Female circumcision as a public health issue.

Abstract

Female circumcision is practiced in 26 African countries, and it is estimated that at least 100 million women are circumcised. The mildest form is clitoridectomy and the more severe type is infibulation. Girls are commonly circumcised between the ages of 4 and 10 years. Since the operator is usually a nonprofessional without surgical experience, complications are common: hemorrhage and severe pain that can even result in shock and death. The most common long-term complication is the formation of dermoid cysts in the line of the scar. Childbirth adds other risks for infibulated women and vesicovaginal fistula is often the result. The attendant urinary incontinence leads to ostracism of these women. In sum, female circumcision is a major contributor to childhood and maternal mortality and morbidity in communities with poor health services. The physical complications add to the psychological trauma: many infibulated women have a syndrome of chronic anxiety and depression arising from their condition, intractable dysmenorrhea, and the fear of infertility. The psychological sequelae of immigrant women who live in societies where such practice is condemned is even worse and may need professional counseling to address their sexual identity and cultural identification. Tightly infibulated women require clinical intervention for deinfibulation in order to preclude serious maternal and fetal complications during childbirth. Reinfibulation is medically harmful and even though some women request it, health professionals who comply are ethically reprehensible. In Sweden a 1982 law makes all forms of female circumcision illegal, as does a law that was passed in the United Kingdom in 1985. In France several cases were brought against parents under child abuse laws for circumcising or attempting to circumcise their French-born daughters. In the United States a 1993 bill drafted by the Congressional Women's Caucus would make the practice illegal and fund a program to assist immigrant communities to deal with the problem.