Posts Tagged ‘Female Circumcision’

Female circumcision, comment

October 1, 2008

Female circumcision posted Tuesday Dec 4 2007

I knew about female circumcision for a few years but I never had the opportunity to evaluate a case. I recently had a woman from Africa who came to my clinic because she was having bleeding every time she had sex. She had been in the country for about two months and stated to me that she was married, but stated she was single to the intake person. A very interested male translator was with this woman and I asked if he was her husband or just a friend. He stated he was her friend so I excused him. People in America do not know that in Africa if a man can afford more wife he may be married to several women depending upon where they are from and what tribe. The man was nervous but left. (Bigamy is a crime in the USA in case you forgot.)
I had to have a telephone translator to ask questions and give this patient information.
I found out this woman did have female circumcision. The bleeding was only after sex.
The pelvic examination revealed both labias including the mons pubis was removed. The genital was only a smooth area where the skin of the mons pubis sewn together. A small speculum fit snuggly into her vaginal hole to evaluate the cervix and the vaginal walls.
Clearly the problem was the small entrance into the vagina.
After the woman was dressed I allowed the male companion back in the room (I suspected he was her husband). I showed them a picture of an uncircumcised vulva and explained to them that the tissue was necessary to stretch to deliver a baby. The patient already knew she would have to be cut open to deliver a baby.
My suggestion was to use K-Y jelly and proceed careful when having sexual encounters. There is a possibility that the vaginal hole could open a little more. If she continued to have bleeding, she would need altering the vaginal orifice with surgery.
The reason for the circumcision is religious and to try and convince women and men not to do this is to bleak.
There are women in Africa that are refusing to have this done. They are getting into groups but are usually osterized by their tribes. Sometimes these circumcisions are done when the female is a child but usually around menarche.

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Forensic Nursing Female Genital mutilation? Female Circumcision, comment

December 4, 2007

Forensic Nursing Female Genital mutilation? Female Circumcision posted Sunday, March 11 2007
I visited a Maasi tribe in Kenya. We spoke to the women about their female circumcision. They could not believe we were not circumcised. They called us “little girls” Without this procedure a girl cannot become a woman in their eyes. The circumcision is usually done with a razor blade some of the time not a new razor. No anesthesia is used and women in the family hold the girl down. Usually the incision usually will be “pinned together by acacia bush thorns. Myrrh is placed on the incision and the girl’s legs are tied together for two weeks. Infection and tetanus sometimes occurs. A problem with periods and urination occurs it often takes several minutes to urinate if the whole is very small. Painful sexual relations also are a problem. If it is a problem to have sex women will increase the whole with a knife.

With childbirth the skin needs to be cut open then restored together. Scar tissue becomes a problem when the woman has many children. Depending upon the repair a vaginal inspection is almost impossible. These women usually do not come in for a vaginal inspection.

The practitioner needs to be accepting of this culture because it is important to the woman and her family.

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Comment: Female Genital Mutilation/Female Circumcision posted Sunday, March 11, 2007

July 18, 2007

I read the posting by one of the students in the Forensic Nursing class about Female Genital Mutilation/ Female Circumcision. I did do a little research since reading your comments. I may not agree with this practice and can’t even begin to understand the cultures that continue this. I believe that it would be hard to educate a woman about this if she truly believes that it is proper based on her cultural belief. I am a Labor & Delivery nurse and had done minimal research on this practice. I have had the experience of taking care of a woman who had undergone this procedure. This particular patient had a typical first stage of labor; however the circumcision complicated the delivery. The physician had to cut a rather extensive episiotomy to facilitate the delivery of the baby. The repair after delivery was rather complicated for the physician as well. Trying to figure out what went where was a challenge. My role as the nurse was on patient education after delivery for this young mother. My assessment skills needed to be sharp and I needed to be extra careful with her. I needed to be assessing for hemorrhaging, infection, and urinary complications. I needed to stress to her the importance of proper hygiene so that the perineum would heal and be free of infection. As much as I would have loved to have had the conversation about the circumcision procedure itself, I needed to remain culturally sensitive to her background.









Female Genital Mutilation/Female Circumcision

March 11, 2007

I am in Dr. Johnson’s class, Forensic Nursing. We are reading “Forensic Nursing” by Lynch. After having read the chapter on Female Genital Mutilation/Female Circumcision (FGM/FC), I was somewhat confused about what I had read. I began to think and wondered why anyone would do this to his or her body. I had heard a little about FGM but had never experienced it in my nursing career. I got on the Internet, Wikipedia encyclopedia online, and did some research. I found out some interesting facts.

The article refers it the practice as female cutting. This is defined as “the amputation of any part of the female genitalia for cultural rather than medical reasons. The text book describes the different type of FGM. The different type are 1) Clitoridotomy, is the removal or splitting of the clitoral hood, 2) Clitoridectomy, the partial or total removal of the external parts of the clitoris, 3) Infibulation or pharaonic circumcision, includes the removal of the clitoris, labia major and the labia minora. The most severe of all of the four different types, 4) is an unclassified type which can include pricking, piercing, cutting, and scraping of the vaginal wall or incisions to the clitoris and vagina, and burning, scarring or cauterizing the tissue.
Historically the practice of FGM dates back to the 5th century B.C. and is believed to have originated in Pharaonic Egypt (hence the name “Pharaonic circumcision”). It has been found to have crossed different religions. It is found among Muslims and Animists. Today FGM/FC is practiced mainly in African countries. It is commonly in a band that stretches from Senegal in West Africa to Somalia on the east coast, as well as from Egypt in the north to Tanzania in the south. It is estimated that in these regions about 95% of all women have under gone this procedure. The practice is also preformed in the Middle East, though it is veiled in secrecy. In the parts of Africa it is practiced openly. Estimates by Amnesty International predict that over 130 million women world wide have been affected by these procedures. Amnesty International estimates that over two million are performed yearly. This practice usually occurs to young women between the ages of 7days to 14 years old.

Female genitalia mutilation is performed for many reasons, which include sexual, sociological, hygiene, and health. Sexually: men of the community feel that it controls or reduces female sexuality. Sociologically: it is used a form of initiation for girls into womanhood. Hygiene; is believed by certain cultures that the female genitalia are dirty and unsightly. Health reasons are the belief that it enhances fertility and child survival.

Female genitalia mutilation has short term and long-term consequences. The short term and most common consequence is that the person can go into shock and bleed to death or die from infection secondary to unsterile procedure. The procedure is very painful as it is usually done without anesthesia. The long-term affects are recurrent urinary tract infections, painful urination, and painful menstrual cycles. Another complication is urinary hesitancy or incontinence. The women can over a period of time develop cyst or abscesses in the vaginal region secondary to the blockage of the Bartholin gland. The skin in the vaginal area becomes very tight and can cause extensive tissue damage during childbirth. The women can develop vaginal/anal fistulas or vaginal/urethral fistulas. The consequences that go with procedure are life long or require extensive surgeries to correct.

Nurses have to have the ability to educate the women that have had this procedure. Most importantly nurses have to be sensitive to the cultural background of the patient and her parents and be respectful to the tradition. The information that should be given to the patient when teaching is a detailed explanation of the female genital anatomy and function. If the parents bring their daughter to have the procedure the nurse should be prepared to explain the adverse side affects and the long-term consequences.
The nurses should also be prepared to know the laws in the United States for performing this procedure to any female under the age of 18. The law states that any one who performs any form of female genitalia mutilations will be charge with a crime and can be fined or be sentenced to a minimum of 5 years in prison, or both.

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