the idea within these societies that women aren’t actual people at all – that they exist as mere chattel for men, to be used for the pleasure and gratification of men and discarded at the whim of men.

Given all these factors, comparing male circumcision and FGM as somehow equivalent is highly inappropriate, and may easily be interpreted as an attempt to dismiss the suffering, and silence the voices, of women by means of a wilfully facile comparison to a superficially similar cultural rite that doesn’t cause anything approaching the same level of physical harm or carry the same toxic social baggage.

Think again and help us end female genital mutilation.

Female Genital Mutilation and HIV/AIDS Risk

 

Female genital mutilation (FGM), is most prevalent in Africa(28 countries plus) and Central Asia, Europe Middle East etal and unfortunately statistics so far show more HIV/AIDS infected people in Africa than anywhere else in the world. Is there a link with the spread of HIV/AIDS.The practice has been linked to obstetrical and gynaecological problems in addition to mental and physical trauma that may result from the more severe forms of the procedure and is being widely condemned for both ethical and health reasons by the World Health Organization and other entities involved with Human Rights. The procedure is for some women a death sentence.  

Let’s face, what are the chances of survival in complications associated with FGM for a woman living in the back of a rural undeveloped African village? Those who think FGM should not end must think again. The horrors of FGM on a girl/ woman starts the day it’s done on her and carries on till death. It is after all women who go through child birth and all the other complications that can result in the death of either mother or child and in some cases both.

 

WHO has defined 4 types of circumcision:

I. Clitoridectomy

II. Excision (cutting of both the clitoris and part or all of the labia minora)

III. Infibulation (cutting of all external genitalia with stitching of the vaginal opening)

IV. Other less radical forms including pricking and piercing

It has been estimated that 80-85% of female circumcision is either type I or II.

From the definition it can be seen how horrific the practice is

K.E.Kun proposed 4 hypothetical mechanisms by which female circumcision could result in an

elevated risk of HIV infection(ref. K.E.Kun, 1997, Intl J Gynecology and Obstetrics)

In light of the alarming spread of HIV among females in a number of African countries where female circumcision continues to be practiced, there is no doubt that this could be linked.

Statistics has shown how much this is true as there are more women with HIV/ AIDS in Africa than anywhere else in the world. Does it mean they are more sexually active than their fellow women in the west? It is clear that there is a possibility that FGM plays a role. Traditional tools are used when performing the procedure and in most cases not sterilised. Because FGM raises the social status of the parents, the dowry demands can be high and therefore the young girls can be married off to older men who are already infected

Women who have had FGM done have a small opening, just large enough for the passage of urine and blood. Penetration or intercourse is difficult, often resulting in tissue damage, lesions, and postcoital bleeding. These tears would tend to make the squamous vaginal epithelium similar in permeability to the columnar mucosa of the rectum, thus facilitating the possible transmission of HIV.

Female circumcision and the risks

Infection/scarring

Partial/complete occlusion of the vagina

Greater risk of inflammation/bleeding during intercourse

Disruption of the genital epithelium/exposure to blood/penile abrasions which have been reported to enhance risk of HIV infection

Female circumcision

Higher incidence of obstructed labor and tearing

Haemorrhage

Higher risk of blood transfusion; blood supply may not be optimally screened for HIV.

 

Let’s call this practice what it actually is: the cultural creation of timid women!

Female Genital Mutilation and Educators

There’s a saying in my language. ”Being ignorant is like being dead”, and it’s true. Since starting my campaign to end Female Genital mutilation, I have realised there is ignorance in parts of the chain and unless this is addressed from above- political leaders down to community leaders and health workers ,the curse of Female Genital Mutilation will always be  haunting us. Recent research has shown that since 11-15 year old girls often resist FGM, some parents are now seeking to mutilate toddlers.  Remember, even when the trans-Atlantic slave trade was in its dying days, owners always found loop holes in the system.

