Short Term Complications
Haemorrhage is one of the most common complications of FGM, as excision of the clitoris involves cutting across the high pressure clitoral artery and attempts to stop bleeding may not be effective. Acute extensive bleeding can lead to haemorrhagic shock or even sudden death in the case of cataclysmic haemorrhage.
Shock may occur because of blood loss and the severe pain and trauma of the procedure. Both haemorrhagic and neurogenic shock can be fatal.
The majority of mutilation procedures are performed without anaesthetics and cause the girl severe pain. Even if a local anaesthetic is used, multiple insertions of the needle are often required.
Urinary Retention is very common and may last for hours or days. It is commonly due to pain, tissue swelling, inflammation, injury to the urethra, and fear of passing urine on the raw wound.
Injury to adjacent tissue
Injury to the urethra, vagina, perineum and rectum can result from the use of crude instruments, poor light, careless techniques, or from the struggles of the girl.
Infection commonly occurs for a number of reasons; unhygenic conditions, the use of unsterilized instruments, applications of traditional herbs or ashes to the wound, contamination of the wound with urine and/or faeces, or binding of the legs following infibulation which prevents wound drainage. Septicaemia and tetanus may also develop.
Fracture or dislocation
Fracture of the clavicle, femur, humerus or hip joint can occur if heavy pressure is applied to a struggling girl during the procedure – as often occurs when several adults hold her down.
Failure to heal
Wounds may fail to heal quickly because of infection, irritation from urine, underlying anaemia or malnutrition.
Long Term Complications
Difficulties with micturition
Difficulties can occur due to damage to the urethral opening, obstruction of the urinary opening, or scarring of the meatus – and can lead to chronic incontinence or difficulty passing urine. For many infibulated girls, passing urine can take up to 20 minutes when they are still virgins.
Recurrent urinary tract infections (UTIS)
Partial occlusion of the vagina and urethra means the normal flow of urine is deflected and the perineum remains constantly wet and susceptible to bacterial growth. Retrograde UTI’s therefore commonly occur, affecting the bladder, uterus and kidneys. Damage to the lower urinary tract during the procedure can also result in urinary tract infections.
Chronic pelvic infections
Partial occlusion of the vagina and urethra increases the likelihood of infection and ascending pelvic infections are common. The infections are often painful and may be accompanied by a noxious discharge spreading to the uterus, fallopian tubes and ovaries – and frequently become chronic.
Infertility can occur due to chronic pelvic infections causing irreparable damage to the reproductive organs.
Vulval abscesses develop due to deep infection resulting from faulty healing or an embedded stitch causing the formation of an abscess.
Neurinoma can develop when the dorsal nerve of the clitoris is cut or trapped in a stitch or in scar tissue. The surrounding area becomes hypersensitive and unbearably painful.
Keloid scars result from slow and incomplete healing of the wound and the production of excess scar tissue. The scars may obstruct the vaginal opening and be so extensive that they prevent penile penetration.
Dermoid cysts result from inclusion of the epithelium during healing, leading to swelling or pockets producing secretion. The cysts vary in size, are extremely painful and can prevent sexual intercourse.
Calculus formation develop due to menstrual debris or urinary deposits in the vagina or in the space behind the bridge of the scar tissue.
Vesico-vaginal or recto-vaginal fistulae can form as a result of injury during circumcision, de-infibulation, re-infibulation, sexual intercourse, or obstructed labour. Urinary and faecal incontinence may be lifelong with severe social consequences.
Difficulties with menstruation
Partial or total occlusion of the vaginal opening commonly results in dysmenorrhoea or amenorrhea. Haematocolpos occasionally occurs from the retention of menstrual blood due to the almost complete coalescence of the labia.
Increased risk of HIV transmission
There is an increased risk of HIV transmission due to the use of the same unsterile instruments in-group circumcisions, repeated cutting and stitching during labour, and the higher incidence of lacerations and abrasions during intercourse.
- in the event of a miscarriage the foetus may be retained in the uterus or the birth canal, and performing a dilation and curettage maybe difficult,
- incorrect assessment of the stage of labour, cervical dilation, and foetal presentation due to the inability to perform vaginal examinations,
- inability to perform an induction with prostaglandins due to the very narrow introitus,
- difficulty applying a foetal scalp electrode, performing a foetal blood sample, or inserting a urinary catheter due to the very narrow introitus,
- difficulty identifying some obstetric emergencies such as cord prolapse due to an inability to perform a vaginal examination,
- increased risk of bleeding, wound infection, and damage to surrounding tissues due to repeated deinfibulation, particularly if it is not performed correctly,
- prolonged and obstructed labour due to partial or total occlusion of the vaginal opening. This can lead to increased risk of uterine inertia, rupture or prolapse, tearing to the perineum, haemorrhage, and fistula formation. The baby may have an increased risk of suffering neonatal brain damage or death as a result of birth asphyxia,
- repetition of deinfibulation and reinfibulation weakens the scar tissue and at the beginning of menopause a woman may have a mass of fibrous tissue resulting in incontinence and prolapses of the vaginal wall.