My two cents on the subject

Female Genital Cutting has always incensed me, as do any women's rights violations. These women do not feel pleasure during intercourse not only because they no longer have a clitoris, but because depending on the degree of the procedure, the vaginal opening can be barely large enough to fit the tip of a pinky through, and so intercourse is often very painful and results in tearing and bleeding and therefore very frequent infections. Other issues arise during childbirth. Some women will allow their vaginas to be cut open so that they can deliver the baby easily, and other women refuse such interventions, which as you can only imagine, results in very bloody and greusome childbirths.

In the recent years, when men of the societies involved have been asked about how they feel having a wife who has undergone FGC, it has become more and more common to hear them say that they are not fond of it either, for the same reasons as above. Many of the men want to know that they are pleasing their wives. This is a tradition that although has some patriarchal roots, is definitely reinforced and upheld by the women in the society.

I can put some pictures up if you would like to see them.

Female Genital Cutting throughout Sub-Saharan Africa

Female Genital Cutting (FGC) is a traditional form of body mutilation practiced throughout western, north central, and northeastern Africa. Also known as female circumcision, it can be defined as a wide range of practices involving the partial or total alteration or removal of the external genitalia for non medical reasons.

There are four recognized types of FGC. Type I is a “clitoridectomy” that is an excision of the prepuce* and Type II is an “excision” that includes removal of the prepuce, clitoris, and potentially the labia minora. More severe, Type III is called “infibulation” and it is the removal of all outer genitalia and stitching of the vaginal opening. The most drastic form is Type IV is considered “unclassified” as it includes all of the above, plus burning, piercing, pricking, or stretching of the genitalia.

The health problems that arrive from the procedure are too numerous to count, but they include uncontrolled bleeding, infection of the cuts, fistulae, and life-threatening complications during childbirth.

Although there has been a plethora of technical information on the practice since it was brought to the fore of international human rights discourse, it is actually little understood for its cultural entrenchment. We do know that the operation is performed generally

before or around puberty. There is intense social stigma for those adult girls who have not undergone genital cutting, which interferes with their abilities to have their own families. Therefore, many parents insist on FGC because they believe it will make the girls less

promiscuous and therefore better wives to potential husbands. On a continent where a daughter is often viewed as an economic burden, FGC is mainly practiced in impoverished rural areas to ensure that the daughter does not remain at home unmarried.

Although the practice spans all religions in Africa, it is commonly associated with Islam

and the most severe form of FGC is practiced in countries with a Muslim majority, such as Somalia and Sudan.

Public awareness campaigns were first prevalent internationally, and those campaigns only later became localized. The most well-known film about FGC is Alice Walker and Pratibha Parmar’s 1993 British film Warrior Marks. It internationally convinced large numbers of people that a highly damaging, oppressive ‘ritual’ was being inflicted without reflection, based on patriarchy and lack of education. The goal of the filmmaker was to galvanize a global movement against the practice. A year earlier, the Inter-American Committee had produced a film on Nigeria called Female Circumcision: Beliefs and Misbeliefs. It depicts how FGC can be done even on a three-year old through decorative scarification and tattooing by a male barber. This film weakened the cultural argument that the ritual is solely helping young women make the transition into womanhood. Contrary to Warrior marks, Beliefs and Misbeliefs was actually intended for African audiences as an education tool. It includes spoken language and subtitles in various indigenous languages and includes culturally-pertinent images related to FGC. Interestingly, when this film was screened by a health worker to groups of women, the health worker had the chance to clarify certain misconceptions of audience members about health. For example, she debunked the myth that if the clitoris touches the baby’s head during labor, the baby will die. The screening led to a great discussion about other violations of women, such as early marriage.

Perhaps the spread of technical health education coupled with culturally-relevant media is the key to mitigating the harm caused by female genital mutilation.

written by Laine Strutton

*prepuce is a retractable piece of skin which covers part of the genitals of primates and other mammals.

On a male, this covers the head of the penis (glans penis).

On a female, it surrounds and protects the head of the clitoris (glans clitoridis).

Sources:

Gruenbaum, E. (2001). The female circumcision controversy: An

anthropological perspective. Philadelphia: Philadelphia: University of

Pennsylvania Press.

Shell-Duncan, B., & Hernlund, Y. (2000). In Shell-Duncan B., Hernlund

Y. (Eds.), Female "circumcision" in Africa : Culture, controversy, and

change. Boulder: Lynne Rienner Publishers.