You have to pardon me for going ahead of myself. We have not reached the dying days of FGM. We are just starting and more work is needed in raising awareness alone, before we can even begin to expect governments to legislate. We are a long way from making big enough numbers of people aware of the evil consequences of female genital mutilation which is why those in influential positions should support the call to end FGM. Let’s talk about it rather than say ‘’O it is embarrassing!’’ Why should we be embarrassed by our bodies? Sex is used to sell cars, chocolates, perfume etc so why be embarrassed by talking about something we know is wrong?  Just a little research I carried out in Oxford suggested that not many people seem to know what FGM is. Most (both men and women) said to me, ‘I have never heard of such a thing’. Yes I know what you are thinking. There are many evil practices that take place in different parts of the world but that does not stop us from taking action when we know (figures from WHO) that between 100 and 140 million girls and women have undergone this unnecessary procedure and a further 2 million girls are at risk each year. This is not just an issue that concerns Africa where 28 countries practice FGM but also the Middle East, Asia and among immigrant communities in Europe, Australia ,New Zealand , the United States of America and Canada et al.

Where do we start? What do we think of the women who could take their girls to be mutilated? Is it ignorance, or is it that they are bound by the shackles of culture? When TB was rife everyone knew the dangers (from uneducated village people of developing countries to bespectacled professors in Universities), yet, excepting those who have gone through it, FGM is a mystery to all but a few campaigners and activists.

It’s time to educate. And its time we took a hard look at what is going on around us rather than ignore the unspeakable because its happening to “ them”, not “us’’

Let’s say NO TO FGM!

 

 

Female Genital Mutilation and Mental Health

 

I know from the experience of close relations, that people may prefer to keep their abusive historys secret. They can often be ashamed and even fear being ridiculed if they share their experiences.  Sometimes people think it’s for the best but is it really? Bottling up things especially bad experiences has consequences and often leads to mental distress. Girls who go through FGM tend to be scarred for life mentally. A few do manage succeed in adult life but the majority are affected to the extent that they lose any confidence and self esteem they ever had.

Victims of Female Genital Mutilation have no peace of mind. They worry about being discovered and what would be said of them. Some are frightened of bonding in sexual relationships, simply because of the awkwardness of having to explain why they are different from other women. As a result these women suffer silently. They don’t find it easy to talk to anyone about it and fear they will be blamed for being weak.

What are the results of all this?

• Women who are easy to control
• Women who are emotionally weak
• Women who can not look after themselves
• Women who are resentful bitter and angry with the world

I spoke to a girl once from a community that practices FGM and when I raised the subject she brightened up and asked if I had gone through it myself. I told her I hadn’t and she shrank, informing me that she didn’t want to discuss it. I tried  later but she would not say anything. Had I been subjected to the same procedure, she would have found it easier to talk. As an ‘’outsider’’, she thought I would not understand. The truth is that the pain of being mutilated is unimaginable.

The mental burden is worse especially as some of the girls are married off immediately after going through FGM. They are burdened with forced maturity and carry that burden till death. Their mental stability is further challenged if the procedure results in obstetric fistula.

These vulnerable women and girls need our help and support. Let’s stamp our feet on FGM and end it.

 

