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FGM – Female Genital Mutilation Kvinnlig Könsstympning

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FGM – Female Genital Mutilation Kvinnlig Könsstympning Trollhättan, 17+18/11 2016 Senior FGM – Female Genital Mutilation Kvinnlig Könsstympning Dr. med. Johannes Leidinger, MD., MPH. Senior Consultant in Gynaecology and Obstetrics Överläkare på Kvinnokliniken Södersjukhuset Stockholm & Mälarsjukhuset Eskilstuna Lehrbeauftragter/Dozent der Ludwig-Maximilians-Universität München 16 days of activism 2016 From 25 November, the International Day for the Elimination of Violence against Women, to 10 December, Human Rights Day, the 16 Days of Activism against Gender-Based Violence Campaign is a time to galvanize action to end violence against women and girls around the world. http://www.unwomen.org/en/what-we-do/ending-violence-against-women/ take-action/16-days-of-activism#sthash.zXvSzU8E.dpuf Sexual Violence: ¨ Rape ¨ Indecent Assault ¨ Forced Marriage ¨ Sexual Slavery http://www.eldis.org ¨ FGM (Female Genital Mutilation) ¨ Forced Pregnancy ¨ Forced Abortion ¨ Sexual Harassment WHO: FGM ¨ „FGM comprises all procedures that involve altering or injuring the female genitalia for non­ medical reasons - , and is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women and girls.“ Program 18 Nov 2016, 9-12 am ¨ Nomenklatur ¨ Klassifikation ¨ Global Prevalens ¨ Förklaringsmodeller ¨ Medicinska komplikationer ¨ Nationell & internationell Lagstiftning ¨ Vård i Sverige – AMEL-mottagning – Operativa rekonstruktioner – Desert Flower Scandinavia ¨ Global perspektiv – Internationella strategier (WHO och NGOs) – Medicalization of FGM Terminology ¨ The expression ”Female Genital Mutilation" gained growing support from the late 1970s. The word ”mutilation” establishes a clear linguistic distinction from male circumcision, and emphasizes the gravity and harm of the act. ¨ In 1990, this term was adopted at the ”3rd Conference of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children”, in Addis Ababa, Ethiopia. ¨ In 1991, WHO recommended that the United Nations adopt this term. It has subsequently been widely used in United Nations documents and elsewhere and is the term employed by WHO. Definition ¨ WHO: „all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons.“ Classification of the WHO (1) ¨ Type I: „Sunna“: excision of the prepuce, with or without excision of part or all of the clitoris Classification of the WHO (2) ¨ Type II: „Exzision“: excision of the clitoris with partial or total excision of the labia minora Classification of the WHO (3) ¨ Type III: „Infibulation“ („pharaonic circumcision“): excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening Classification ot the WHO (4) ¨ Type IV: pricking, piercing or incision of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue ♁ ♀ www.machimon.wordpress.com Stephan G. Gilbert: Practical Human Embryology, 1989 ”… three man caught me, bundled me in to the toilet, pinned me down and undressed me. …I saw the knife and knew what was going to happen.” – young girl, Burkina Faso Statistics (UNICEF, February 2016) ¨ Global: > 200 Mio. women and girls – ca. 80% Type II („Excision“) – ca. 15% Type III („Infibulation“) ¨ Incidens: + 3,6 Mio./year (Tendency ) = ca. 10.000/day = > 400/h 2014 www.unicef.org/media/files/FGM-C_Report_7_15_Final_LR.pdf (GAMS – Belgique 2013) WHO Spreading FGM type II & type III Humanitarian News and Analysis a service of the UN Office for the Coordination of Humanitarian Affairs YEMEN: Eradicating FGM will be a slow process, experts say SANA, 14 November 2005 FGM is believed to be performed on approximately one quarter of all girls in Yemen WHO (2008): prevalence 30% UNICEF (2013): 97% of FGM within the first month of a baby girl "Female Genital Mutilation in Iraqi Kurdistan" Presentation to the conference: 1ère Journée Humanitaire sur la Santé des Femmes dans le Monde organized by Gynécologie sans Frontières Paris May 8th 2006 By: Sandra Strobel and Thomas v. der Osten-Sacken, Wadi e. V. www.stopfgmkurdistan.org Iran: „About 50% among Sunni minorities“ http://www.stopfgmmideast.org/countries/iran (2015) United States Department of State: Indonesia: Report on Female Genital Mutilation (FGM) or Female Genital Cutting (FGC), 1 June 2001 ”… According to the study, of 100 mothers in the Kemayoran community in Jakarta, 97% of their female children had been circumcised. …” available at: www.unhcr.org [accessed 10 February 2013] Total prevalence of FGM in Indonesia: 51% www.data.unicef.org, february 2015 FGM in Western Countries Globale prevalence on FGM (Source: Waris Dirie Foundation, Desert Flower) Publications USA, middle of 20th century ¨ Female Circumcision, Indications and a New Technique W. G. Rathmann, MD Inglewood, California September, 1959 Dr. Rathmann writes: "The value of this procedure [female circumcision] in improving function has been recognized by various cultures for the past 3,500 years." ¨ Circumcision of the Female C. F. McDonald, MD Milwaukee, Wisconsin September, 1958 Dr. McDonald writes: "If the male needs circumcision for cleanliness and hygiene, why not the female?" 