4+Types+of+FGM

There are four different types of Female Genital Mutilation. According to Efua Dorkenoo, the author of Cutting the Rose, the mildest form of female genital mutilation is to remove the clitoris with a sharp object such as scissors, glass, razors and even stones and fingernails. In order to stop the bleeding some use one or two stitches to seal the wound. This type of FGM is called circumcision. The next type of FGM has severely more cutting. In this case not only the clitoris is removed but also the labia minora are either practically, or totally removed, too and there are no stitches to stop the bleeding. According to Efua Dorkenoo, this type of FGM is called excision, and it accounts for 80 % of all FGM. The clitoris as well as the labia minora, together with the inner surface of the labia majora, are being cut off is the third type of FGM. After the removal of this part the bleeding endings of the labia majora are stitched or just brought together with thorns or poutices. The legs have to squeeze strongly together for 2-6 weeks. Once a woman is married and ready to experience intercourse, it is necessary to create a small opening. The last type of FGM is called intermediate infibulations. In this case there is a scraping of the tissue around the vaginal opening. Waris Dirie has to live with the third type. The women who used to perform the circumcision stitched the labia majora together with a large needle. None of these types are in any way human or helpful to women’s health. The women do not only get damaged psychically but also physiologically.

According to [|the World Health Organization] the following forms of FGM are used: **Description of the different types of female genital mutilation** Female genital mutilation is usually performed by traditional practitioners, generally elderly women in the community specially designated for this task, or traditional birth attendants. In some countries, health professionals trained midwives and physicians are increasingly performing female genital mutilation. In Egypt, for example, preliminary results from the 1995 Demographic and Health Survey indicate that the proportion of women who reported having been circumcised by a doctor was 13%. In contrast, among their most recently circumcised daughters, 46% had been circumcised by a doctor. The procedures employed in each type of female genital mutilation are described below. In the commonest form of this procedure the clitoris is held between the thumb and index finger, pulled out and amputated with one stroke of a sharp object. Bleeding is usually stopped by packing the wound with gauzes or other substances and applying a pressure bandage. Modern trained practitioners may insert one or two stitches around the clitoral artery to stop the bleeding. The degree of severity of cutting varies considerably in this type. Commonly the clitoris is amputated as described above and the labia minora are partially or totally removed, often with the same stroke. Bleeding is stopped with packing and bandages or by a few circular stitches which may or may not cover the urethra and part of the vaginal opening. There are reported cases of extensive excisions which heal with fusion of the raw surfaces, resulting in pseudo-infibulation even though there has been no stitching. Types I and II generally account for 80-85% of all female genital mutilation, although the proportion may vary greatly from country to country. The amount of tissue removed is extensive. The most extreme form involves the complete removal of the clitoris and labia minora, together with the inner surface of the labia majora. The raw edges of the labia majora are brought together to fuse, using thorns, poultices or stitching to hold them in place, and the legs are tied together for 2-6 weeks. The healed scar creates a hood of skin which covers the urethra and part or most of the vagina, and which acts as a physical barrier to intercourse. A small opening is left at the back to allow for the flow of urine and menstrual blood. The opening is surrounded by skin and scar tissue and is usually 2-3 cm in diameter but may be as small as the head of a matchstick. If after infibulation the posterior opening is large enough, sexual intercourse can take place after gradual dilatation, which may take weeks, months or, in some recorded cases, as long as two years. If the opening is too small to start the dilatation, recutting (defibulation) before intercourse is traditionally undertaken by the husband or one of his female relatives using a sharp knife or a piece of glass. Modern couples may seek the assistance of a trained health professional, although this is done in secrecy, possibly because it might undermine the social image of the man's virility. In almost all cases of infibulation and in many cases of severe excision, defibulation must also be performed during childbirth to allow exit of the fetal head without tearing the surrounding scar tissue. If no experienced birth attendant is available to perform defibulation, fetal and/or maternal complications may occur because of obstructed labour or perineal tears. Traditionally, "re-infibulation" is performed after the woman gives birth. The raw edges are stitched together again to create a small posterior opening, often the same size as that which existed before marriage. This is done to create the illusion of virginity, since a tight vaginal opening is culturally perceived as more pleasurable to the man. Because of the extent of both the initial and repeated cutting and suturing, the physical, sexual and psychological effects of infibulation are greater and longer-lasting than for other types of female genital mutilation. Although only an estimated 15-20% of all women who experience genital mutilation undergo type III, in certain countries such as Djibouti, Somalia and Sudan the proportion is 80-90%. Infibulation is practised on a smaller scale in parts of Egypt, Eritrea, Ethiopia, Gambia, Kenya and Mali, and may occur in other communities where information is lacking or still incomplete. //**Type IV**// Type IV female genital mutilation encompasses a variety of procedures, most of which are self-explanatory. Two procedures are described here. The term "angurya cuts" describes the scraping of the tissue around the vaginal opening. "Gishiri cuts" are posterior (or backward) cuts from the vagina into the perineum as an attempt to increase the vaginal outlet to relieve obstructed labour. They often result in vesicovaginal fistulae and damage to the anal sphincter. There is no mention of removing only the clitoral hood as [|described by Dr. Nowa Omoigui.] While the clitoris is the analogue of the glans penis, it should not be assumed that it is innervated in the same way. The evidence is that the glans clitoris is far **more** sensitive than the glans penis, and that the nearest analogue to the clitoris in sensitivity is the male foreskin.
 * //Type I//**
 * //Type II//**
 * //Type III//**

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