Nuala is nineteen and studying to be a doctor, she is a thoughtful, bright and confident young woman. Nuala is in love, she and her boyfriend plan to marry. While, for many young women in this position the biggest worry is "will my bum look big in my wedding dress" for Nuala it is "will my incontinence pad show". Nuala is a victim of female genital mutilation (FMG), a barbaric operation that has left her incontinent and with a vaginal opening no bigger than a matchstick head.
As you read this article somewhere in the world a young girl is pinned to a table, screaming in pain as a rusty knife cuts into her genitals. Before you go to bed this evening almost 6,000 young girls will have undergone FMG. Many of us will think 'there but for the grace of god go I' but Africa is a distant continent yet it doesnÂ’t just happen in Africa or the Middle East. Although illegal, FMG is carried out, under secrecy, in the UK and North America.
Female genital mutilation is often called Female circumcision but this is an extremely misleading comparison. FMG, in some cases, is more akin to a full penisdectomy- that is the removal of the entire penis. Mutilation is carried out with varying degrees of medical knowledge and equipment. It may be done by a doctor, midwife, relative or barber. The cutting instrument could be a scalpel or broken glass, a razor blade, a tin lid or scissors. Rarely does it involve the use of anaesthetic or even antiseptic. The results being many young girls die from haemorrhaging and septicaemia.
There are different types and degrees of FMG. In its most severe form FMG is known as infibulation. Infibulation involves the removal of the clitoris, the labia majora and the labia minora to create raw surfaces that are then stitched together using thorns, catgut or cotton, A small hole is left to allow urine and menstrual blood to flow. Clitorectomies are the most common type of circumcision and involve removal of the entire clitoris (both prepuce and glans) and the adjacent labia. In its least severe form it is often called 'Sunna' circumcision; this involves the removal of the clitoral hood or tip.
FMG crosses cultures,countries and faiths. It is not just an Islamic practice; the majority of Muslims do not practice FMG and it predates Islam. Catholics, Protestants, Animists and Coptic Christians in Africa, the Middle –East, parts of Latin America and the Pacific also practice FMG. Nor is it just the very poor and ill educated FMG is practices across all socio-economic groups. The differences are only under what circumstances is it carried out(For the rich, the procedure is performed by a doctor and under anaesthetic), to what degree and at what age (usually between the ages of 4 and 12).
Apart from the fact it is a deeply rooted traditional practice the reasons for FMG also vary between cultures and countries. In some societies FMG increases a girl's marriage prospects, "An uncircumcised vulva is unclean and only the lowest prostitute would leave her daughter uncircumcised. No man would dream of marrying an unclean woman". He would be laughed at by everyone."
It is believed to increase fertility and protect against stillbirths, "Leaving a girl uncircumcised endangers both her husband and her baby. If the baby's head touches the uncut clitoris during birth, the baby will be born hydrocephalic [excess cranial fluid]. The milk of the mother will become poisonous".
In some societies it is seen as a rite of passage, or that it discourages promiscuity and increases male sexual satisfaction "A circumcised woman is sexually more pleasing to her husband. The tighter she is sewn, the more pleasure he has."
Whatever the reasons for FMG the complications are devastating. In the Short term, FMG can cause severe pain, urine retention, shock, ulceration and, in some cases, death. FMG can also lead to HIV infection as the same instrument is used time and time again.
Long-term complications include delayed menarche, incontinence, chronic pelvis complications, cysts and abscesses, painful sexual intercourse, sexual dysfunction, infertility and obstetric complications, for example the head of the foetus may be crushed in the damaged birth canal. In the majority of cases an infibulated woman must be opened up prior to childbirth, often to be reinfibulated after the birth– this can happen as many times as she has children.
FMG has been illegal in the UK since 1985, it is difficult to get precise figures as to how many young women are at risk but with the growth in refugees fleeing from Africa and the Middle East it is believed the practice is increasing in the UK. A Parliamentary Committee last year put the figure for young girls at risk at 6,000. No one will speak openly about FMG, although from time to time medical staff, teachers, social workers, immigration caseworkers will hear about it or see the evidence.
Nuala and her family fled from the war torn and famine stricken Sudan but she underwent FMG in the UK. Nuala says she was infibulated as punishment. She had always been a rebel and one day a family friend saw her wearing a mini-skirt (she would change from her usual 'modest' clothes in the school toilets). She was severely beaten and two months later disappeared from school. When she returned she was a different girl – no longer as bright and sassy, Nuala had been infibulated.
How do you explain to a beautiful bright 18 year old, on the brink of womanhood, what the purpose of a clitoris is when she tells you she does not have one. Sala was eight when she was mutilated. She doesnÂ’t remember the event, she thinks she fainted but she remembers waking up with her legs bound together. "When I woke up the painÂ… it's difficult to describe, it was so intense I wanted to die".
I first met Sala when she was fourteen. She, like about 400 children under the age of 16 every year, entered the UK without family. It was another four years before she confided that she had undergone FMG. Sala said she was lucky because where she came from (in Ethiopia) they only took away the clitoris. Her best friend – Ashem -who is Sudanese had undergone a full infibulation.
It was Sala's 18th birthday and late in the evening when she and Ashem began to discuss boys, as many teenagers do. Then Ashem asked me, "does it make a difference not having anything ‘down there’". I had suspected she may have undergone FMG and was prepared to deal with the questions. Even so, it was difficult to explain, to find words that were truthful, not patronising, that did not make her feel incomplete, excluded or less feminine. To say that when she did have sexual intercourse it would be with someone she loved and that sexuality is not just physical, that sexual response is complicated (some studies have reported that many women who have undergone FMG do reach orgasm), and finally to make sure Ashem understood FMG did not make her less of person or less loved. Ashem is a fighter, she is confident and intelligent. She has turned the anger that she feels outwards to campaign against FMG. She is training to be a midwife and believes she can educate and inform women best in this role, to make sure when a girl baby is born it will not be at risk of FMG.
During the last 10 years more and more women in Africa and the Middle–East as well as in the West, are campaigning to end FMG. It is long process and requires a multi-disciplinary approach involving raising public awareness and education, as well as legislative and governmental action. Parents do not have their daughters mutilated because they do not love them. Parents, because of tradition and cultural practices, beleive they are doing the best that they can for their children and this is also why it is so difficult to eradicate.
While acknowledging this is a deeply rooted practice, it is not pe se a religious practice and many Islamic countries have outlawed FMG. There is also evidence that in a few places the rite has become purely ceremonial -a knife is waved over the genitals but there is no cutting.
As a woman I cannot but view FMG as a form of violence against women. It is a human rights issue and unacceptable regardless of culture and tradition. Culture and tradition are not set in stone. We need to remember that it was not so long ago, in the west, that the clitoris was viewed as dangerous -encouraging licentiousness, hysteria and promiscuity. Freud in 'Sexuality and the Psychology of Love' said, "elimination of clitoral sexuality is a necessary precondition for the development of femininity."
Nuala has decided to have surgery and Ashem is considering this as well. All three make it clear their daughters will never be subjected to FMG.