Generality
Infibulation is a form of female genital mutilation performed for predominantly socio-cultural reasons. This practice has as its purpose the almost complete closure of the vulvar ostium and is often accompanied by the excision of the clitoris; the suture following the mutilation leaves only one hole open, to allow urine and menstrual blood to escape.
Support for the practice is in decline, but in some countries it is still widespread.
What is it about?
The term "infibulation" derives from the Latin " fibula " (brooch) to indicate the function of the practice, ie the "closure" of the vaginal lumen . This mutilation of the female genitalia involves, in fact, the removal of the small lips and part of the large vaginal lips, with or without the excision of the clitoris. After this act, the cauterization and suturing of the vulva follows with string or the insertion of pins or spines, which leaves only an opening of 1-2 cm to allow the escape of urine and menstrual blood. At the end, the victims' legs are often tied together and remain like this for at least two to four weeks, to promote wound healing.
- Infibulation and other female genital mutilation are performed mainly on girls and young girls between 4 and 15 years of age. To carry out the procedure is traditionally a woman without medical training (like an old woman in the village, a midwife, a spiritual guide of the community etc.), who uses rudimentary tools, such as knives, scissors, pieces of glass or razor blades. Usually, surgery is performed without anesthesia and antiseptic treatments. Complications of genital mutilation may include bleeding and infections (including tetanus).
Infibulation aims to preserve and indicate the virginity of the girl to her future husband (as well as making it a sexual object incapable of experiencing pleasure).
Traditionally, infibulated women are engraved by the groom before the marriage is consummated. To allow sexual intercourse, in fact, it is necessary to resort to an operation of ungluing the vulva (or defibulation ).
After each birth, the women are subjected to reinfibulation, in order to restore the condition of premarital purity.
Other genital mutilation
Female genital mutilation is a vast and complex phenomenon.
These procedures that intentionally modify or cause injury to the female genital organs for non-medical reasons. Mutilations can be of various types and severity levels, ranging from incision to partial or total removal of the external female genitalia. Among these, the most radical is infibulation.
The variants
The most common types of female genital mutilation are:
- Type I (circumcision or infibulation as sunnah) : circumcision and removal of the foreskin of the clitoris;
- Type II (excision or clitoridectomy with uasat) : removal of the clitoris and partial or total cut of the labia minora;
- Type III (pharaonic or Sudanese infibulation) : clitoridectomy, complete excision of the labia minora and seam of the labia majora, with almost complete closure of the vulvar ostium.
Depending on the ethnic community of belonging, " other interventions " are also practiced on female genitalia, such as:
- Stings, perforations or incisions of the clitoris or small lips;
- Scarification of the vestibular mucosa;
- Introduction into the vagina of salt or corrosive substances in order to cause bleeding or shrinkage.
The definition of the WHO
The World Health Organization (WHO) defines female genital mutilation as "all forms of partial or total removal of the external female genitalia or other modifications induced to female genital organs, performed for cultural reasons or other non-therapeutic reasons".
Infibulation and other mutilations are recognized as a violation of the human rights of girls and women. In December 2012, the UN General Assembly voted unanimously to proceed with the elimination of female genital mutilation around the world.
Where is it spread
Infibulation is a widespread practice mainly in ethnic groups and groups in sub-Saharan Africa, for which genital mutilation is part of the tradition. A decidedly smaller share is recorded, instead, in predominantly Islamic countries of Asia (Iran, Iraq, Yemen, Oman, Saudi Arabia and Israel).
According to the UNICEF report " Female Genital Mutilation / Cutting: A statistical overview and exploration of the dynamics of change ", published in 2013, it is estimated that more than 125 million women undergo genital mutilation; given these statistics, about 30 million girls are still at risk of suffering this practice in the next ten years.
At present, there is a high prevalence of female genital mutilation in 29 African countries and in the Middle East; in eight of these - Egypt, Somalia, Guinea, Djibouti, Eritrea, Mali, Sierra Leone and Sudan - almost all young girls and women between the ages of 15 and 49 were subjected to infibulation.
The increase in migratory flows towards the western world has made the phenomenon visible also in Europe. However, clitoridectomy is not totally foreign to Western countries: in the second half of the 19th century, in England and America, a school of thought maintained that this intervention was necessary to treat sexual aberrations and other non-compliant behaviors, such as nymphomania and hysteria.
Because it is practiced
The reasons given to justify the practice of female genital mutilation are different:
- Socio-cultural : in some countries, female genital mutilation is performed as a passing ritual, to mark the transition of adolescents to adulthood and their willingness to marry. The infibulation represents, therefore, a practice that defines the cultural identity of the ethnic group to which one belongs and allows the integration of the young in the community. In Somalia, for example, a non-inflamed woman is considered impure, therefore she risks being turned away from society.
