The external female genitalia comprises the mons pubis, which is a mound of fatty tissue covering the pubic bone; labia majora, which are large tissue folds that enclose and protect the other external genitalia; as well as the labia minora, which are small tissue lips that lie inside the labia majora and surround the vaginal and urethral openings.
There is also the clitoris, which is located between the labia minora at its upper end and is very sensitive to sexual stimulation; perineum, which is the area between the openings of the vagina and anus; and Bartholin’s glands, which are located inside the vaginal opening.
Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
Classification of FGM
FGM is classified into four types.
Type 1 (clitoridectomy) is the partial or total removal of the clitoris – a small, sensitive and erectile part of the female genitalia. Sometimes, only the prepuce – a fold of skin surrounding the clitoris – is removed.
Type 2 (excision) is the partial or total removal of the clitoris and the labia minora – the inner vulval folds – with or without excision of the labia majora – the outer vulval folds.
Type 3 (infibulation) is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora or labia majora – sometimes through stitching – with or without removal of the clitoris (clitoridectomy).
Type 4 includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area.
No health benefits
There are no health benefits from FGM, only harm for girls and women. The removal and damage to healthy and normal genital tissue interferes with natural bodily functions.
The harm increases with increasing severity of FGM, and are both physical and mental. The immediate physical complications are severe pain, excessive bleeding, genital swelling, damage to surrounding tissue, infections, urinary and healing problems, shock, and even death.
The long-term physical complications are urinary problems, e.g. painful urination and infections; vaginal problems, e.g. discharge, itching and infections; menstrual problems, e.g. painful periods and difficulty in discharging menstrual blood; and scars.
Sexual and reproductive problems are also a major physical complication, e.g. painful intercourse; increased risk of childbirth complications, e.g. difficult delivery, excessive bleeding, Cesarean section and the need to resuscitate the baby, and newborn deaths; and need for later surgeries, e.g. type 3 FGM needs to be cut open later to allow for sexual intercourse and childbirth.
Immediate and long-term physical risks are increased by repeated suturing of genital tissue, especially in childbirth. The mental harms include depression, anxiety, post-traumatic stress disorder and low self-esteem.
Malaysia was severely criticised by several Muslim countries at the 69th session of the United Nations (UN) Convention on the Elimination of All Forms of Discrimination Against Women.
The UN Committee report (CEDAW/C/MYS/CO/3-5) dated Mac 14, 2018, stated:
“The Committee stresses that female genital mutilation, female circumcision or female genital cutting cannot be justified on religious grounds and constitutes a harmful practice to exert control over the bodies and sexuality of women and girls in violation of the Convention, irrespective of the extent of removal or cutting of the female genital organs and of whether or not it is performed within or outside a medical institution.”
It recommended that Malaysia:
• “Prohibit all forms of female genital mutilation in its criminal code that cannot be overruled by any fatwas or issuance from religious or clerical authorities, as well as in practice, in accordance with the Committee’s joint general recommendation No. 31 (2014) of the Committee on the Elimination of Discrimination against Women and No. 18 of the Committee on the Rights of the Child on harmful practices, as well as target 5.3 of the SDGs (Sustainable Development Goals) and General Assembly resolution 69/150 on intensifying global efforts for the elimination of female genital mutilations;
• “Engage in constructive dialogue with religious authorities, women’s non-governmental organisations and the public to convey the point that female genital mutilation cannot be justified by religion;
• “Undertake awareness-raising and educational activities aimed at promoting consensus towards the elimination of female genital mutilation, in particular by addressing the misconception that female circumcision is acceptable as it is presumed to lead to medical and hygienic benefits.”
Human rights violation
The Malaysian delegates to the Universal Periodic Review (UPR) on human rights in Geneva, Switzerland on Nov 9, 2018, reportedly defended the practice of FGM as a “cultural obligation”.
This was described as unconvincing and misleading, and had the “potential of damaging further Malaysia’s international standing on women’s rights”, by the Human Rights Commission of Malaysia (Suhakam) chairman, Tan Sri Razali Ismail.
Earlier in 2012, the UN General Assembly had passed a resolution calling FGM a human rights violation. The resolution was adopted by all UN members, including Malaysia.
The Health Ministry announced in 2012 that it was developing guidelines for female circumcision, a type of FGM. The current status of the guidelines is not in the public domain.
The health professionals in the ministry need to ask themselves whether FGM is evidence-based practice, which the ministry claims to practise, and whether it is in accordance with its vision and mission.
The UN Population Fund (UNFPA), UN International Children’s Emergency Fund (Unicef), the International Confederation of Midwives and the International Federation of Gynecology and Obstetrics, stated: “We call on all health workers to abandon the practice of FGM and to use their influence, not only in the communities where they work, but also with their colleagues to accelerate the abandonment of FGM everywhere.
“We also call on all health workers to protect the sexual and reproductive health of those who have already undergone FGM.”
The claim that female circumcision is different from FGM is a lame attempt to justify a harmful act. Healthcare workers who carry out female circumcision have to reflect on whether this is in keeping with their ethos, “First, do no harm.”
Many Muslim countries have criminalised FGM with custodial punishments. It is time that Malaysia considers this solution, together with education of the public – particularly key opinion leaders – of the need to respect every individual’s bodily integrity.
The female, whose biological task is the continuation of the human species, is owed nothing less.