Culture, Beliefs, Attitude and Peer Group Influence on Female Genital Mutilation in Southeast Nigeria

Background: Female Genital Mutilation is still practiced in Ebonyi State in Southeast Nigeria, despite the complications that follows it and government legislation against the practice. Aim: To determine the impact of Culture, Beliefs, attitude and Peer Group Influence on the persistence Female Genital Mutilation practice in the State especially in the rural areas. Materials and Methods: Qualitative study that used Focused Group Discussion and In-depth interviews for data collection. Those willing and given consent were recruited into the group discussion according to age, marital status, educational level and their location in the state. In-depth interviews were used with the Stake Holders, Opinion Leaders, Traditional Rulers and the Clergy. Result: A total of 454 participants were recruited from the 13 local government areas of Ebonyi State but only 420 (92.5%) participated. The age ranges of participants were 25 to 35 years for single males and females while the married participants male and female were aged 35 to 70 years. One hundred single females (23.8%) and 94 single males (21.4%) participated while 97 (23.1%) married women and 95 (22.6%) married men participated. Out of the 26 health workers recruited only 22 (5.2%) participated. Four traditional rulers, 4 women leaders, 4 youth leaders and 2 clergy 12 (2.9%) in number had in-depth interviews. All the participants had knowledge of FGM and its practice. Rural health workers are getting more involved. ‘Female Genital Crushing’ is replacing actual cutting. The participants all agreed there is no benefit and the practice should stop. Conclusion: Female Genital Mutilation is secretly practiced and is getting replaced by “Female Genital Crushing” perpetrated by rural health workers as well as mothers, fathers, traditional birth attendants and the peer group playing a major role with low knowledge of the Law against Female genital mutilation.

Underlying Sociocultural Practices Influencing Prevalence of Female Genital Mutilation/Cutting in Kajiado County

Background: Female Genital Mutilation/Cutting (FGM/C) often has lifelong negative consequences for a woman’s physical and mental health but is still practiced in some parts of Kenya including Kajiado County. We aimed to estimate the current prevalence as well as the socio-cultural beliefs and power relations that are in favor of or against the practice in Kajiado, Kenya. Methods: A mixed method cross-sectional study was conducted in Kajiado County. The study targeted: women of reproductive age (15 to 49 years);community health volunteers (CHVs);opinion leaders;health care workers;officials from the ministries of Education, Health, Culture, Gender and Social Services;Community Health Assistants (CHAs);Traditional Birth Attendants (TBAs);teachers;morans and adolescent boys and girls aged 10 to 24 years. Data were collected both quantitatively through a household questionnaire and qualitatively through the focus group discussions and key informant interviews. Factors influencing Female Genital Mutilation/Cutting (FGM/C) were classified as either social, cultural beliefs or economic. Results: From the study, quantitative results revealed that the prevalence of FGM/C in Kajiado County was 91%, with most of them (96.7%) practicing type 2 (excision) circumcisions. From the interviews, girls undergo the cut as a rite of passage to womanhood and thus a prerequisite for marriage. It is also believed that girls who are uncircumcised cannot be helped by TBAs in delivery. It is believed that their blood is poisonous and can cause bad omen to whoever comes in contact with dirty blood. Additionally, it is believed that girls go through the cut to avoid conflict and natural phenomena;for instance, drought and outbreaks of diseases that kill many people. Finally, it is a practice that earns respect for the parents of the girls and incentives as dowry to the father of the girl. TBAs that perform FGM/C get paid in cash and kind. Conclusion: Female genital mutilation/cutting practice in Kajiado County is still high. Efforts to end the practice will need to have an integrated approach to include all the players. Suggested alternatives to the cut must, therefore, be inclusive so as to address the myths/beliefs, misconceptions, socio-cultural and economic factors in favor of the vice. The alternatives must be inclusive for the beneficiaries, supporters, and practitioners.

