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Female Circumcision - The Process And Complications.

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Female cirumcision is the process where by part or all of the external female genitalia is removed. It can also be referred to female genital mutilation (FMG)or female genital cutting.This can cause injury to the female genitalia and has no medical benefit whatsoever.This is mostly found in Africa ,Southeast Asia and the Middle east. 

This is carried out from a few days after birth to puberty and there are different types of female cirumcision.It has been discovered to be carried out in about 27 African countries as at 2016.

Female genital mutilation is carried out by a traditional circumciser and about half of the girls that undergo FMG have it carried it before the age of Five.

This practice is rooted in gender inequality and in a bid to control women and further promote the ideas of purity,modesty and beauty as defined by the society.

The effects vary based on the kind of procedure carried out.The effects include development of cysts, difficulty in mentrual flow and urination,recurrent infections,inability to get pregnant and painful childbirth.

As at 2016 ,about 25% of girls in Nigeria have undergone cirumcision.

 The circumcision is referred to as different terms in different languages.The Bambara language, spoken mostly in Mali, it is known as bolokoli ("washing your hands") and in the Igbo language in eastern Nigeria as isa aru or iwu aru ("having your bath"). Other terms include khifad, tahoor, quodiin, irua, bondo, kuruna, and kene-kene. It is also known in Arabic as khafḍ or khifaḍ. Communities may refer to FGM as "pharaonic" for infibulation and "sunna" circumcision for everything else.Infibulation is the extreme female genital mutilation involving complete excision of the clitoris, labia minora, and most of the labia majora followed by stitching to close up most of the vagina.The term infibulation derives from fibula, Latin for clasp; the Ancient Romans reportedly fastened clasps through the foreskins or labia of slaves to prevent sexual intercourse. The surgical infibulation of women came to be known as pharaonic circumcision in Sudan, and as Sudanese circumcision in Egypt.In Somalia, it is known simply as qodob ("to sew up").

HOW IT IS CARRIED OUT.

The process is usually carried out in the girls home with or without the application of an anaesthetic.When traditional cutters are involved, non-sterile devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks and fingernails.The process is carried out by an older woman or a male depending on the community. In some countries ,health professionals are involved in the process and they have been discouraged from carrying out this process as it has no health benefits but can be harmful.The WHO, UNICEF and UNFPA issued a joint statement in 1997 defining FGM as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons".

There have been discovered to be about three types of FGM.

(1) cut, no flesh removed (symbolic nicking),This is the most common of all the types that have been discovered.It involves the removal of the clitoral hood only or the complete of partial removal of the clitoral glans which is the visible tip of the clitoris.The circumciser pulls out the clitoral glans with her thumb and cuts it off and she doesn't do it alone.

(2) cut, some flesh removed.This is the complete or partial removal of the inner labia with or without the removal of the clitoral glans or inner labia.

(3) sewn closed.This is infibulation or pharaonic circumcision, the "sewn closed" category, is the removal of the external genitalia and fusion of the wound. The inner and/or outer labia are cut away, with or without removal of the clitoral glans.This is found largely in northeast Africa, particularly Djibouti, Eritrea, Ethiopia, Somalia, and Sudan (although not in South Sudan).

The girl is told to squat on a stool or mat and her legs are spread open.The clitoris is pinched and immediately slashed off .The organ is then shown to the senior female relatives of the child who will decide whether the amount that has been removed is satisfactory or whether more is to be cut off.

After the clitoris has been satisfactorily amputated ... the circumciser can proceed with the total removal of the labia minora and the paring of the inner walls of the labia majora. Since the entire skin on the inner walls of the labia majora has to be removed all the way down to the perineum, this becomes a messy business. By now, the child is screaming, struggling, and bleeding profusely, which makes it difficult for the circumciser to hold with bare fingers and nails the slippery skin and parts that are to be cut or sutured together. ...

Having ensured that sufficient tissue has been removed to allow the desired fusion of the skin, the circumciser pulls together the opposite sides of the labia majora, ensuring that the raw edges where the skin has been removed are well approximated. The wound is now ready to be stitched or for thorns to be applied. If a needle and thread are being used, close tight sutures will be placed to ensure that a flap of skin covers the vulva and extends from the mons veneris to the perineum, and which, after the wound heals, will form a bridge of scar tissue that will totally occlude the vaginal introitus.The vulva is closed with surgical thread, or agave or acacia thorns, and might be covered with a poultice of raw egg, herbs and sugar. To help the tissue bond, the girl's legs are tied together, often from hip to ankle; the bindings are usually loosened after a week and removed after two to six weeks.If the remaining hole is too large in the view of the girl's family, the procedure is repeated.

A single hole between 2-3 mm wide is left for the girl to urinate and menstruate.

Complications

The complications from thus process include fatal bleeding, anaemia, urinary infection, septicaemia, tetanus, gangrene, necrotizing fasciitis (flesh-eating disease), and endometritis, pain, urine retention, and healing problems/wound infection on a short term

Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and growth of nerve tissue involving nerves that supplied the clitoris.A girl who has been infibulated may be left with an opening as small as 2–3 mm, which can cause prolonged, drop-by-drop urination, pain while urinating, and a feeling of needing to urinate all the time. Urine may collect underneath the scar, leaving the area under the skin constantly wet, which can lead to infection and the formation of small stones. The opening is larger in women who are sexually active or have given birth by vaginal delivery, but the urethra opening may still be obstructed by scar tissue.Holes that allow urine or faeces to seep into the vagina. This and other damage to the urethra and bladder can lead to infections and incontinence, pain during sexual intercourse and infertility.Painful periods are common because of the obstruction to the menstrual flow, and blood can stagnate in the vagina and uterus. Complete obstruction of the vagina can result in a situation where the vagina and uterus fill with menstrual blood). The swelling of the abdomen and lack of menstruation can resemble pregnancy; Asma El Dareer, a Sudanese physician, reported in 1979 that a girl in Sudan with this condition was killed by her family.

This practice can also lead to difficulty or extreme pain in childbirth.It can also lead to anxiety ,depression.Although the history of FMG is uncertain ,gynaecologists in 19th-century Europe and the United States removed the clitoris to treat insanity and masturbation. A British doctor, Robert Thomas, suggested clitoridectomy as a cure for nymphomania in 1813.Whatever the practice's origins, infibulation became linked to slavery. Mackie cites the Portuguese missionary João dos Santos, who in 1609 wrote of a group near Mogadishu who had a "custome to sew up their Females, especially their slaves being young to make them unable for conception, which makes these slaves sell dearer, both for their chastitie, and for better confidence which their Masters put in them". Thus, Mackie argues, a "practice associated with shameful female slavery came to stand for honor.

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