Medical complications of female genital mutilation.

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation "surgery."     

Labia Minora Elongation and its Implications on the Health of Women: A Systematic Review

ABSTRACT

Objectives: Labia minora elongation (LME) is a female genital modification practice categorized among the types included in the fourth group of female genital mutilation. In this article, we display the results of a systematic review of the evidence-based knowledge published on the health risks and benefits of LME as informed by African female respondents who are insiders of the practice. No other systematic review on this specific topic has been published before. Methods: A methodological bibliographic search was done in scientific databases by manual referencing and by contacting experts on this area of knowledge. Seventeen articles were eligible for this review, which corresponded to nine different studies. Eight of these studies were conducted in Eastern and Southern African countries and one was carried out in Italy. Results: This review concludes that pain at the beginning of the practice, nuisances related to the use of caustic herbs, and stigmatization in failing to comply with the practice are the principal health risks associated with LME. At the same time, there is evidence that labial elongation may benefit the sexual health and well-being of women. Conclusions: More research of a quantitative nature is necessary to determine the prevalence of LME across the practicing cultures and to determine its implications on the sexual and reproductive health of women who engage in this female genital modification.     

Local Rites and Body Politics

The growing awareness of violence against women has resulted in endorsement of various international codes and conventions relating to physical, psychological and sexual violence. Female genital mutilation is one form of violence against women that has polarized people within and across national borders. Here, I explore its popular representation, consider how activism against genital mutilation has been confounded by sex and race and how activism to eradicate the practice is understood by immigrant women in Australia. In doing this, I draw on research conducted with women immigrants to Australia from north Africa (the Sahel areas) and the Middle East, from countries where female genital mutilation is most common. These women are often frustrated by what they see as contradictions in hospital policy and practice that arise in response to their requests to be reinfibulated after childbirth. I tease out the dilemmas that emerge when refusal is contrasted with other permissible practices of the body, such as hymen reconstruction, and given the commodification of bodies and related issues of age and agency, the individual and the community. The perceived discrepancies suggest to these African women that rights discourse is discriminatory, racist and informed by sensational portrayals of traditional practices. I question the ethics, values and rights that inform public discourse about sexual and reproductive rights, when women’s rights and values are so discrepant from our own ideals.     

Female circumcision: the view from Sudan. Interview [with Ikhlas Nouh Osman

Female circumcision involves removing either all or part of the clitoris, labia minora, and/or labia majora. The practice is therefore increasingly being described as female genital mutilation. More than 90% of women in Sudan have undergone female genital mutilation. Pharonic circumcision is the most prevalent in Sudan. This form of mutilation involves the full removal of the clitoris and the labia. The two sides of the wound are then sewn together, leaving a small hole through which urine and menstrual blood may pass. Female genital mutilation occurs because women believe that the resultant narrow vaginal entrance will give pleasure to a future husband, due to tradition, uncircumcised women have great difficulty finding a spouse, and from the belief that the practice is mentioned in Islam. Koranic law is widely respected and followed in the Islamic areas of Sudan. Contrary to the belief of women that female circumcision keeps the vagina very clean, considerable health and psychological problems may result following the operation and throughout the woman's life. An activist against female genital mutilation describes her experience undergoing the operation, the trauma of first penile penetration with her husband, giving birth, and how women have their genital orifice restitched after delivery to the size before penetration. Nongovernmental organization efforts in Sudan against female circumcision are described.     

Female genital mutilation and human rights

Abstract

This article evaluates five different discourses on female genital mutilation for affinities with the language of international instruments codifying human rights: an activist physician's fieldwork journal; two novels, one a Lebanese-American's lyrical work largely indebted to a human rights perspective and, in contrast, a Kenyan publicist's fiction which mutes that approach; an American activist's auto-ethnography; paintings by Nigerian artists in an exhibition travelling in Germany; and a letter to the editor of an African American magazine. I read these varied lexica in light of recent literature on female genital surgery that tends to oppose academics, mainly anthropologists captive to their training, to activists impatient with post-modern wavering who claim that global instruments for women's human rights should be enforced to stop genital torture. Creative writing is instrumental in presenting a clear moral imperative confronted by the complexities of human lives.     

