ABOUBAKR ELNASHAR

1. Impact of
Female Genital Cutting
on
maternal and
reproductive health
Prof. Aboubakr Elnashar
Benha University Hospital, Egypt
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2. CONTENTS
1. DEFINITION
2. PREVALENCE
3. REASONS BEHIND FGC
4. ASPECTS
5. TYPES
6. PROCEURE
7. IMPACT ON HEALTH
 CONCLUSION
 RECOMMENDATION
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3. 1. DEFINITION
All procedures that involve
partial or total removal or injury of the female
external genitalia
whether for cultural or any other non-therapeutic
reasons
(WHO, 1997)
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4. Nomenclature
 Female circumcision
(Male analogy)
 Female genital mutilation
(Women’s health & human rights organizations – offensive)
Female genital cutting
(more accepted)
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5. Is it an analogy to male circumcision?
Male Circumcision FGC
Cutting of small piece of
skin
Cutting of Large piece of
skin
No effect on sexual
pleasure
Highly sensitive parts
that decreases sexual
pleasure
Aim: Sign of manhood Aim: Decrease sexual
desire
No psychological impact
(Practiced before
neurological maturation)
Grave psychological
impact (practiced after
adulthood)
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6. 2. PREVALENCE
 140 million women & girls worldwide are affected
(WHO RHL, 2012).
 92 Million of them live in Africa
 2 Million girls undergo the procedure every year
(WHO, 1999).
 6000 girls are circumcised daily.
 500 girls during this lecture!
 A girl every 15 seconds!
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7. ABOUBAKR ELNASHAR

8.  Some ethnic groups in
 Oman, UAE, Yemen,
 India, Indonesia, Malaysia.
 An important issue in
 Australia, Canada, England, France, USA
{its practice by immigrants from countries where FGC
is common}
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9. Egypt demographic and health survey: 2000
 Conducted by the National Population Council
 Respondents: 15,573 women aged 15 to 49 years
 Prevalence: 97%
 Practiced by all social classes and educational groups
 Egypt Demographic and Health Survey: 2008
 Prevalence:
 91% among women aged 15-49
 74% among girls age 15-17
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10.  2014
{Criminalization of FGC in 2008}.
 The prevalence: 88%.
(Alkhalaileh et al, 2017)
2018, Beni-Suef
 Of the 3353 women
 FGC:1846 (55%)
(Haaew et al,2018)
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11.  2015
(Aouelfetouh et al,2015)
 A cross-sectional study
 600 Egyptian medical students
 using a previously validated online Google survey.
Medical students FGC
Overall 14.7%
Non rural 10.8%
Upper(southern) Egypt 20.6%
Lower(northern) Egypt 8.7%
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12. 3. REASONS BEHIND FGC
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13. FGC and Islam
 FGC
 Predates Islam.
 Not mentioned in the Qur’an
 Not practiced in Saudi Arabia or Iran
 Copts in Egypt practice it (cultural not religious)
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14.  In 2008:
 Al-Azhar Supreme Council of Islamic Research
 (the highest religious authority in Egypt)
 ruled that
 FGC has no basis in core Islamic law:
 The government completely outlaw FGC.
 (Micheal, 2007)
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15.  Real reason behind FGC: False belief
 To reduce sexual desire
 To save her chastity before marriage and her
fidelity after marriage
 To make a woman more feminine
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16. (Tag-Eldin et al, 2008)
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17. (Tag-Eldin et al, 2008)
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18.  Trends in Egypt
2008, Egypt DHS
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19. 2014
Support for the continuation of FGC:
58% .
(Alkhalaileh et al, 2017)
 Opposition to FGC increased considerably
 The improvement of women's social position
 Better educated and less traditional women
were at the heart of this change
 Poorly educated rural women remain least likely to
oppose FGM
(Rossem et al, ,2015, 2016)
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20. 4. ASPECTS
Ethical aspects
 Against human rights:
“Harmful procedure done to a child who can not
give an informed consent.”
 The question is:
“Does FGC is the reason behind virtue?”
“Are our women in a bad need to be controlled sexually?”
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21. ABOUBAKR ELNASHAR