- Psychological and sexual : in populations where virginity is considered a prerequisite for marriage, infibulation is practiced to keep the woman's fluidity intact. This practice also represents a tool to subdue or reduce the sexual desire deriving from stimulation of the clitoris and prevent the temptations to indulge in extra-marital relationships. Genital mutilation would therefore favor a sort of control over female libido : the removal of the clitoris and the labia minora - considered by some as the correspondent of the male sexual organ in a woman's body - is often synonymous with chastity, docility and obedience. According to other beliefs, the clitoris is considered a "dangerous organ", capable of causing impotence in men and killing newborns at birth.
- Religious and spiritual : in some communities, infibulation is linked to tribal anthropological cultures and is practiced as it would make women spiritually pure . Female genital mutilation is predominantly practiced by Muslims, but it can also occur among Christians (especially among Orthodox and Catholic Copts), animists and Jews. It should be noted that there is no unanimous opinion about the link between this practice and religion, although there is a tendency to attribute a spiritual justification, foreseen by the sacred texts, to the infibulation. For example, infibulation and excision of the clitoris are not mentioned by the Koran, while in Christianity mutilation is prohibited, as it is considered a sin against "sanctity of the body". In Africa, then, female genital mutilation was practiced in ancient Egypt (hence the name " Pharaonic infibulation "), therefore before the advent of Islam.
- Hygienic : in certain cultures, unmutilated women are considered impure, therefore they are not allowed to manage food and water; in fact, there is a belief that the female genitals are dirty and unpleasant from an aesthetic point of view. The more or less radical removal of the external parts would make the woman more beautiful and clean.
- Gender factors: often, female genital mutilation is considered necessary so that a girl can be considered a complete woman; infibulation also emphasizes the divergence between the sexes in terms of future roles in marriage and life. If mutilation is part of an initiation rite, then, it takes on the meaning of explicit teaching about the tasks that the woman must assume in her society. According to the WHO, these practices reflect a deep-rooted gender inequality and constitute a form of extreme discrimination against women.
Consequences
Infibulation has no health benefits for girls and young girls who suffer from it. On the contrary, it represents an extremely traumatic act, not without serious consequences from a physical, psychological and sexual point of view.
The possible complications of infibulation depend on the severity of the mutilation, on the way it was practiced, on the hygienic conditions and on the resistance opposed by the victim held by force.
Immediate effects
Infibulation is an extremely painful practice that can cause severe intra- or post-operative bleeding, acute urine retention, tissue damage and damage to other nearby organs, such as the urethra (where urine passes) and the intestine . The mutilation procedures, performed without anesthesia and in poor hygienic conditions, can cause shock, tetanus, sepsis (generalized infection) and, in some cases, even death. Furthermore, it is not to be underestimated that with this practice the mutilated woman is predisposed to the transmission of HIV and hepatitis B and C by blood.
Long-term consequences
In the long term, infibulation can lead to the formation of urethro-vaginal fistulas, cutaneous cysts, keloid scars and abscesses in the genital region. On the psychological level, on the other hand, serious behavioral disorders, post-traumatic stress disorder, anxiety, depression and psychosis can occur. Other consequences include severe pain during menstruation (dysmenorrhea), sterility, difficulty in urination, chronic infections of the urinary tract and pelvis (eg cystitis and pyelonephritis) and kidney failure.
Sexually, vaginal intercourse becomes painful and difficult. Furthermore, the infibulated woman completely loses the chance to feel pleasure.
Complications during childbirth are not infrequent, which correlate with an increased risk of neonatal and maternal mortality due to closed labor and obstacle to fetal progression (the child must pass through scarred and unelastic tissue), rupture of the uterus or postpartum hemorrhages .
Surgical therapy
The intervention to correct female genital mutilation, especially deinfibulation, is recommended in all girls and women suffering from complications.
Surgical treatment of infibulated women aims to remove labia major and restore complete vaginal canal patency.
- Deinfibulation is an operation carried out in order to create an anterior incision on the scar tissue resulting from mutilation and restore the labia majora with the mucosal cutaneous flaps mobilized from the adjacent area. The latter can be subsequently subjected to aesthetic treatments ( labioplastica ).
In the case of total clitoridectomy, the clitoris cannot always be reconstructed, but it is possible to intervene to free the dorsal nerve and reduce compression hyperesthesia with clitoridoplasty (a surgical technique inspired by penile reconstruction interventions).
