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
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?
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