Bivariate Logistic Regression of Knowledge as Predictor of the Practice of Female Genital Mutilation in Ekiti State,Nigeria

Female genital mutilation/cutting(FGM/C)is a harmful traditional practice with severe health implications among women and girls.This study determined whether knowledge reduced the practice of female genital mutilation and identified the socio-demographic factors that predicted the practice of female genital among parents in Ekiti State,Nigeria.A cross-sectional quantitative research method was employed among 600 selected parents in the three senatorial districts of Ekiti-State,Nigeria between March and June 2019.A pretested structured questionnaire was used to collect data.Our analysis revealed that 468(78%)of the respondents believed that the practice was high as against 132(22%)who said the practice was low.Female is two times more likely to practice FGM than male(OR=1.614,B=0.479,p<0.05,CI=1.088-2.394).Respondents with low knowledge were significantly 11 times likely to practice female genital mutilation compared with respondents with high knowledge(OR=10.597,B=2.361,p<0.05,CI=6.813-16.483).Those who lived in rural areas were two times significantly(OR=1.690,B=0.525,p<0.05,CI=3.246-13.197)likely to practice female genital mutilation than the urban dwellers.The study concluded that respondents’knowledge,location(urban/rural),sex,age,and ethnicity were strong predictors of the practice of FGM/C in Ekiti-State,Nigeria.With these findings in mind,the community institutions would play a great role in changing the community through spreading information about the health implications of FGM/C for the practice to be drastically reduced.

Obstetrical Complications of Female Genital Mutilation: Management Maternal-Fetal Medical Care and Prognosis, Obstetrical Gynecology Regional Hospital, Unit of N'zérékoré

Introduction: Female Genital Mutilation (FGM) is a public health problem. There are 100 to 140 million girls and women who suffer every year in the world [1]. The aim of this study is to improve the medical care and reduce complications of FGM at the Regionalhospital of N’zérékoré, to determine their frequency, and to evaluate the maternal-fetalprognosis. Methods: The study was conducted at the Regional Hospital of N’zérékoré. This was a cross-sectional, descriptive and analytic study of 6 months, from 1 September 2016 to 28 February 2017, including all pregnant women admitted for childbirth who had a complication of female genital mutilation. Results: A total of 1295 women gave birth in the service, of which 1204 women were women with female genital mutilation. Given a frequency of 92.97%, of these 1204 mutilated women, 223 presented obstetrical complications during their delivery, a proportion of 17.22%. They were mostly young patients, mostly housewives who were not in school. Type II FGM was the most common (53.06%). Obstetric complications were dominated by complicated perinatal tears (54.08%), and hemorrhages (40.81%). The catch was dominated by perineorrhaphy. Conclusion: The frequency of FGM was 92.97% and that of their obstetric complications 17.22%. Most were house-wives, not in school. There was FGM type II. The abandonment of FGM would reduce maternal and perinatal morbidity and mortality.

Genital and Urinary Tract Obstruction as a Late Complication of Female Genital Mutilation at Latifa Hospital, Dubai, UAE—Case Report

Female genital mutilation (FGM) is partial or total excision of female external genitalia or other deliberate injury to the female genital organs for non-therapeutic purpose. It is cultural and traditional practice. Female genital mutilation may result in immediate complications such as severe pain and bleeding and long-term complications such as: psychological, psychosexual, trauma, infertility, urinary and genital complications.

Self-Genital Mutilation and Attempted Suicide by Cut Throat in the Same Patient at Presentation: A Rare Event

Genital self-mutilation is an uncommon event that is commonly associated with psychotic disorders. Such injuries have also been reported secondary to complex religious beliefs and delusions regarding sexual guilt. Even though few case reports of male genital self-mutilation are available in literature, it is?rareto have a combined self-genital mutilation and attempted suicide by cut throat occurring in the same patient at presentation. We presented the case of a 38-yr-old male who presented to the accident and emergency centre of a tertiary hospital in Accra, Ghana.

Survey Study of Acute and Long Term Effects of Female Genital Mutilation among Women in Sharkia Governorate

