Helping health professionals to start conversations about female circumcision
This information complements ‘Starting conversations about female circumcision’, a video produced by cohealth which aims to both support health professionals to communicate with women who may have experienced female circumcision, and to prioritise women’s health. Click here to watch the video and learn more about starting the conversation.
What is female circumcision?
Female circumcision is the practice of partially cutting or totally removing the external female genitalia. There are four major types of female circumcision:
Type I: removal of the clitoral hood - the skin around the clitoris - with partial or complete removal of the clitoris
Type II: removal of the labia minora (the inner lips that cover the vagina), with partial or complete removal of the clitoris and the labia majora (the large skin folds that cover the genital area)
Type III: removal of all or part of the labia minora and labia majora, with the stitching of a seal across the vagina (infibulation), leaving a small opening at the back for the passage of urine and menstrual blood and for sexual intercourse
Type IV: various other things done to the female genitals, including pricking, piercing, cutting or cauterisation of the clitoris, cutting of the vagina, and introduction of herbs or corrosive substances
Taken from: http://www.netfa.com.au/what-are-the-different-types-of-female-genital-mutilation-cutting-fgm-c.php
Are there other terms for female circumcision?
Other commonly used terms are female genital cutting (FGC) or female genital mutilation (FGM). Female genital mutilation is the term preferred by the World Health Organisation and the United Nations, and is used in Australian legislation. Referring to the practice as FGC, FGM, or FGM/C is appropriate with other health professionals, however these can be disrespectful or likely to cause shame for some female patients. It is best to use the terms female circumcision or traditional cutting with clients.
What are the health effects of female circumcision?
Female circumcision has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls' and women's bodies.
It is internationally recognised as a violation of the human rights of children, girls and women, and reflects deep-rooted inequality between the sexes. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.
The effects of female circumcision can be acute and long-term, and affect the physical, sexual, and psychological health of clients who present to a wide range of primary and allied health practitioners.
Immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue. Ongoing and long-term consequences can include:
Slow and painful menstruation and urination
Chronic pain due to trapped or unprotected nerve endings
Painful sexual intercourse
Recurrent bladder and urinary tract infections
Increased risk of childbirth complications and newborn deaths
Need for later surgeries:
For example, the procedure that seals or narrows a vaginal opening (type III) needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks.
Decreased sexual pleasure:
Removal of or damage to highly sensitive genital tissue, especially the clitoris, may affect sexual sensitivity and lead to sexual problems such as decreased sexual pleasure and pain during sex. Scar formation, pain and traumatic memories associated with the procedure can also lead to such problems.
What are the origins of female circumcision?
The practice of female circumcision is a cultural practice. It is thousands of years old and it predates Islam and Christianity. For some women the procedure is understood to be sunna (also known as sunnah), a religious requirement prescribed within teachings of the Prophet Mohammed. Although commonly perceived to be part of the Islamic religion, many Islamic people do not practise female circumcision.
Taken from: http://whwest.org.au/wp-content/uploads/2014/05/FGM_Mandatory-reporting.pdf
Where is female circumcision practised?
More than 125 million girls and women alive today have undergone female circumcision in the 29 countries in Africa and the Middle East where the practice is concentrated. Female circumcision is mostly carried out on young girls some time between infancy and age 15, and about 3 million girls in Africa are at risk of the practice each year.
Taken from: http://www.who.int/mediacentre/factsheets/fs241/en/
In Australia, New Zealand, Canada, Europe, the United Kingdom and the United States some immigrant populations are considered to be at risk. While the main risk is when young girls return to their country of origin, there have been cases where female circumcision has been practised in destination countries.
Taken from: http://www.netfa.com.au/where-does-female-genital-mutilation-cutting-fgm-c-happen.php
For comprehensive prevalence data, refer to the 2013 UNICEF report ‘Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change’
Is female circumcision illegal?
Female circumcision (referred to as FGM in the legislation) is illegal in every state and territory in Australia. It is also illegal to take a child to another country for the purpose of female circumcision.
Female circumcision is illegal in most countries. A small number of girls and young women are arriving in Australia from countries where circumcision continues to be practised illegally.
