F E M A L E G E N I T A L C U T T I N G FACTS FOR HEALTHCARE PROFESSIONALS What is Female Genital Cutting? Female genital cutting (FGC), sometimes called female circumcision or female genital mutilation, means cutting, removing, or sewing closed all or part of a girl’s or woman’s external genitals for no medical reason. FGC is sometimes incorrectly identified as a religious practice — it is not. However, it is often a part of the culture in countries where it is practiced. FGC has no health benefits and can cause long-term health problems. FGC is against the law in Michigan. Stock photo. Posed by models. Four Main Types of FGC TYPE IV TYPE III TYPE I TYPE II All other harm to the Sewing the labia Partial or total female genitalia for Partial or total together to make the removal of the nonmedical purposes, removal of the vaginal opening clitoris and the including pricking, clitoris or smaller or infibulation. labia or excision. piercing, cutting, scraping, “clitoridectomy.” The clitoris may be left and cauterization in place. (burning). Visit AAP online at https://bit.ly/2vcBvFN for figures that depict FGC, see American Academy of Pediatrics (2010). "Policy Statement – Ritual Genital Cutting of Female Minors." Pediatrics, Vol 125, No 5. doi:10.1542/peds.2010-0187. W H O I S A T R I S K ? The practice is most common in the western, eastern, and north-eastern regions of Africa, in some 3M 200M countries in the Middle East and Asia, as well as among Worldwide more than 3 More than 200 million migrants from these areas. are at risk for FGC alive million girls girls and women Some immigrant families in annually. Procedures are today have been cut. FGC the US from these countries mostly carried out on young is concentrated in 30 also practice FGC, or may girls between infancy and countries across Africa, the send their daughters back to adolescence, and occasionally Middle East and Asia. their family homeland for on adult women. FGC. Other immigrant families stop practicing FGC once they are in the US. 1 | JULY 2019 F E M A L E G E N I T A L C U T T I N G F A C T S POSSIBLE INDICATORS OF FGC Factors that might indicate risk for Indicators that a girl or woman FGC: may have been subjected to FGC: a girl’s or woman’s community or have difficulty walking, standing or country of origin. sitting; a girl’s mother, sibling or other spend longer in the bathroom or relatives have undergone FGC. toilet; a girl’s father comes from a appear withdrawn, anxious or community known to practice depressed; FGC. a family believes FGC is important have unusual behavior after an to cultural or religious identity. absence from school or college; elders hold strong influence in be particularly reluctant to undergo child rearing practices. normal medical examinations; a girl tells a professional that she is ask for help but may not be to have a ‘special procedure’ or to explicit about the problem; attend a special occasion to ‘become a woman.’ a girl or woman or family member tells a professional that FGC has a girl talks about a long holiday to taken place a country where the practice is prevalent. a girl or woman has frequent urinary, menstrual or stomach a parent or family member problems; expresses concern that FGC may be carried out on the girl. a girl avoids physical exercise or asks to be excused from physical education; there are prolonged or repeated absences from school or college; a girl talks about pain or discomfort between her legs. 2 | JULY 2019 F E M A L E G E N I T A L C U T T I N G F A C T S WHAT ARE THE RISKS? How can I help patients who FGC can cause short term and long term are at risk for or have consequences for girls and women. undergone FGC? Immediate Complications Provide accurate and clear information Severe pain to patients. Excessive bleeding Refuse to perform FGC when asked. Genital tissue swelling Communicate with cultural sensitivity. Fever Infections (e.g. tetanus) Understand your obligations under the Urinary problems law. Wound healing problems Learn strategies for working with at risk Injury to surrounding genital tissue and affected individuals and Shock communities. Death Treat the health conditions that may affect women with FGC: Long Term Consequences – Gynecological complications (e.g. Urinary problems (painful urination, menstrual problems, pelvic pain) Urinary Tract Infections) – Obstetric complications (e.g. difficult Vaginal problems (discharge, itching, labor); bacterial vaginosis, other infections) – Mental health disorders (e.g. Menstrual problems (painful menses, depression, anxiety); difficulty passing menstrual blood) – Sexual dysfunctions (e.g. painful Sexual problems (pain during intercourse). intercourse, decreased satisfaction) Refer to local or national