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FGM

July 31st, 2007  |  Penlight

Last month the Egyptian government banned all female “circumcision” following the death of a 12 year old girl. Technically it had been banned in 1997, but continued on through a loop hole that allowed it in cases of medical necessity. Research done by Unicef in 2005 found that 96% of Egyptian married women aged 15-49 reported being circumcised. All this was first brought to my attention by TofuLou at her blog, Manifest Destiny. It’s a good post and she has drawings and descriptions of the different extents to which it’s done.

I prefer the term Female Genital Mutilation. Circumcising a woman, if that is what’s done, would be the equivalent of removing a man’s foreskin, meaning the clitoral hood would be removed. In FGM, the entire clitoris is removed and in many cases, the labia minora are also removed. In a practice called infibulation, the the clitoris and the surrounding area, including the labia minora, are excised and the labia majora are sewn together. I once took care of an older woman who had this done. She was in heart failure and needed a foley catheter inserted. She was very upset about having to disrobe, but with her female relatives helping her and her privacy protected, she did. As I went to insert the foley I was astonished to find-nothing. There was nothing there except for the tiniest orifice. I knew what FGM was, but I never expected to see it.

Although sometimes associated with Islam, FGM is more of a cultural phenomenon and is practiced by followers of animism, Christianity and Islam. In other Muslim countries it is unheard of. FGM is usually done on prepubescent girls, but has even been done on infants, according to the WHO. Very often, it is done without anesthetic and in unhygienic conditions. (The State Department) Although families with money will find doctors who will do it under anesthetic and in better conditions, the World Health Organization considers the “medicalization” of FGM to be unethical and condemns the practice. Defenders say that being “cut” ensures a woman being faithful to her husband and that without it, she is unmarriageable. Suffice it to say, this practice is known to cause numerous complications, not the least of which is the risk of bleeding and infection at the time it’s done. According to Our Bodies, Ourselves For The New Century, long term complications include abscess formation, scar neuromas, dermoid cysts, painful sexual intercourse, and vulvar adhesions. Scar tissue can lead to urinary retention and infections, kidney stones, dysmenorrhea and chronic pelvic inflammation, which can lead to infertility.

Communities in the US with high percentages of immigrants may see an influx of FGM. According to the CDC, in some communites, doctors report that as many as 2/3’s of their population has had it done. It is becoming common enough that they have introduced ICD codes for the condition. It goes on to say that women that have undergone infibulation must have surgery before they can have intercourse or deliver a baby. Multiparous women who have undergone infibulation and then reinfibulation following birth are more likely to have complications and a high incidence of maternal and fetal death with subsequent births.

Women who have undergone FGM live in our country and it’s possible you will encounter them in your nursing practice. If a woman presents in labor she may have to have surgery to enlarge the vaginal opening or have a C-section. Knowledge of this practice will help you understand the many complications that can result. Of utmost importance is to be nonjudgemental in your dealings with them. Some may worry that being against FGM could be considered racist or not being culturally sensitive, but this practice is condemned by the WHO, the UN and many other international organizations, as well as leaders in some of the countries where it is practiced. For more information go to CARE.

Susan McNicholas
About Susan McNicholas
I graduated Brookdale Community College in December, 1996. Most of my nursing experience has been in the emergency room, but I've also done stints in the OR and PICU. For the last 3 years I've worked as a transplant coordinator for an organ procurement organization. These experiences I share in my blog at Donor Cycle. I also live with my amazing husband, my teenage daughter and my new baby girl. Along with a smelly dog, various cats and too many fish they make up the rest of my life.

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