Mandatory reporting to Child Protection applies to education staff, police, medical and nursing staff if they have formed a belief on a reasonable ground that a child has suffered, or is likely to experience, female circumcision.
For further information about the law in Victoria, refer to:
Women’s Health West’s publication ‘Female Genital Mutilation/Cutting - A mandatory reporting tool to support health professionals’
Royal Women’s Fact Sheet ‘Female Circumcision (Traditional Cutting) And The Law In Victoria’
Why do health service providers in Australia need to know about female circumcision?
Women and girls are increasingly migrating to Australia from countries where female circumcision is widely practiced, so there needs to be timely and culturally appropriate healthcare, support and community education.
Taken from: http://whwest.org.au/wp-content/uploads/2014/05/FGM_Mandatory-reporting.pdf
When might health professionals need to have a conversation with a client about female circumcision?
A conversation about whether or not a client has undergone female circumcision would be needed for any health care related to sexual health, pregnancy, childbirth and gynaecological issues. If the woman has undergone female circumcision, it is important to know which type of circumcision has been performed, as de-infibulation may be needed to allow intercourse or to facilitate childbirth. De-infibulation is a simple medical procedure, carried out under anaesthesia, to open the area that has been sewn closed.
Do not assume that women will initiate discussions or disclose whether they have been circumcised, even if they are pregnant. This may be due to a number of reasons:
they may believe that it is normal for all women to be circumcised;
they do not know that medical intervention may be needed to facilitate childbirth; or
they may have been made to feel different or ashamed in their exchanges with other health practitioners.
The practice of female circumcision not only affects women and girls who have undergone the procedure, but also their families including male partners, parents, grandparents and children. Hence there may be times when conversations occur that include other affected family members.
The video ‘Starting conversations about female circumcision’ features an example of a conversation between a health professional and a client. The questions asked by the health professional in this video have been included here as a helpful example of a conversation starter:
Health professional: “There are many countries around the world where female circumcision is practised, has that happened to you?”
The client’s partner was with her during the consultation, and the health practitioner acknowledged this and asked a further question.
Health professional: "Would you like your husband to stay here with you during the consultation?"
After the client consented to her husband staying in the room, the health professional asked:
“The more we know about your circumcision, the better we can assist you through your pregnancy and giving birth as safely as possible. Would you like to tell me about that?"
For further information on talking about female circumcision, refer to Women’s Health West’s publication ‘Female Genital Mutilation/Cutting - A mandatory reporting tool to support health professionals’.
Further information about services, support and referrals
You can contact your local Family And Reproductive Rights Education Program (FARREP) provider through:
health.vic, the Victorian state government website
For more information about referrals go to the Royal Women’s Hospital website:
The FARREP workers at the Royal Women’s Hospital are available Monday to Friday 9am to 5pm.
Tel: (03) 8345 3058
Fax: (03) 8345 3053
You can also talk to a women’s health nurse at the Royal Women’s Hospital about the health impacts of female circumcision.
Tel: (03) 8345 3045
Rural/Regional Callers: 1800 442 007
You can go to the NETFA website to find out the relevant contacts in your state or territory.
Homed, I., Taylor, E., Makregiorgos, H., (2014). Female genital mutilation/cutting: A mandatory reporting tool to support health professionals. Melbourne, Women’s Health West.
The National Education Toolkit for Female Genital Mutilation/Cutting in Australia
The Royal Women’s Hospital, (2014). Royal Women’s Fact Sheet ‘Female Circumcision (Traditional Cutting) And The Law In Victoria’.
United Nations Children’s Fund, Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, UNICEF, New York, 2013.
Vaughan, C., White, N., Keogh, L., Tobin, J., Murdolo, A., Quiazon, R. & Bayly, C. (2014). Female genital cutting/mutilation in regional Victoria: Research to practice. Melbourne, The University of Melbourne
Vaughan, C., White, N., Keogh, L., Tobin, J., Ha, B., Ibrahim, M. & Bayly, C. (2014). Listening to North Yarra Communities about female genital cutting. Melbourne, The University of Melbourne.
World Health Organisation. (2015). Female genital mutilation: Fact sheet N°241 (Update February 2014).
World Health Organisation. (2015). Sexual and reproductive health: Health complications of female genital mutilation