Rahman, A., & Toubia, N. (2000). In Center for Reproductive Law &

Policy, RAINBO (Organization) (Eds.), Female genital mutilation: A

guide to laws and policies worldwide. London ; New York: Zed Books in

association with Center for Reproductive Law and Policy and Research,

Action and Information Network for the Bodily Integrity of Women.

The World Health Organization's website,

<http://www.who.int/gender/other_health/en/index.html>.

Sorry for the long hiatus from this blog. If you've read my regular blog, you would know that this last month has been one of hectic transition for me. I hope to put the Female Genital Cutting post up this weekend and then hopefully add to the blog at least every 2-3 weeks. This first year of residency training will either prove to power my Women's Health Corner or overshadow it. I hope and pray that I am able to do both and give each of my posts the time and effort that they deserve. Thanks for your patience.

Human Papilloma Virus

When many think of Human Papilloma Virus (HPV),the first thing that comes to mind now a days is the alarming link between HPV infection and the development of cervical cancer.
What is even more scary, is that both men and women can be carriers of this virus and not ever know it. But, what is less commonly known is that there are symptomatic manifestations of HPV infection as well.

There are different types of HPV. HPV types are often referred to as “low-risk” (wart-causing) or “high-risk” (cancer-causing), based on whether they put a person at risk for cancer. In 90% of cases, the body’s immune system clears the HPV infection naturally within two years. This is true of both high-risk and low-risk types. For example, HPV type 1 causes plantar warts. HPV type 6 causes anogenital warts and HPV type 16 infection can produce abnormal cervical cell changes, a process called Dysplasia. These dysplastic cells can then progress to becoming cervical cancer.



The clinical manifestations of HPV infection depend on the location of the lesion and the type of the virus.

• Common warts usually occur on the hands as flesh colored to brown lesions that are raised above the skin (exophytic) and are thicker than skin in texture (hyperkeratotic).
  

• Plantar warts may be quite painful. They look a bit like calluses, but have thrombosed capillaries underneath

• Flat warts (verruca plana) are most common among children and occur on the face, neck, chest and flexor surfaces of the forearms and legs.
  

• Anogenital warts usually appear as small bumps or groups of bumps, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. Warts may appear within weeks or months after sexual contact with an infected person. Or, they may not appear at all. If left untreated, genital warts may go away, remain unchanged, or increase in size or number.They will not turn into cancer.

-Genital HPV is contracted through genital contact, most often during genital and anal sex. A person can have HPV even if its been years since he or she has had sex. Most infected people do not realize that they are infected or that they are passing the virus to a sex partner.
- Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during vaginal delivery. In these cases, the child may develop warts in the throat or voice box- a condition called Recurrent Respiratory Papillomatosis (RRP)


-There are no symptoms for cervical cancer until it's reached its later stages, so it is very important that all women from age 21 or no later than one year after their first sexual intercourse, should have yearly PAP smears so that any abnormal cells can be identified and further examined for any existence of HPV.

-Other less common HPV-related cancers, such as cancers of the vulva, vagina, anus and penis, also may not have signs or symptoms until they are advanced.

-An HPV DNA test, which can find high-risk HPV on a woman’s cervix, may also be used with a Pap test in certain cases. The HPV test can help healthcare professionals decide if more tests or treatment are needed.

• There is a vaccine available called Gardasil, which protects against HPV types 6,11,16 and 18. It is administered in three doses and is a recommended vaccination for females 11-12 years of age; catch-up vaccination is recommended for females 13-26 years of age. It is best to have received the vaccine before becoming sexually active so that there is optimal chance of preventing acquiring genital warts and cervical and vaginal cancers.

(I am not personally endorsing Gardasil, just presenting all that is available. It is a personal choice that parents have to make for their young girls)

-Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine does not protect against all cervical cancers.There is currently no vaccine licensed to prevent HPV-related diseases in males.

While it can be difficult to prevent coming into contact with all of the types of HPV, genital HPV and all of its consequences can be easily averted by abstinence from sex, always using barrier methods such as condoms, and being honest about you and your partner's sexual history. Keep in mind though, that apart from abstinence, there is no method with 100% guarantee that you won't become symptomatically infected, or a carrier of the virus. This is because a condom only covers the penis, leaving other parts of the genitalia that can carry the virus, and unless men have had a genital wart episode, they may never know that they are infected.