Saturday, 9 May 2015

FGM: A COUPLE'S SEXUAL DILEMMA






                             Photo: ©scrapetv.com
She walked in looking forlorn, supported by a man who was later identified as her husband. Her demeanour was that of a woman who had wrestled with her chi and returned broken. With haunted eyes that looked but didn't see, she delved into the past to tell her story.
Onome is a 29year old ex-runway model who owns a high-end boutique that catered to the rich. She hails from the southern part of the country and she's married to Obi, a prosperous entrepreneur who hails from the same region. She is the envy of her peers, her life appears perfect.
Onome's marriage is about a year old but already, it's on the brink of collapse.

What could possibly be wrong?
At the age of 7, on one of their visits to the village, Onome and her younger sister were left in the care of their grandmother while her parents attended a family function. After breakfast that fateful day, their grandmother holding their hands marched with them to the hut of the village healer claiming they were going to be purified like angels. The girls were excited. As they entered the dark hut, the girls were each seized by two women who undressed them. A girl was sobbing in the background. As Onome struggled, she heard her sister give off a piercing scream, that was when she saw an old woman approach her with a bloody knife. Gripped by fear, she struggled frantically. At the same time, the women applied more pressure. Suddenly, she felt a sharp pain go through her. A pain that changed her life forever. A pain so deep her soul was shaken. Her genital organs had been desecrated. She had been circumcised.
Their wounds were covered with leaves "to heal quicker". She was later to learn that the young girl she heard sobbing in the background had died a few days later as a result of uncontrolled blood loss. The women blamed her for not having had the spirit of a survivor.
On their return, her father was furious but her mother justified the action claiming it was the tradition and every responsible young girl from their village had being circumcised. The imperfection of the female body which led them to be promiscuous had been removed. Her girls had been initiated in the rites of womanhood.
Onome had never forgotten the incident though she never spoke about it. She felt shame whenever the memory resurfaced.
Her younger sister has been married for three years and has fertility challenges as a result of recurrent episodes of pelvic inflammatory disease she suffered which were a complication of the circumcision.
In Onome's case, she had not let any man touch her prior to her marriage. She entered Obi's house a virgin and since then, sex has been an issue. She feels a lot of pain during intercourse. Obi is at his wit's end, he has tried to be patient and understanding as he loves his wife dearly. His mother has been after him to give her a grandchild. On the other hand, having sexual relations with his wife has become a dreaded experience. She shrinks away each time she is touched and makes heart-rending noises whenever he attempts penetration.
Neither of them wants to lose their marriage and in a bid to salvage what they share, they decided to seek medical help.

FGM as an abbreviation stands for female genital mutilation which is synonymous with female circumcision.
Female Genital Mutilation encompasses all procedures that lead to the partial or complete removal of the female external genitalia or other injury to the female genital organs for non-medical purposes.
Practically, the procedure varies from the removal of the tip of the clitoris to the radical extent of excision of the clitoris, labia minora and majora with the sewing together of the edges, leaving only a small orifice for the passage of menstrual blood and urine.
FGM is a global issue with a lot of speculation as to its origin which dates back more than 2000 years. It is most common in the Western, Eastern and Northeastern regions of Africa but also is still widely practised in Northern America and European countries. Immigrants to these areas play a major role.
Interestingly, most parents send their daughters back to their countries of origin to be circumcised.
It is revealing to note that a lot of women in such communities do not regard female genital mutilation as an ill and would ensure their daughters were circumcised. After all, it is a privilege to be initiated into the ranks of womanhood, they claim.

The World Health Organisation has classified female genital mutilation into four major types:
Clitoridectomy: Partial or total removal of the clitoris and in very rare cases only the prepuce (fold of skin surrounding the clitoris)
Excision: Partial or total removal of the clitoris and the labia(lips) minora +/- excision of the labia majora.
Infibulation: Narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by repositioning the inner or outer labia with or without removal of the clitoris.
Others: All other harmful procedures to the female genitalia for non medical purposes eg pricking, piercing, incising, scraping and cautering of the genital area.

FGM is a violation of the fundamental rights of girls and women. It's embers are constantly kept aflame by factors such as cultural beliefs, rituals, myths and taboos. It has left in it's wake the lifeless bodies of untold numbers of women and girls.
The memory of the procedure is usually glaringly clear and never leaves the minds of the affected girls and women.
In such communities, it is interesting to learn that the men refuse to marry uncircumcised females and these women are viewed as lower cadre citizens by their
womenfolk.

Reasons cited for the continued survival of this practice include:
Religious requirement
Rite of passage to womanhood
To ensure cleanliness
Preservation of virginity
Prevention of promiscuity among young girls
Better prospects of marriage
Enhancement of male sexuality .
Female Genital Mutilation has no health benefits and the above listed claims are unfounded. Some have tried comparing fgm to male circumcision but this does not stand as male circumcision has proven long term physical and psychological benefits.                                

Complications of the procedure could include:
Immediate complications:
Pain
Blood loss
Shock
Wound infection
Long term complications:
Recurrent urinary and genital tract infections
Painful or blocked menses
Prolonged labour
Increased risk of maternal and child death
Infertility
Psychological complications:
Anxiety
Post traumatic stress disorder
Low self esteem
Depression
Sexual complications:
FGM destroys some or all of the vulval nerve endings, delaying arousal and/or impeding orgasm.
Pain during sexual intercourse
There is increased risk of transmission of infectious diseases; HIV, Hep B, Hep C,etc as a result of the sharing of unsterile instruments.

Challenges:
The life of a young girl had already been lost as a result of uncontrolled blood loss.
Onome's sister was battling with the complications of the procedure: Recurrent pelvic  inflammatory disease and infertility.
Onome's marriage is on the brink of collapse, she has self esteem issues, sexual intercourse is painful and she has problems conceiving due to difficult penetration.

Management:
This entailed : Counselling sessions for both Onome and Obi as she needed a strong support base to deal with the problem.
Scheduled reconstructive surgery by the obstetrics and gynaecology unit.
Registration with an FGM support group.

In conclusion, I believe every woman has the right to wholesome health. This includes sexual health and not merely the absence of disease, also the right to feel sexual pleasure for her psychological and physical wellbeing as an individual and a member of the society. 

Do Stay Safe and Live Clean with Dr Ib Orabueze.
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