Given the recent shocking figures released from the Health and Social Care Information Centre (HSCIC) stating that between April 2015 and March 2016 there were 5,702 new cases of FGMin England, I decided to dedicate my latest blog to the cause of increasing awareness and putting an end to this act of abuse.
Female Genital Mutilation (FGM) or ‘cutting’ is a procedure where the female genitals are deliberately cut, injured or changed, in the absence of medical reason(1). It is usually carried out on young girls between infancy and the age of 15, most commonly before puberty starts. It is very painful, often being carried out without medical training and against the will of the girls, and can seriously harm their health not to mention the potential for long-term problems with sex, childbirth and mental health. Reports suggest anaesthetics and antiseptics are not generally used, and the procedure can be carried out using knives, scissors, scalpels, pieces of glass or razor blades (my pelvic floor muscles have never clenched so tight as when I typed that…).
There are 4 main types of FGM (2):
Type 1 (clitoridectomy) – removing part or all of the clitoris
Type 2 (excision) – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips).
Type 3 (infibulation) – narrowing of the vaginal opening by creating a seal, formed by cutting and repositioning the labia.
Type 4 Other harmful procedures to the female genitals, including pricking, piercing, cutting, scraping or burning the area.
FGM is practiced in more than 28 countries in Africa, parts of the Middle East, South East Asia, Europe, America and other countries where migrants from FGM-affected communities live. This includes the UK (3), in keeping with my opening statistics. Unicef estimates that at least 200 million girls and women alive today have undergone the abuse of FGM (3).
There are NO known health benefits to FGM however myths surrounding the practice include ‘it is healthier’, ‘cleaner’, ‘prepares a woman for childbearing’, ‘increases fertility’, ‘God’s wish’, ‘assure faithfulness of women to their husbands’ and it ‘preserves virginity’. Shockingly, other rational for why it is carried out includes decreasing a woman’s sexual desire (4).
Problems associated with FGM include:
repeated infections, which can lead to infertility
bleeding, cysts and abscesses
problems during labour and childbirth, which can be life-threatening for mother and baby
vaginal problems (discharge, itching, bacterial vaginosis and other infections);
menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.);
scar tissue and keloid;
sexual problems (pain and/or difficulty having intercourse, decreased satisfaction, etc.);
difficulty getting pregnant due to inability to have intercourse,
increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths;
need for later surgeries: for example, the FGM procedure that seals or narrows a vaginal opening (type 3) needs to be cut open later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks;
psychological issues e.g. depression, flashbacks and self-harm
girls have been known to die from blood loss or infection as a direct result of the procedure.
Many women put up with these symptoms as the norm and this needs to change. Women need to be empowered to understand that these symptoms are not normal, that the act of FGM is not indicated, and that it is in fact an act of abuse. FGM is against the law in the UK and is widely recognised as a human rights violation, a form of child abuse, and a severe form of violence against women and girls that breaches the United Nations Convention on the Rights of the Child (5). It is also illegal to facilitate the process of FGM .In October 31st 2015 it also became mandatory duty for all regulated health professionals within the UK to report any cases of FGM that they encounter (Serious Crime Act 2015).
The International Organization of Physical Therapists in Women’s Health (IOPTWH) is strongly against FGM. At the 2011 WCPT Amsterdam meeting, the IOPTWH presented the results of its international survey, showing that physiotherapists around the world are treating victims of FGM. The survey indicated the most common reasons for referral are urinary dysfunction, perineal trauma during vaginal delivery, dyspareunia, postnatal urinary dysfunction, chronic painandvaginismus. Of the 18 participating countries, UK physiotherapists treated the most women for the long-term effects of FGM.
Women who have suffered this traumatic and life changing procedure need to access help for the problems they have been left with. Some women may require surgical procedures to correct or reverse the mutilation, others may have no surgical options but require treatment in the form of medication, counselling, or specialist pelvic physiotherapy.
What can pelvic physiotherapy offer to someone who is suffering FGM?
Specialist Pelvic Physiotherapists can address issues such as chronic pelvic pain, dyspareunia (painful intercourse), vaginismus, urinary or bowel problems, as well as helping to increase the patients understanding of FGM. Treatment approaches may include manual therapy and soft tissue release for the pelvic floor and surrounding area, visceral mobilisation, breathing techniques, pain education, biofeedback including real-time ultrasound, bladder/bowel training, scar mobilisation, dilator therapy, electrotherapy, acupuncture and much more. As Specialist Physiotherapists we may refer onward or communicate with a consultant or other health professional whom we feel you would benefit from seeing.
Each year, 6 February is the International Day of Zero Tolerance to FGM when various non-governmental organisations and world bodies not only condemn the practice, but also report on progress towards abandoning it. Last year the world welcomed Nigeria making history when it outlawed FGM under the ‘Violence Against Persons (Prohibition) Act 2015’. Lets hope that by Feburary 6th 2017 this practice is extinct and that victims of this abuse find help whether that is surgery, physio, counselling, etc.
Please do your part to achieve this by spreading the word and sharing this blog.