Female Genital Anatomy and Female Genital Mutilation/Cutting ‘Development Issues – A course for Transition Year’ Gender

The external view of the female genitals It should be highlighted that not all womens genitals look the same just as every womans body is not the same. Point out and give a brief description of the function of each part listed below. STRUCTURE FUNCTION Vaginal opening Allows escape of the menstrual flow, sexual intercourse and delivery of the baby Urethral opening Allows emptying of the bladder within a few minutes Clitoris Assists women to achieve sexual satisfaction Perineum Supports the pelvic organs and separates vagina from anus Labia minora Protects structures and internal openings Labia majora Protects the inner structures and openings

What is FGM/C? All procedures which involve the partial or total removal of the external genitalia or injury to the female genital organs whether for cultural or any other non-medical reasons The World Health Organisation

Why does FGM/C occur Justifications for FGM may include: custom and tradition - mothers may have undergone FGM and expectations exist for daughters. social acceptance, especially for marriage family honor a sense of belonging to the group and conversely the fear of social exclusion cultural identity – a tribal initiation into adulthood religion, in the mistaken belief that it is a religious requirement preserving virginity / chastity hygiene and cleanliness enhancing fertility Before presenting the justifications to the students, brainstorm with the class as to why they think that female genital mutilation might be practiced in some cultures. Introduce each of the reasons. It is advisable that you do some background reading on the subject to give some examples. Further reading can be found: http://www.unicef.org/malaysia/FGCM_Lo_res.pdf

Prevalence of FGM/C in Africa and Middle East source UNICEF (2013) A map of the African continent, showing the average prevalence of FGM The rate of instance is not well documented. Figures are not necessarily accurate Importantly, in countries where the average prevalence is low – there can be individual communities in that country where the prevalence is above average and in some cases high. Safeguarding risks should not be based solely on prevalence rates. It is more therefore more accurate to view FGM as being undertaken by specific community groups, rather than by a whole country, as communities who perform FGM straddle national boundaries Not every woman from a practicing community will have had FGM. Not every woman who has had FGM will support the practice.

Who performs FGM/C In cultures where FGM is the custom, the operation is performed by traditional excisors, commonly elderly women in the community specially designated this task. FGM is sometimes performed by traditional birth attendance and village barbers. Implements used are sometimes blunt razor blades or knives. Often these are not sterilized. What risks are the babies and young women exposed to as a result?

Types of FGM/C There are 4 known types of FGM/C FGM may be performed between the age of a few days through to adolescence or young motherhood. Six to ten years is a commonly selected age. The procedure is often performed in poor light, without anaesthesia and using blades, knives, broken glass or non-surgical instruments that are often shared. Girls have to be forcibly restrained. Following more extensive forms of FGM, the legs may be tied together for many days to aid healing. The information here may upset some people in the room. Basic diagrams will depict the 4 types of FGM/C but no photographs are being used. If students find it too disturbing they should be allowed to leave the room to a safe zone.

Type 1 FGM Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). Type 1 FGM usually removes all of the clitoris and prepuce. Diagrams sourced from ‘Female genital mutilation - A Royal College of Nursing educational resource for nursing and midwifery staff’. Text sourced from WHO Fact Sheet on FGM.

Type 2 FGM Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina). Diagrams sourced from ‘Female genital mutilation - A Royal College of Nursing educational resource for nursing and midwifery staff’. Text sourced from WHO Fact Sheet on FGM.

Type 3 FGM Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris Diagrams sourced from ‘Female genital mutilation - A Royal College of Nursing educational resource for nursing and midwifery staff’. Text sourced from WHO Fact Sheet on FGM.

Type 4 FGM All other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping stretching the labia and cauterizing the genital area. Diagrams sourced from ‘Female genital mutilation - A Royal College of Nursing educational resource for nursing and midwifery staff’. Text sourced from WHO Fact Sheet on FGM.

Short term risks from procedure Severe pain, shock Hemorrhaging (sometimes to death) abscesses septicemia gangrene tetanus emotional depression, chronic anxiety risk of bacterial or HIV infection due to instruments being re-used without sterilisation Urinary tract infections Ask the class if they know what short term risks would result for a young woman having undergone FGM.

Long term risks from procedure psychosocial trauma and flashbacks, post-traumatic stress disorder lack of trust in carers vaginal closure due to scarring neuromata – cut nerve endings causing permanent pain pain and chronic infection from obstruction to menstrual flow recurrent urinary tract infection and renal damage painful intercourse lack of pleasurable sensations and orgasm, marital conflict infertility from pelvic inflammatory disease and obstructed genital tract risk of HIV through traumatic intercourse childbirth trauma – perineal tears and vaginal fistulae postnatal wound infection prolonged or obstructed labour from tough scarring Again ask students what they think might be the long term effects/risks from the procedures outlined in previous slides.