Objective: The aim of this study is to evaluate the acute and long-term effects of female genital mutilation (FGM) among women in Sharkia Governorate. Method: This was a cross-sectional descriptive study carried out in Zagazic University Hospital (ZUH) over a two years period from January 2012 to January 2014. The overall sample consisted of 1500 women. An interview was utilized to collect the necessary data. The questionnaires were administered face to face, in Arabic language. Four open and 25 close-ended questions were used to collect socio-demographic data of the sample: women’s experience about the circumcision, occurrence of health hazards after circumcision, and sexual effects on married women. Intention of all women (circumcised or not) to circumcise?their daughters was also documented. Results: This study revealed that the prevalence of FGM in?Sharkia Governorate was about 85.5%. The majority of circumcised women were Muslims (94.4%), married (87.9%), housewife (81.4%), illiterate or with low education level (45.5% and 38.5% respectively) and from rural areas (82.2%). The most common types of FGM were type I (49.2%) and type II (50.8%). The most common motive of FGM was the religious cause (46.6%). The majority of circumcised women (59%) denied the occurrence of any acute complication. The reported acute complications in this study were bleeding (19.6%), urine retention (2.3%), infection (6.3%) and difficult walking (12.8%). The majority of circumcised women (86%) denied the occurrence of any problems at labor related to circumcision. The reported problems at labor in this study were narrowing of introitus (8.4%), laceration (0.7%) and bleeding (4.9%). In this study, 74.6% of circumcised women believed that there was no effect of circumcision on their sexual satisfaction and 92.1% of circumcised women believed that there was no effect of circumcision on their husband’s sexual satisfaction. Approximately 16% of circumcised women complained of dyspareunia and believed that it was related to circumcision. Conclusion: Female circumcision is deeply rooted in our community and laws alone will not eradicate it. Moreover, this approach may drive it underground. Increased media coverage, statements by ministers, religious leaders and non-governmental organizations may lead to increased discussion of the topic at a local level. Spreading the message by means of pictures, song and drama as well as economic development will be more effective.

Obstetric Complications Due to Female Genital Mutilation (FGM) at N’Djamena Mother and Child Hospital (Chad)

Background: Female genital mutilation (FGM) or female circumcision is all procedures involving partial or total removal of the external female genital organ or other injuries to the female genital organ whether for cultural or any other non-therapeutic reasons. Female genital mutilation causes numerous complications. Four in such cases multiplies obstetric complications. The aim of this study was to identify obstetric complications due to FGM. Patients and Material: We conducted a comparative prospective case-control study for three months, from January 1st to March 31st, 2014 in the maternity of N’Djamena Mother and Child. It focused on identifying neonatal and/or maternal complications during childbirth due to FGM. The study population consisted of pregnant women at term admitted for delivery labor. All parturients had to present the same sociodemographic and clinical profiles. A history of FGM was the main distinguishing criterion. Results: During the study period, we recorded 312 births to women with genital mutilation, among 1905 deliveries, representing a prevalence of 16.4%. One hundred ninety-one cases of circumcised women responding to the inclusion criteria were selected. Most of these women were between the ages of 20 and 29. The extreme age group was 15 and 39 (with a mean of 24.5 years). FGM was significant in age group over 20 years (Khi2 = 10.8;OR = 2.6 [1.4 - 4.9];P = 0.001). The type II of FGM which removed a part of the clitoris and the adjacent labia minora represented 64.40% patients in the group of women with FGM. Perinea laceration was the frequent maternal complication among parturient with FGM (Khi2 = 9.8;OR = 2.2 [1.4 to 3.6];P = 0.0007). FGM type III was associated with a high proportion of maternal complication (Khi2 = 11.2;OR = 7.3 [1.97 - 31.6];P = 0.0001). Still births were significantly higher in the group of parturient with FGM (11.5%, P = 0.015). Conclusion: Female genital mutilation is a common cultural practice in our country;it contributes to worsening maternal and fetal complications.

Clitoral Pain and Dyspareunia after Female Genital Mutilation/Cutting: A Case Report

Background: Current evidence has focused on the complications of female genital mutilation/cutting (FGM/C) types 2 and 3, and there is a gap in the knowledge of the complications of FGM/C types 1 and 4, which are often considered milder forms of cutting. Case Presentation: A 23-year-old Somali woman with FGM/C was referred for chronic clitoral pain and superficial dyspareunia after several inconclusive gynecological examinations. Her clitoris was found to be entrapped under the scar of the cut clitoral hood. We surgically lysed the scar and reconstructed a prepuce. At the two-month follow-up, the patient reported no pain and physiologic sexual response. Conclusion: Clitoral pain and dyspareunia after FGM/C can be due to the incarceration of the clitoral glans. Treatment is surgical lysis of the scar.