Female Genital Mutilation and the Culture Curse

 I am writing this article for all the girls around the world who have been genitally mutilated.Culturalists will argue that this subject should be left untouched as it projects and demeans a people’s culture. To such people I have this to say,- FGM is a cruel, inhuman practice that not only belittles women but takes away their dignity, and should have no place in any culture. Having grown up in a culture that had some people follow this practice, I realised how unnecessary the practice was in women’s lives. Rather it brings pain, distress and trauma to its victims. FGM has always been done in secret, but that has never stopped the rest of the community from knowing when it was done. When two of my distant cousins underwent FGM, life was never the same. I am talking about girls who were outgoing, happy with a high likelihood of success in life had circumstances been different. After FGM, the girls became withdrawn and timid. They lost their self esteem and one by one, they dropped out of school for fear of ridicule from classmates who knew of their secret. At that point I questioned this barbaric practice and have never since understood why it is ever deemed necessary.  I realised I had lost friends forever. I still feel the pain that my cousins went through – not direct pain of course but empathy beyond the imagination of most. Unless you have been there or know someone who has, it’s hard to imagine the piercing pain as the knives slashed through their clitoris. I know, because I saw the bleeding and the long road to healing. I am also aware of some of the lousy explanations given to justify FGM, besides its primary purpose – to arrest or at any rate stifle a woman’s sexual desires. I also know that my cousins, unlike their brothers, never gained anything from the procedure, but were instead condemned to a life of misery. Their lives changed from the moment they went through these ‘rights of passage’. As a woman and Mother, I am incapable of understanding how anyone could send their child to hell on earth. FGM is simply a way of instilling fear and controlling women and it’s time it stopped! Culture evolves, and it is a crime against humanity to justify a procedure, without any regard for the trauma that it causes, purely because it is traditional. William Ewart Gladstone made himself very unpopular in the Indian subcontinent when he outlawed the practise that required widows to throw themselves on their husbands’ funeral pyre. Who nowadays would say he was wrong?

Things not to wear for work

Just some tips for work. Ladies what do you think?

 

1. Leggings

Tights, leggings, whatever you call them – don’t wear them to work. Actually, unless you’re going to gym or covering up your nether regions with a long enough dress, don’t ever wear leggings as pants.

It doesn’t matter how skinny you are – no one wants to see your bum cheeks or the occasional camel toe. This is such a major no no!

Rather try: Jeggings. More jean, less legging. But it shouldn’t look like pantyhose.

2. Plakkies

You’re not at the beach and there’s really no need to flip flop around the office. You’ll end up looking sloppy and unprofessional.

Rather try: Pretty embellished sandals

3. Shorts

Yes, I know it might be hot but  like I mentioned above, this isn’t the beach. You are not on holiday. You’re in an office and you need to look professional – even if the vibe is laid back.

Rather try: A maxi dress. You’ll still feel summery, but without looking like a lady of the night.

4. See-through shirts

Sheer shirts might be all the hype right now, but showing off your lacey bra to everyone at work is not a good idea. So, instead of exposing Victoria’s Secret, rather wear a simple strappy top underneath and trust me, you’ll still look pretty!

Rather try: Layers. It’s easy: Bra – strappy top – then sheer shirt.

5. Cleavage

Yes, you heard me – don’t wear your cleavage to work. Leave those puppies at home, or at least, tuck them away till after 17:30.

Rather try: Balance. Wear a statement neckpiece or a beautifully patterned top. You can be sexy without being slutty.

 

Female Genital Mutilation v Male Circumcision: Back to Basics.

Circumcision is the surgical removal of the skin covering the tip of the penis. Circumcision is fairly common for newborn boys in certain parts of the world, including the United States. Circumcision after the newborn period is possible, but it's a more complex procedure.

 

For some families, circumcision is a religious ritual. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring. After circumcision, it isn't generally possible to re-create the appearance of an uncircumcised penis

 

Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. Sometimes there's a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans. In other cases, particularly in certain parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.

 

The American Academy of Pediatrics (AAP) says the benefits of circumcision outweigh the risks. However, the AAP doesn't recommend routine circumcision for all male newborns. The AAP leaves the circumcision decision up to parents — and supports use of anesthetics for infants who have the procedure.

 

Circumcision might have various health benefits, including:

 

Easier hygiene. Circumcision makes it simpler to wash the penis. Washing beneath the foreskin of an uncircumcised penis is generally easy, however.

Decreased risk of urinary tract infections. The overall risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later on.

Decreased risk of sexually transmitted infections. Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential.

Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.

Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.

 

Circumcision might not be an option if certain blood-clotting disorders are present. In addition, circumcision might not be appropriate for premature babies who still require medical care in the hospital nursery.

Circumcision doesn't affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners

The most common complications associated with circumcision are bleeding and infection. Side effects related to anesthesia are possible as well.