22.  Medical Aspects
 Practicing FGC by physicians can not be justified as
 it is harmful: Doctors should not do harm
 It is non-therapeutic procedure
 Doing it by health professionals gives the
procedure a societal acceptance.
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23.  Legal Aspects
In 1996:
Ministry of health prohibited the performance of FGC in
public & private hospitals & clinics except if it was medically
necessary.
The State Council upheld this order even in the presence of
a consent from parents & girl ruling that FGC is not an act
that emanates from the Shari`a.
In 2008:
Criminalization of FGC
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24. 5. TYPES OF FGC
WHO, 1997:
 Type I
 Type II
 Type III
 Type IV
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25. Type I:
Excision of part or all of the clitoris
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26. Type II:
Excision of the clitoris with partial or total excision of
the labia minora
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27. Type III (infibulation):
Clitoridectomy + labia minora + labia majora + sealing the
vagina
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28. Type IV:
Other forms of incisions, burns, piercing, or
manipulation of external genitalia.
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29. Types I – II - III
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30.  Types of FGC In Egypt
0
20
40
60
Clitoris
only
Labia
minora
only
Clitoris
and labia
minora
Labia
majora
only
EFCS Study: El-Zanaty F., 1996
80
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31. 6. THE PROCEDURE
Timing
Between ages of 5 and 12 y
Celebrations
Girl receives gifts
Music
Invited families and
friends
Girls are abducted in the
middle of the night to be
cut
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32.  Operator:
 ±non-medical
 Anesthesia:
 rarely used
 Antibiotics:
 rarely used
 Instruments:
 old rusty knives, razors, scissors, heated pebbles, coal
 Hemostasis:
 acacia thorns, sugar, coffee, sutures
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33. Type III (infibulation):
Clitoridectomy + labia minora + labia majora + sealing the
vagina
legs are tied for 40 days to heal & not allowed to move for
a week or so
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34. Ghagaria
3%
TBA
(daya)
32%
Doctor
52%
Nurse/
midwife
9%Barber
4%
 Who performs FGC in EGYPT
(Egypt Demographic and Health Survey 2000)
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35. (Tag-Eldin et al, 2008)
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36. 7. IMPACT OF FGC ON HEALTH
Short-term Complications
Maendeleo & Wanawake, 1993, Hosken, 1993
 Pain
 Neurogenic shock (13%)
 Bleeding (48.5%):
 death, shock, anemia
 Infections (23.9%):
 cellulitis, abscess, & tetanus (5%)
 Urine retention (19.4%)
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37. ABOUBAKR ELNASHAR

38. Long-term Complications
Ozumba, 1992
 Scarring:
 urethral stricture, labial fusion, & keloid
 Inclusion cysts: dermoids
 Psychological:
 trauma, anxiety & depression
 Sexual:
 Loss of libido, vaginismus, dyspareunia &
apareunia
 Infertility:
 Type III 25-30% [Macleod, 1995].
 Child birth complications: Type III
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39. FGC Complications
Egypt Demographic and Health Survey 1995
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41. •264 newly married women
•(duration of marriage < 5 yr) were randomly
selected.
•Data were collected using:
1. Interviewing questionnaire.
2. Symptoms check list 90:
developed by Leonard et al & translated by El-
Behery(1984): Psychological function
3. Gynecological examination.
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42. 264 females
Non FGC
64 (24.2%)
FGC
200 (75.8%)
1st degree
78 (39%)
2nd degree
122 (61%)
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43. Non FGC: No illiterates were found, 67.2% were at university level or higher
The majority (76.6%) were women workers, all were living in urban areas
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45. Sexual dysfunction disorders are statistically higher in
FGC than in non-FGC group
2nd degree than in 1st degree FGC
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46. ABOUBAKR ELNASHAR

47. ABOUBAKR ELNASHAR

48.  FGC
 significantly higher level of psychological problems
 Somatisation
 Depression,
 Anxiety, phobic anxiety and
 Hostility compared with non-FGC girls
(p < .0001).
(Ahmed et al, 2017)
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49.  FGC was associated with
 reduced scores of FSFI on
 all domains scores, and
 among both types I and II
(Ismaeil et al, 2017)
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50.  FGC was present in: 87.4%
 superficial dyspareunia:
 FGC: 77.4%
 Non FGC: 29.6%
 poor quality of life
 FGC: 74.2%
 Non FGC: 24.1%
(Abdelhaleem et al, 2016)
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51. CONCLUSION
FGC:
violates children’s rights and the right of healthy life.
form of discrimination against women.
Condemned by all major international medical
organizations
 WHO
World Medical Association
 FIGO
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52. FGC:
still a prevalent traditional act in our society
particularly, among
Rural
Illiterates
low-educated
non-working women.
has definitely many short and long-term health
problems
gynecological
Marital
obstetric
psychological
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53. RECOMMENDATIONS
Criminalization of FGC in all countries
WHO recommendation against medicalization of FGC
is advocated
Shifting adolescent girls' attitudes in favor of
discontinuation of FGC by
 increasing media coverage
 education
 reducing poverty
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54. Women's organization, hospitals, health centers,
ministries of health and mosques
All should cooperate together in
raising the awareness about its harms
encourage people to stop such practice
through different means including mass media
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55. You can get this lecture and 424 lecture
from:
1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/22
7744884091351/
2.Slide share web site
3. elnashar53@hotmail.com
4.My clinic: Althwara st, Mansura,
Egypt
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