“You see,one day they cut”: The evolution,expression, and consequences of resistance for women who oppose female genital cutting

ABSTRACT

It is estimated that more than 200 million women alive today have undergone female genital cutting (FGC). While emerging evidence shows that attitudes toward FGC may evolve for immigrants as they acculturate to the host country, scant empirical research explores how women come to oppose the practice. This qualitative study used grounded theory methods to explore the trajectory of resistance to FGC for seven women circumcised in childhood who sought asylum in the United States as adults to protect their daughters from the practice. Participants originated from Burkina Faso, Guinea, The Gambia, and Chad. Analysis revealed nine themes tracing the evolution of resistance to FGC and other gender role norms for participants: coercion, threat, and retribution narratives; traumatic memories of circumcision; growing awareness of the personal implications of circumcision; emergence of critical thinking; trangressive thoughts and acts; navigating the consequences of resistance; everyday reinforcement; negotiating resistance dilemmas; and making meaning of resistance. In contrast to previous studies linking opposition to FGC to post-settlement acculturation or pre-migration exposure to organized international human rights campaigns, findings of this study indicate that traumatic memories of the circumcision rite, combined with the capacity to reflect on “taken for granted” cultural practices and to employ critical thinking skills, may lead to resistance to FGC for some women. Furthermore, findings highlight that FGC, and opposition to it, has lasting consequences for women from societies where the practice is embraced, and these consequences persist after migration. Practice and policy recommendations are drawn from the analysis.     

Changes in Sexual Distress,Depression and Sexual Function after Clitoral Reconstruction in Women with Female Genital Mutilation/Cutting

Abstract

Background: Female genital mutilation/cutting (FGM/C) links health complications and psychological distress. However, there is scarce literature on how women with FGM/C respond to treatment interventions. Objective: In this study, we aimed to assess changes in depression symptomatology, sexual function, and distress following clitoral reconstructive surgery combined with a psychoeducational intervention. Methods: The reconstructive surgery consisted of recovering the remaining clitoris and placing it externally and as close to the vagina as possible. FGM/C patients (n?=?27) received psychological support and sexual counseling upon undergoing the surgical intervention and were further assessed at 6-month follow-up. Moreover, they completed the Beck Depression Inventory and the Female Sexual Distress Scale Revised at these two time points. Patients’ sexual dysfunction was assessed according to DSM-5 criteria. Results: Statistically significant clinical changes after FGM/C were reported. Overall, patients presented reduced depression and sexual distress levels, and decreased female sexual interest/arousal disorder prevalence. Results also revealed that sexual distress improvements were more significant in Type I FGM/C patients. Conclusions: Significant improvements in sexual distress, psychopathology, and sexual function were observed in our sample following reconstructive surgery, suggesting that combined interventions are effective for treatment.     

Socially Sanctioned Violence Against Women: Female Genital Mutilation Is Its Most Brutal Form

A historic survey indicates that Female Genital Mutilation occurs not only in the Third World but has also been practiced in the Occident. Though the differences in the practices, scope, and extent of the genital mutilations performed in these two divergent cultures are great, the basic goal has been the same. In the prevalent patriarchal societies, men sought and seek to curb, at times even eradicate, women's sexuality. Psychoanalytic findings indicate that the motive for female genital mutilation is based on men's unconscious fear of women's sexuality. The minimal psychic consequences following the mutilation of female genitals are loss of trust, a prevailing lack of bodily well-being, post-traumatic shock and depression.     

A case history based assessment of female genital mutilation in Sudan

The subject of female genital mutilation is discussed through a selection of excerpts from a narrative derived from interviews with educated Sudanese women. The original interview form ensures an inside, contextual presentation of the subject, providing the clues for approaches towards elimination of the practice. With evaluation and planning strategies in mind, the issues are placed in the conceptual framework of the segregation of the sexes and viewed through the ideas of gender-based discrimination as outlined in CEDAW.     