 

Rarely, circumcision might result in foreskin problems. For example:

• The foreskin might be cut too short or too long
• The foreskin might fail to heal properly
• The remaining foreskin might reattach to the end of the penis, requiring minor surgical repair

 

Female Genital Mutilation

 

Female genital mutilation (FGM), also known as female circumcision or female genital cutting, is defined by the World Health Organisation (WHO) as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons".

The procedure is traditionally carried out by an older woman with no medical training. Anaesthetics and antiseptic treatment are not generally used and the practice is usually carried out using basic tools such as knives, scissors, scalpels, pieces of glass and razor blades. Often iodine or a mixture of herbs is placed on the wound to tighten the vagina and stop the bleeding.

Types of Female Genital Mutilation

The World Health (WHO) classifies FGM into four types:

Type I

involves the excision of the prepuce with or without excision of part or all of the clitoris.

 

Type II

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

 

Type III

excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening, also known as infibulation. This is the most extreme form and constitutes 15 per cent of all cases. It involves the use of thorns, silk or catgut to stitch the two sides of the vulva. A bridge of scar tissue then forms over the vagina, which leaves only a small opening (from the size of a matchstick head) for the passage of urine and menstrual blood.

 

Type IV

includes pricking, piercing or incision of the clitoris and/or the labia; stretching of the clitoris( this is practiced in Zimbabwe) and or the labia; cauterisation or burning of the clitoris and surrounding tissues, scraping of the vaginal orifice

 

Consequences of FGM

 

Depending on the degree of mutilation, FGM can have a number of short-term health implications:

 

• severe pain and shock
• infection
• urine retention
• injury to adjacent tissues
• immediate fatal haemorrhaging

 

Long-term implications can entail:

 

• extensive damage of the external reproductive system
• uterus, vaginal and pelvic infections
• cysts and neuromas
• increased risk of Vesico Vaginal Fistula
• complications in pregnancy and child birth
• psychological damage
• sexual dysfunction
• difficulties in menstruation

 

Surely the two (Male Circumcision and Female Genital Mutilation) can not be compared. Female Genital Mutilation is a punishment for life to the women and girls who go through it.  While there is a case for male circumcision, there is clearly none for FGM. Let’s end it together.

 

By Abigal Muchecheti

Refuse to be genitally mutilated: Female Genital Mutilation v Vaginal Surgery

Men love vaginas: their shapes and taste and everything about them. Some even know what to do with them. We all know how evil female genital mutilation is. None of the girls and women have a choice but why conform to a man made vagina just to please men? There is no perfect vagina and the only thing that matters to men is making love.

To those considering Labia Reduction Surgery this procedure is not without their risks, among them haemorrhage, infection, loss of sensitivity, lingering pain from nerve damage. Besides you are violating yourselves.

I think this is a way of preying on vulnerable women. Vaginal tightening has been done for decades to help women with extremely compromised vaginal integrity. For the even fewer women out there with true genital “deformities” — extraordinarily long or protruding labia, for example, or excessive vaginal flesh — surgery has also been an option for years, but having surgery just to please a man is bizarre. Like FGM a very unnecessary procedure. Men don’t care how the vagina looks. So why go through the pain.

 

Types of Vaginal Surgery

The main types of vaginal surgery available in the UK are:

 

Labiaplasty or labia/lip reduction, sometimes also called vulvaplasty, where the labia minora or inner vaginal lips can be reduced in size and reshaped.

Vaginoplasty or vaginal rejuvenation/tightening, where the inner vagina walls and muscles can be reshaped and tightened to produce a more toned and tight vagina.

 

Hymenoplasty, or hymen repair/re-virgination, where a torn hymen is repaired or rebuilt to imply the virginal state of a women; this is most frequently done for religious, ethnic or cultural reasons with the utmost discretion.

What are the risks and potential complications from Vaginal Surgery?

 

Like all surgical procedures, there is always a possibility of complications or side effects and, although rare, these can include infection (such as urinary tract infections), a reaction to the anesthesia, blood or fluid collection underneath the skin (hematoma), prolonged bleeding, nerve damage, and an irregular or a “lop-sided” appearance to the labia after the operation.