support Increased risk of childbirth organizations, including: complications (difficult delivery, – World Health Organization excessive bleeding, Cesarean Section, www.who.int need to resuscitate the baby, newborn death) – AHA Foundation Scar tissue and keloid www.theahafoundation.org – Equality Now Psychological consequences for www.equalitynow.org undergoing or resisting FGC Feelings of loss of trust and betrayal – Orchid Project Post-traumatic stress www.orchidproject.org Depression and suicidal ideation – Sahiyo Anxiety www.sahiyo.com Guilt/shame Sexual fears and/or decreased sexual – Tahirih Justice Center pleasure www.tahirih.org Social rejection and shame for “uncleanliness” May be at risk for honor violence or abuse 3 | JULY 2019 F E M A L E G E N I T A L C U T T I N G F A C T S Do pregnant women who have had FCG need special care? Women who have had FCG may be at risk for problems during and after childbirth. Risks include: longer labor and cesarean section birth. excessive bleeding after childbirth. urine retention. psychological problems if childbirth was difficult. No special care is necessary for women with uncomplicated and well-healed Type 1 or 2 FGC. If a Type 3 infibulation is present, then reopening of the stitched or narrowed vaginal opening (defibulation) is necessary. If the woman presents while in labor, defibulation should be done during the second stage of labor, with a low-presenting part. If a woman requests restitching of the opening (re- infibulation) following childbirth, follow the counseling recommendations above, and explain why it is inadvisable to recreate the urethral/vaginal obstruction. Also, discuss the advantages of defibulation, including ease with sexual intercourse and future childbearing. Stock photos. Posed by models. How do I counsel/communicate with a patient who experienced FGC? Create a welcoming Ensure privacy and Pay attention to parental environment. confidentiality. attitudes. Stay open to other health Pay attention to your body Do not judge the woman or issues. language. her culture of origin. Remember that FGC is only Use a professional yet Show cultural awareness one aspect of the girl’s or friendly tone. and respect. woman’s life. Listen attentively and allow Use appropriate language the woman to speak. and terminology. 4 | JULY 2019 F E M A L E G E N I T A L C U T T I N G F A C T S WHY IS FGC DONE? FGC IS AGAINST THE LAW Different communities and cultures have different reasons for FGC is in the Michigan practicing FGC. Social acceptability is the most common reason. Public Health Code Families often feel pressure to have their daughter cut so she is 333.9159, effective October accepted by their community. Other reasons may include: 9, 2017. The laws: Prohibit FGM/C on The desire to ensure a Hygiene. Some minors; woman remains a virgin communities believe that Allow exceptions for necessary medical until marriage. Parents the external female genitals procedures; believe FGC is in the child's that are cut (the clitoris or Apply to the labia or both) are best interest and therefore parents/guardians who is an expression of love. unclean. facilitate as well as the individual who performs Rite of passage. In some Condition of marriage. In the procedure; countries, FGC is a part of some countries, a girl or Prohibit travel outside the ritual that a girl goes woman is cut in order to be the state for the through to be considered a considered suitable for purpose of FGC/M; Exclude cultural/ritual woman. marriage. reasons and/or consent as a defense; Belief that FGC increases Religious duty, although Provide a civil cause of sexual pleasure for the no religion’s holy texts action by the victim for man. require FGC. physical and emotional damages until the victim reaches age 28; Why do many countries oppose FGC? Provide for a felony The World Health Organization (WHO) considers FGC a human sentence of up to 15 year imprisonment; and rights violation because: Provide a basis for It violates the rights to termination of parental health and bodily integrity. rights. Is a form of violence and Depending on the facts and torture against women. evidence in each specific case, FGC may amount to parental child abuse or Violates the rights of neglect under the Child children who undergo the Protection Law. practice without consent. For more information, Because of this many countries Stock photo. Posed by review the Michigan Penal have made laws banning the model. Code sections listed on practice of FGC. page 7. 5 | JULY 2019 F E M A L E G E N I T A L C U T T I N G F A C T S RESOURCES FOR MORE INFORMATION Organizations Professional References for FGC American College of Obstetricians and American Academy of Pediatrics Gynecologists (2010).