WHO Types I–II
The WHO has created a more detailed typology, Types I–III, based on how much tissue is removed; Type III is "sewn closed." Type IV describes symbolic circumcision and miscellaneous procedures.[43]
Type I is subdivided into Ia, removal of the clitoral hood (rarely performed alone),[n 6] and the more common Ib (clitoridectomy), the complete or partial removal of the clitoral glans and clitoral hood.[45] (When discussing FGM, the WHO uses clitoris to refer to the clitoral glans, the visible tip of the clitoris.)[46] Susan Izett and Nahid Toubia write: "[T]he clitoris is held between the thumb and index finger, pulled out and amputated with one stroke of a sharp object."[47]
Type II (excision) is the complete or partial removal of the inner labia, with or without removal of the clitoral glans and outer labia. Type IIa is removal of the inner labia; IIb, removal of the clitoral glans and inner labia; and IIc, removal of the clitoral glans, inner and outer labia. Excision in French can refer to any form of FGM.[48]
Type III
Type III (infibulation or pharaonic circumcision), the "sewn closed" category, involves the removal of the external genitalia and fusion of the wound. The inner and/or outer labia are cut away, with or without removal of the clitoral glans. Type IIIa is the removal and closure of the inner labia and IIIb the outer labia.[n 7] The practice is found largely in Djibouti, Eritrea, Ethiopia, Somalia and Sudan (though not South Sudan) in northeast Africa. Estimates of numbers vary: according to one in 2008, over eight million women in Africa have experienced it.[n 8] According to UNFPA in 2010, 20 percent of women with FGM have been infibulated.[12]
Comfort Momoh, a specialist midwife, writes of Type III: "[E]lderly women, relatives and friends secure the girl in the lithotomy position. A deep incision is made rapidly on either side from the root of the clitoris to the fourchette, and a single cut of the razor excises the clitoris and both the labia majora and labia minora."[49] In Somalia the clitoral glans is removed and shown to the girl's senior female relatives, who decide whether enough has been amputated. After this the labia are removed.[50]
A single hole of 2–3 mm is left for the passage of urine and menstrual fluid by inserting something, such as a twig, into the wound.[n 9][52] The vulva is closed with surgical thread, agave or acacia thorns, or covered with a poultice such as raw egg, herbs and sugar.[53] The parts that have been removed might be placed in a pouch for the girl to wear.[54] To help the tissue bond, the girl's legs are tied together, often from hip to ankle, for anything up to six weeks; the bindings are usually loosened after a week and may be removed after two.[55] Momoh writes:
[The entrance to the vagina] is obliterated by a drum of skin extending across the orifice except for a small hole. Circumstances at the time may vary; the girl may struggle ferociously, in which case the incisions may become uncontrolled and haphazard. The girl may be pinned down so firmly that bones may fracture.[49]If the remaining hole is too large in the view of the girl's family, the procedure is repeated.[56] The vagina is opened for sexual intercourse, for the first time either by a midwife with a knife or by the woman's husband with his penis. In some areas, including Somaliland, female relatives of the bride and groom might watch the opening of the vagina to check that the girl is a virgin.[57] Psychologist Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the 1980s about sexual intercourse with Type III:
The penetration of the bride's infibulation takes anywhere from 3 or 4 days to several months. Some men are unable to penetrate their wives at all (in my study over 15%), and the task is often accomplished by a midwife under conditions of great secrecy, since this reflects negatively on the man's potency. Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation, and the woman's vaginal passage is then cut open to allow birth to take place. ... Those men who do manage to penetrate their wives do so often, or perhaps always, with the help of the "little knife." This creates a tear which they gradually rip more and more until the opening is sufficient to admit the penis.[58]The woman is opened further for childbirth and closed afterwards, a process known as defibulation (or deinfibulation) and reinfibulation. Reinfibulation can involve cutting the vagina again to restore the pinhole size of the first infibulation. This might be performed before marriage, and after childbirth, divorce and widowhood.[n 10][60]
from: https://en.wikipedia.org/wiki/Female_genital_mutilation
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