Following labiaplasty and vaginoplasty, urinating post-surgery may be difficult and somewhat painful, due to the burning/stinging sensation caused by the urine passing over the wound. This can be alleviated by either urinating in the shower, or by pouring a jug of lukewarm water over the area as one urinates in the toilet.

 

Look after yourself. Refuse to be genitally mutilated!  Lets celebrate Women International Day together by ending Violence against women and girls

Abigal Muchecheti

 

Things to Know about Women’s Genitalia: Why mutilate it?

When I blogged about men helping us end Female Genitalia Mutilation, a  male friend of mine said ‘’this female genital mutilation is robbing both men and women’’. True isn’t it?

The vagina is just one part of a woman’s private parts

Sometimes, a woman's entire genital region is referred to as the vagina. But in fact, the vagina is just a part of the package, so to speak. The outer portion of a woman’s privates is actually called the vulva. That includes the inner and outer labia, the clitoris, clitoral hood and the opening to the urethra and vagina.

The actual vagina is an internal structure, along with the other parts of the female reproductive system including the cervix, uterus, ovaries and Fallopian tubes (which are sometimes called the oviducts).

The clitoris isn't just a small pink/brown nub

The clitoris has 8,000 nerve endings aimed for sexual pleasure — that's double the number in the penis, according to experts.

The clitoris, which is a small pink/brown organ that lies underneath the clitoral hood, is a powerhouse of pleasure. Although it extends into the vagina for about three inches, and connects with the controversial G-spot area, the clitoris is considered an "external" organ. As researchers noted in a 2011 article in the journal Obstetrics and Gynecology, "the glans and body are visible, while the roots are hidden, therefore they are not "internal.'"

In other words, the most visible part of the clitoris is only a small part of it — it extends from there like roots of a tree. The length of the whole clitoris has been estimated to be nearly four inches long.

Good and bad bacteria

It's normal to have bacteria in your vagina. In fact, there are some bacteria known as lactobacilli that keep the acidity of the vagina in the normal range.

But sometimes the balance between good and bad bacteria can be disrupted. When that happens, women could experience a discharge that smells fishy, or have an itching or burning sensation.

But there are ways that women can keep their vaginas healthy, and keep the good bacteria present. Check my previous articles!

Sex can keep the vagina healthy — especially for postmenopausal women

Through the various stages of women's lives — including childbirth and breastfeeding, as well as normal aging and menopause — the body undergoes hormonal changes that could lead to vaginal dryness.

Estrogen helps keep the vagina healthy and lubricated. Once estrogen levels drop, the vagina can become dry, and sometimes even be a source of pain.

Experts say that having sex can prevent the vagina from becoming thin and tight.

Safe vaginal intercourse can help keep the vagina healthy and dilated.

To help make intercourse more comfortable, it is important for women to discuss options with your doctor before making a decision to use them

Discharges women should worry about

 

Although the vagina is considered a self-cleaning organ, and some discharge is normal, that doesn’t mean it’s not vulnerable.

Any vaginal discharge that seems excessive, painful, irritating or foul in odor should be evaluated by a doctor.

Some women try to diagnose their own vaginal infections at home, and use over-the-counter medications. This can be misleading as it could be more complicated than that or even a sexually transmitted disease.

More about the clitoris

Just in case you need a refresher course, here are the basic facts: Her clitoris is a small bud-like formation that is located slightly above the opening to her vagina, at the top of her inner labia. Clitoris size and shape differs from woman to woman, but it is generally between 1/8 to 3/8 of an inch in size. Her clitoris is the equivalent of your penis; it's packed with nerve endings and becomes engorged when she's aroused.

Vital info: The vast majority of women require clitoral stimulation to achieve orgasm -- penetration just isn't always enough on its own. Sounds like a good enough reason to makes its acquaintance, doesn't it? Lets respect  nature and leave be what was meant to be.

Where does female mutilation come in all this? It’s not necessary and will have no benefits to anybody. Let’s make FGM a thing of the past.

By Abigal Muchecheti