Female Genital Cutting (FGC)

OR
Female Genital Mutilation(FGM)

By: Dr Addis Gebru

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 Session objectives

• Define FGC
• Describe the different types of FGC
• Describe the complications of FGC
• Describe the cultural aspects of FGC

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 FEMALE GENITAL CUTTING

• Defined by WHO as:-

– “The partial or total removal of the female external
genitalia or other injury to the female genital organs for
cultural or other non therapeutic reasons”

• Also called as genital mutilation & female circumcision

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 Note on terminology

Female circumcision is not preferred not to confuse it with

that of male circumcision.
The word "mutilation" emphasizes the gravity of the act.

 Some United Nations agencies use the term "female genital

mutilation/cutting" wherein the additional term "cutting" is
intended to reflect the importance of using non-judgemental
terminology with practising communities.
Both terms emphasize the fact that the practice is a violation
of girls’ and women’s human rights.

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 Prevalence of FGC

Is still a deeply rooted tradition in more than 28 countries in

Africa and in some countries in Asia and the Middle East.
In the world today there are an estimated 100 million to 140
million girls and women who have been subjected to the
operation.
Currently, about 3 million girls, the majority under 15 years of
age, undergo the procedure every year.
In Ethiopia in 2005 report Prevalence of FGC is 74.3% and the
prevalence in their daughters is decreasing (48%).

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Prevalence of FGC in Africa (women aged 15–49)

Less than 10%

10.1% – 25%
25.1% – 50%
50.1% – 75%
75.1% or more
missing data or FGM not widely practiced
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 Types of FGC (1997 WHO Classification)

• Type I (Clitoridectomy, Sunna): Excision of the prepuce, with or without

excision of part or the entire clitoris.
• Type II (Excision):Excision of the clitoris with partial or total excision of the
labia minora.
• Type III (Infibulation):Excision of part or all of the external genitalia and
stitching/narrowing of the vaginal opening.
• Type IV(Unclassified): pricking, piercing or incising of the clitoris and/or
labia; stretching of the clitoris and/or labia; cauterization by burning of the
clitoris and surrounding tissue; scraping of tissue surrounding the vaginal
orifice (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of
corrosive substances or herbs into the vagina to cause bleeding or for the
purpose of tightening or narrowing it; and any other procedure that falls
under the broad definition of female genital mutilation.

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 Types of FGC (2007 Modified WHO
Classification)
• Type I: Partial or total removal of the clitoris and/or the prepuce
(Clitoridectomy).
– Type Ia, removal of the clitoral hood or prepuce only;

– Type Ib, removal of the clitoris with the prepuce.

• Type II: Partial or total removal of the clitoris and the labia minora,
with or without excision of the labia majora (excision).
– Type IIa, removal of the labia minora only;

– Type IIb, partial or total removal of the clitoris and the labia minora;

– Type IIc, partial or total removal of the clitoris, the labia minora and the
labia majora.

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• Type III (Infibulation): Narrowing of the vaginal orifice with
creation of a covering seal by cutting and appositioning the
labia minora and/or the labia majora, with or without excision
of the clitoris.
– Type IIIa: removal and apposition of the labia minora;

– Type IIIb: removal and apposition of the labia majora.

• Type IV (Unclassified): All other harmful procedures to the

female genitalia for non-medical purposes, for example,
pricking, piercing, incising, scraping and cauterization.

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 Origin & rationale

• Origin is unknown but dates back to the ancient Egyptians,

pre-Islamic Arabs, Rome & Tsarist Russia.
• Rite of passage for girls in to womanhood within some
cultures.
• Some considered a religious custom but no religion condemns
it.

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 Origin & rationale

• Customary beliefs about FGC:

1. Maintain girl’s chastity
2. Preserves fertility
3. Ensures marriageability
4. Improves hygiene
5. Enhances sexual pleasure in men

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 Complications & outcome
• Both short term & long term complications occur
• Health care providers should be aware of these complications

Short term complications include:

1. Hemorrhage

2. Severe pain…..as it is done with out anesthesia

3. Shock….from pain and/or hemorrhage

4. Infection (eg. Tetanus) / Sepsis / or septic shock

5. Urinary retention /difficulty of passing urine due to swelling or edema or pain

6. Urethral injury

7. HIV infection due to use of same blade without sterilization

8. Psychological trauma

9. Death due to hemorrhage or infection or shock

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 Long term complications:

1. Chronic pelvic/back pain

2. Dysmenorrhea, dyspareunia

3. Chronic vaginal infections (STIs)

4. Meatal obstruction & urethral strictures

5. Urinary stone, Chronic UTI

6. Fibrosis, keloid, dermoid cysts

7. Vulvar abscesses

8. Hematometra/ hematocolpos

9. Vaginsmus

10. Infertility

11. Increased risk of C/S delivery, PPH, Perineal tears, Obstructed labor, Obstetric fistula

12. Higher fetal death, reduced Apgar score

13. Psychological consequences: fear of sexual intercourse, post-traumatic stress disorder, anxiety, depression and memory loss.

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 Defibulation

• Women seek defibulation:

1. When pregnant or plan pregnancy
2. Because of dyspareunia
3. Urinary and menstrual problems Eg. Amenorrhea
and/or Hematocolpometria, dribbling of urine due to
closed vagina
4. Infertility

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