1958 UNICEF (2015): Why is FGM practiced / background ¨ Tradition (Egypt ca. 2500 A.C.), initiation rites ¨ Religion (known in all religions) ¨ Cultural reasons linked to the place of the women in society ¨ Medical and health reasons ¨ Aesthetics ¨ Hygiene ¨ Money, Power, Prestige ¨ Female discrimination ¨ Suppression of the female sexuality On the sarcophagus of Sit-hedj-hotep, who lived sometime during the 12th dynasty of the middle kingdom (1991-1786 B.C.E.), there is a ritualistic procedure written down which describes circumcision involved in some sort of magical act (source:GenderEgyptANT3145-fall11BrittanniWyatt) Why is FGM practiced / background ¨ Tradition (Egypt ca. 2500 A.C.), initiation rites ¨ Religion (known in all religions) ¨ Cultural reasons linked to the place of the women in society ¨ Medical and health reasons ¨ Aesthetics ¨ Hygiene ¨ Money, Power, Prestige ¨ Female discrimination ¨ Suppression of the female sexuality Why is FGM practiced / background ¨ Tradition (Egypt ca. 2500 A.C.), initiation rites ¨ Religion (known in all religions) ¨ Cultural reasons linked to the place of the women in society ¨ Medical and health reasons ¨ Aesthetics ¨ Hygiene ¨ Money, Power, Prestige ¨ Female discrimination ¨ Suppression of the female sexuality Lit: Toubia, N. (1993): Female Genital Mutilation: A Call for Global Action. New York: Women, Ink; pp. 21. Demographic and Health Survey - Egypt. (1995). Calverton, MD: Macro International Inc. pp. 173. http://www.path.org ”When you cut a girl, you know she will remain pure until she gets married, and after marriage, she will be faithful. …But when you leave a girl uncut, she sleeps with any man in community.” – female circumcisor, Kenya FGM Performing: Who and how? ¨ Crude instruments: Knifes, scissors, glassfragments, razor-blades etc. ¨ Stitching with all kind of threads, thorns, horsehair, metalrings. ¨ Anaesthesia: no ¨ Dressing: unsteril, everything you find ¨ Usually performed by women (midwives, traditional healer, local practitioner) ¨ Age: usually 4-10 years older (Tendency ) ¨ Mostly in the rural areas, low education Female genital mutilation Fact sheet N°241 February 2010 updated February 2016 “… FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls' and women's bodies … violation of the human rights of girls and women. “ 16 May 2016 May 2016 November 2016 – Volume 128 - Issue 5 – p 958–963 Female Genital Mutilation: A Visual Reference and Learning Tool for Health Care Professionals Abdulcadir, Jasmine MD; Catania, Lucrezia MD; Hindin, Michelle Jane PhD; Say, Lale MD; Petignat, Patrick MD; Abdulcadir, Omar MD ¨ „ …The tool can be consulted by caregivers when unsure on the type of female genital mutilation diagnosed and used for training and surveys for monitoring the prevalence of female genital mutilation types and subtypes.“ http://journals.lww.com/greenjournal/Citation/2016/11000/Female_Genital_Mutilation__A_Visual_Reference_and.4.aspx Health consequences (1) immediate: ¨ Acute psycho­ trauma ¨ Severe pain ¨ Infection – Localinfection – Abscess formation – General infection – Septic shock – HIV-infection – Tetanic – Gangrene ¨ Problems with urine – Urine retention, edema of the urethra, dysuri ¨ Injury – of the neighbouring organes (i.e. bladder) – Fractures (femur, claviculae, humerus) ¨ Bleading – Haemorrhage, anemia, shock ¨ Mortality because of acute complications: ca. 10% Photographies from publications 1920 ff. Health consequences (2) chronic diseases: ¨ Mortality because of long term complications (ca. 25%) ¨ Sexuality / menstruational bleeding – Dyspareuny/Apareuny, painful intercourse – Vaginal stenosis – Infertility – Dysmenorrhoea – Menorrhage – Chronic vaginitis, endometritis, adnexitis ¨ Problems with urine – Chronical urinary tract infections – Urinary tract obstruction – Incontinence ¨ Complications with the scar – Failure to heal – Abscessformation – Keloids, Dermoid cyst – Scar neuroma – Hämatokolpos – Pseudo infibulations A large sebaceous cyst after circumcision (© www.vulvovaginaldisorders.com)
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