Gender and Sexuality: The Myth of Female Genital Mutilation

The rights to good health, fulfilment and happiness should not be segregated. Boys and girls, men and women, as created by God are entitled to the right to live in health, feel fulfilled and enjoy a certain level of happiness. In some parts of Nigeria, the female gender is expected to be chaste as well as inactive sexually. In order to maintain chastity in young girls and keep married women faithful during marriage, females are made to go through circumcision medically known as female genital mutilation (FGM). The age and kind of mutilation varies from tribe to tribe. However, this precaution is not reciprocal in male, because the man has the right to decide to be faithful to his spouse or not. Drawing from primary and secondary data, the paper seeks to solve the puzzle: Does genital mutilation reduce the sexual drive of a female? Primary data were obtained from focus group discussions and interview, while secondary data were obtained through relevant literature pertaining to female genital mutilation in Nigeria were obtained from journals, textbooks, selected documents, and Internet. A review of these articles was conducted and after critical appraisal, using narrative analysis, the data extracted from the articles regarding FGM were analysed. Using a comparative scope covering the northern and southern parts of Nigeria, the paper argues that FGM is a women rights violation. The paper therefore recommends that females be allowed to enjoy equal sexual rights as their male counterparts.

Management of a Total Coalescence of the Labia Majora in an 11-Year-Old Girl Following a Female Genital Mutilation: A Case Report

Female genital mutilation (FGM) is still a topical practice in several African regions or countries. They constitute a violation of human rights, in particular because of their harmful consequences for the health of the people who suffer them and are the source of various complications. We report a case of FGM complications in the form of total coalescence of the labia majora with a small hole from which urine flows permanently. The management was a disinfubilation with suturing of the edges and urethral reimplantation and the evolution was favorable with complete healing after two (2) weeks.

Circumcision of Infants and Children: Short-Term Trauma and Long-Term Psychosexual Harm

Non-therapeutic infant male circumcision is a permanent surgical alteration to the penis that may cause significant physical, sexual and psychological harm. Physical harms include unintended adverse effects of the surgery itself (e.g., complications such as bleeding, infection, excessive removal of foreskin leaving insufficient shaft skin to accommodate erections, etc.), as well as the inherent loss of healthy, functional tissue. Sexual harms that necessarily follow from circumcision include the loss of all sensation in the foreskin itself, and the loss of all sexual functions that involve the physical manipulation of the foreskin. Additional sexual harms that may follow circumcision include reduced sexual sensation in the remaining penile structures, difficulty with masturbation, increased chafing in both the circumcised man and his sexual partner, as well as reduced overall psychosexual/psychological tension relief and subjective satisfaction. Psychological harms include short-term trauma as well as the potential for long-term emotional disturbances, including sadness, frustration, distress, and anger—akin to post-traumatic stress disorder (PTSD). In this paper, the extent and severity of these various harms are considered and it is argued that they are more serious and more widespread than is commonly believed.

Bilateral Pedicled Superficial Epigastric Flap in the Management of Circumferential Combined Degloving and Full Thickness Burn Hand Injury—A Case Report

We report a case of combined hand trauma in the form of circumferential degloving injury of the hand with full thickness friction burns of the hand, forearm and the distal part of the upper arm. On exploration the hand was found avascular with loss of vital structures and full thickness burns. As a salvage procedure the hand was embedded in the subcutaneous tissue of the abdomen for 4 weeks and after that elevated as an inferiorly based flap on the bilateral superficial inferior epigastric arteries. Two weeks later the hand was freed by division of the base of the flap bilaterally. The details and description of the injury, the procedure and the outcome are discussed.

Epidemiological Particularities and Indications of the Mutilating Surgery of the Eyeball in Abidjan (Ivory Coast)

Objective: To describe the epidemiological profile and indications of mutilating eyeball surgery in Abidjan. Patients and methods: This is a retrospective descriptive study on the files of eviscerated, enucleated or exentered patients in the Ophthalmology Department of the University Hospital of Yopougon from January 2010 to December 2016. The parameters studied were: socio-demographic characteristics, indications of mutilating surgery, anesthetic technique, operative technique and patient evolution. Results: During the study period, 59 patients underwent surgery for mutilating eye surgery out of a total of 11,114 procedures, a frequency of 0.53%. The average age of the patients was 31 years with extremes of 3 years and 67 years. Men predominated in 62.1% of cases with a sex ratio of 1.64. Patients came from rural areas in 68.5% of cases. The main indications of the mutilating surgery were: post-inflammatory phthisis (58.6%) and tumoral affections (29.31%). Evisceration was the most common operative technique (67.2%). In 68% of cases the interventions were performed under peribulbar anesthesia. Patients with evisceration (67.2%) and enucleation (5.1%) all benefited from prosthetic equipment. Conclusion: The mutilating surgery of the eyeball is responsible for serious psychological and sociological impacts. The seriousness of these repercussions requires primary prevention through early and adequate management of eye conditions.