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  • Title: Assessment of the impact of female circumcision on the gynecological, genitourinary and obstetrical health problems of women from Somalia: literature review and case series.
    Author: Arbesman M, Kahler L, Buck GM.
    Journal: Women Health; 1993; 20(3):27-42. PubMed ID: 8266706.
    Abstract:
    Approximately 80 million women worldwide have undergone surgery for circumcision. A variety of health risks resulting from the procedure have been reported in the literature including: bleeding, infection, shock, difficulties with menstruation and urination as well as painful intercourse. Prolonged labor and perinatal difficulties have also been noted. After an extensive literature review, a description of gynecological and obstetrical complications is provided. We had the opportunity to survey 12 Somali refugee women who were temporarily residing in a refugee center in Western New York about their personal experience with circumcision. We were interested in determining whether this convenient sample of women substantiated the clinical sequelae of circumcision reported in the literature. Structured interviews were conducted and included questions on sociodemographic, circumcision and health factors. Our findings, however limited, support the presence of heavy bleeding at the time of the surgery as a complication arising from circumcision. 80 million women worldwide have been circumcised. At least 20 African countries practice female circumcision. They tend to have the highest child mortality ratios. Most women underwent circumcision between 4 and 8 years of age. Immediate complications of female circumcision are bleeding, shock, wound infection, and swelling. Delayed complications include urinary complications, especially chronic urinary tract infection; keloid scar formation; painful or difficult menstruation; chronic pelvic infection; painful intercourse; obstructed labor; prolonged pressure of the head of the vagina; prolonged Stage II labor; and hemorrhaging after delivery. Pharaonic circumcision is the removal of the clitoris, labia minora, and most of all the labia majora and the stitching together of sides leaving just a small opening through which urine and menstrual blood can pass. Women who underwent Pharaonic circumcision are more likely to find it difficult to urinate and to have urinary complications than those who underwent Sunna circumcision (removal of the tip of prepuce of the clitoris). In June-August 1990, twelve 8-75 year old female refugees from Mogadishu, Somalia, were interviewed at a refugee center in Buffalo, New York, while waiting to immigrate to Canada. The mean age of circumcision was 7.4 years 58% had undergone Pharaonic circumcision and infibulation. 5 women suffered from heavy bleeding after the circumcision. The circumcision was performed by a physician or nurse-midwife in 74% of the cases. 82% had their legs bound for about 10 days after the circumcision. 60%, 38%, and 27% respectively, experienced pain during menstruation, at other times during the month, and during urination. 38% had been treated for a urinary infection. Defibulation was achieved by a physician (4 cases), a husband's penis (1 case), a husband using other means (1 case), and a special woman (1 case). 4 women experienced pain during intercourse. 5 women did not want their daughters to undergo Pharaonic circumcision. 7 women supported Sunna circumcision.
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