Transgender Activism

Abstract

Feminist analysis of transsexualism such as that of Janice Raymond has seen it as a deeply conservative phenomenon in which surgical mutilation is employed to maintain the genders of male dominance and female subordination. Transsexualism has a new face in the nineties in “transgenderism” which employs queer and postmodern theory to render transsexualism progressive. This paper argues that “transgenderism” is also deeply problematic from a feminist perspective and that transsexualism should be seen as a violation of human rights.     

Measurement of the sexual health and wellbeing of women who have undergone female genital mutilation/Cutting: A scoping review

Objective: We conducted a scoping review to identify and assess instruments used to measure sexual health and wellbeing in women who have undergone female genital mutilation/cutting (FGM/C). Method: We retrieved and assessed 10 validated instruments using an 18-item checklist derived from the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Results: All instruments were developed and initially validated among literate, predominantly Caucasian participants in North America and Europe. Only 1 validation study was conducted among women living with FGM/C. Conclusion: Most instruments only measured sexual functioning. Findings underscore the need to validate instruments appropriate for use among FGM/C survivors.     

Final report on position of female circumcision in Nigeria

Survey data reveal that female genital mutilation (FGM) is being practiced in most Nigerian states, usually on babies and young girls but occasionally during wedding preparations or 7 months into the first pregnancy. Among the few tribes that mutilate women after marriage, husbands carry out the deed. Usually, FGM is performed on a group of girls, but it can also be performed on one girl in her home. The mutilator, who is paid a token fee, uses a knife or a razor. Post-mutilation treatment includes application of a variety of traditional methods. The most usual immediate complication is bleeding but other complications include tearing, septicemia, fistula development, stenosis, delayed second-stage labor, tetanus, urinary obstruction, and dyspareunia. Reasons cited for FGM include tradition, the belief that FGM curbs female promiscuity, and the belief that a baby whose head touches a clitoris during delivery will die. A prominent 1981 newspaper article on the subject reported the view of a physician that the practice ought to be eradicated and the view of a mutilator that it is not likely to be stopped.     

Implications of female genital mutilation on girls’ education and psychological wellbeing in Tarime,Tanzania

Though female genital mutilation is widely practiced in Tanzania, there has been no systematic examination of its long-term implications on girls’ wellbeing. Employing interviews and focus group discussions, this study explored the implications of female genital mutilation (FGM) on girls’ wellbeing in Tarime, Tanzania. The results revealed that the effect of FGM on girls are multifaceted, including early marriages, parents’ negative attitudes towards girls’ education, girls’ change in attitudes and loss of interest in schooling, which lead to poor educational achievement in many ways. Notably, girls who manage to escape FGM suffer from isolation and stigma from their peers who have been circumcised. Arguably, FGM is both a protective and risk factor for girls in Tarime. FGM is a protective factor against stigma and isolation for circumcised girls, and it is a risk factor in denying circumcised girls’ opportunities for education, and in perpetuating stigmatisation for the uncircumcised girls. We have concluded that, in the absence of more positive alternative rites of passage for adolescent girls in Tarime, and despite the widespread awareness about its negative consequences, FGM is likely to continue due to its centrality in the Kuryan cultural, social and economic necessities.     

Where Do Female Conservatives Stand? A Cross-National Analysis of the Issue Positions and Ideological Placement of Female Right-Wing Candidates

ABSTRACT

Many right-wing parties have attempted to increase their share of female representatives to appeal to women in the electorate. Underlying this is the assumption that women will offer a distinct perspective to the party. Using a comparative dataset of male and female candidates of Conservative and Christian Democratic parties across 21 European and Anglo-Saxon countries, we show this is the case. Female candidates in right-wing parties are less right wing than male candidates, both in terms of their overall ideology and their issue positioning. Perhaps as a consequence, female candidates perceive a greater distance to their own party than male candidates.     

