Female circumcision is the term used to identify the practice of removing healthy normal female genitalia by surgical operation. Because of the severity of the operation and its known harmful effects, the term female genital mutilation is now generally used. There are three increasingly severe types of this operation, and each makes orgasm impossible. Clitoridectomy, or sunna (Type 1), is the removal of the prepuce of the clitoris and the clitoris itself (Figure 1-1). When excited, the clitoris swells and becomes erect, and it is this excitement that causes female orgasms. Excision, or reduction (Type 2), is the removal of the prepuce, the clitoris, and the labia minora, leaving the majora intact. The labia minora produce secretions that lubricate the inner folds of the lips and prevent soreness when these lips rub against each other (Figure 1-2). Infibulation, or pharaonic circumcision (Type 3), is the removal of the prepuce, the clitoris, the labia minora and majora, and the suturing of the two sides of the vulva, leaving a very small opening for the passage of urine and menstrual blood (Figure 1-3). This type of circumcision is referred to as pharaonic probably because it is identified with circumcision methods of ancient Egypt under the pharaohs.
In a study of the various types of circumcision undergone by women in Sierra Leone (Koso-Thomas), it was found that 39.03 percent of the women had undergone Type 1, 59.85 percent, Type 2, and 1.12 percent, Type 3. In Somalia, 80 percent of the operations are Type 3 (El Dareer). The prevalence of circumcision in Africa ranges from 10 percent in Tanzania to 98 percent in Djibouti (Toubia).
The most common and basic procedure followed during circumcision is the traditional method. In this method, usually employed by circumcisers who have no medical training, the female is firmly held down on dry ground with her legs wide apart to expose the genitalia and the parts to be removed. In some cases, the genital part to be excised is held with a special hemostatic leaf before excision, or the candidates are made to lie near a cold flowing stream so the excised area can be bathed in chilled water to numb the pain. The implements used are often unsterilized razor blades, knives, scissors, broken bottles, or any other sharp implement. Some form of herbal dressing is applied to the raw wound after the operation. The same implement is used for successive operations without sterilization. When the operation is carried out in modern clinics, standard modern surgical practice is followed.
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