“I Am Not A Victim. I Am A Survivor”: Resilience as a Journey for Female Survivors of Child Sexual Abuse

ABSTRACT

This study was designed to expand our understanding of the positive aspects of coping and resilience in female survivors of child sexual abuse. Research questions focused on women’s lived experiences of being survivors of child sexual abuse and how they have experienced resilience, developed healthy intimate relationships, and viewed themselves as sexual beings. Using a qualitative research lens of phenomenology, we captured the essence of survivors’ experiences of resilience. Although each woman’s experience was unique, similar patterns of processes and outcomes emerged as meaningful in their development of resilient and healthy sexuality and relationship functioning. However, participants emphasized resilience as a process or journey—recovery from trauma, reconceptualization of self, and development of healthy sexuality included deliberate efforts occurring over time. Implications for future research and practice using a positive lens of resilience are provided.     

Campaigning against female genital mutilation in Ethiopia using popular education

In Ethiopia, the Italian Association for Women in Development (AIDOS) has been working with Ethiopia's National Committee on Traditional Practices Affecting the Health of Women and Children for 5 years. AIDOS began working on female genital mutilation in the early 1980s and rejects charges of cultural imperialism that are applied to Northern organizations attempting to help African organizations address this violation of universal human rights. In Ethiopia, 85% of women are mutilated, with most undergoing Sunna, or removal of the prepuce of the clitoris. The joint project seeks to increase awareness about the health consequences of female genital mutilation in the target group. The primary technique used is provision of training of trainers courses and presentation of four modular units and audiovisual materials specifically designed for use with socially influential women, male and female secondary school students, community leaders, and health workers. In addition, an information/education campaign uses videos and sound and slide shows with accompanying story books. A second category of communication tools was developed for a mass information campaign, including radio spots, posters, information leaflets, and a newsletter. When the project was ready for expansion into the southern region of the country, it became clear that a new participatory communication strategy was required to stimulate discussion, such as the use of role playing and theater. Working together, the two organizations have successfully confronted project constraints such as the difficulty in assessing project impact, scheduling problems, and gender-biased assess to information.     

Collaborative Data-Mining in an Adolescent Mental Health Service

Summary

As full participants in a collaborative clinical data-mining project intended to promote staff reflection and to improve services, clinicians discovered just how valuable their practice expertise was in maintaining project relevance. In this paper, they describe challenges they faced as non-experienced researchers and writers and how their practice skills enabled them to overcome these challenges. Benefits derived include: enhanced skills (in both practice and research), sensitization to previously overlooked areas of practice, and an increased sense of professionalism.     

Gender Preference toward Providers of Genital Examinations and Frequency of Genital Self-Examination among College Students

Abstract

Both male and female students who utilize Brandeis University Health Services for primary care were assessed regarding their preference as to the gender of providers of genital examinations, together with the frequency with which each sex and academic class performs genital self-examinations, during a two-month period of the 1981 Spring Semester, using a brief self-administered questionnaire.

Among 234 undergraduate and graduate student men and women who returned questionnaires, women and men preferred to be examinated by same-sex examiners; less than half of the women and nearly none of the men would want a chaperone present during the examination, even when the examiner is not the same gender. An increasing percentage of these young women perform breast examinations as they get older, but there is no comparable rise in testicular self-examinations with increasing age among the men. It is important for physicians who care for adolescents and young adults in university health services to provide access to same-gender health care providers when genital exams are done. It is also important to educate men about testicular examinations, just as women are educated about breast examinations.     

Adult and Adolescent Female Sex Offenders

Abstract

Female sex offenders (N = 18) were compared with male sex offenders (N = 332) and with females who were not sex offender (N = 215) on various experiences in their personal histories. Female sex offenders who were victims of sexual abuse were compared to female sex offenders who were not. The present study is part of a comprehen sive, seven-year research project described elsewhere (Miccio-Fonseca 1995, 1996). The project dealt with comparative experiences and char acteristics of adult and adolescent sex offenders, victims, and thei families. The groups in the present study were analyzed with regard to an array of variables, including psychological, medical, gynecological urological, drug, law enforcement, and homicidal and suicidal histories Other variables studied were sexual difficulties and dysfunctions, sexu al health, and life stressors.

Female and male sex offenders differed significantly on numerou psychological, life-stressor, and sexual variables. Female sex offender differed significantly from females who were not sex offenders on the same sets of variables, and they were significantly younger. Implica tions for clinical practice with this population are discussed.