Editing Female genital mutilation (section)

==Complications==
===Short term===
[[File:Anti-FGM campaign, Walala Biyotey, 25 January 2014.jpg|thumb|left|upright=1.5|alt=photograph|FGM awareness session run by the [[African Union Mission to Somalia]] at the Walalah Biylooley refugee camp, [[Mogadishu]], 2014]]
FGM harms women's physical and emotional health throughout their lives.{{sfn|Berg|Underland|Odgaard-Jensen|Fretheim|2014}}{{sfn|Reisel|Creighton|2015|loc=49}} It has no known health benefits.<ref name=WHO2018health/> The short-term and late [[complication (medicine)|complications]] depend on the type of FGM, whether the practitioner has had medical training, and whether they used antibiotics and sterilized or single-use surgical instruments. In the case of Type III, other factors include how small a hole was left for the passage of urine and menstrual blood, whether surgical thread was used instead of agave or acacia thorns, and whether the procedure was performed more than once (for example, to close an opening regarded as too wide or re-open one too small).{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}}

Common short-term complications include swelling, excessive bleeding, pain, [[Urinary retention|urine retention]], and healing problems/[[wound infection]]. A 2014 systematic review of 56 studies suggested that over one in ten girls and women undergoing any form of FGM, including symbolic nicking of the clitoris (Type IV), experience immediate complications, although the risks increased with Type III. The review also suggested that there was under-reporting.{{efn|Berg and Underland (Norwegian Knowledge Centre for the Health Services, 2014): "There was evidence of under-reporting of complications. However, the findings show that the FGM/C procedure unequivocally causes immediate, and typically several, health complications during the FGM/C procedure and the short-term period. Each of the most common complications occurred in more than one of every ten girls and women who undergo FGM/C. The participants in these studies had FGM/C types I through IV, thus immediate complications such as bleeding and swelling occur in setting with all forms of FGM/C. Even FGM/C type I and type IV 'nick', the forms of FGM/C with least anatomical extent, presented immediate complications. The results document that multiple immediate and quite serious complications can result from FGM/C. These results should be viewed in light of long-term complications, such as obstetric and gynecological problems, and protection of human rights."{{sfn|Berg|Underland|2014|loc=2}}}} Other short-term complications include fatal bleeding, [[anaemia]], [[urinary infection]], [[septicaemia]], [[tetanus]], [[gangrene]], [[necrotizing fasciitis]] (flesh-eating disease), and [[endometritis]].<ref>{{harvnb|Reisel|Creighton|2015|loc=49}}; {{harvnb|Iavazzo|Sardi|Gkegkes|2013}}; {{harvnb|Abdulcadir|Margairaz|Boulvain|Irion|2011}}.</ref> It is not known how many girls and women die as a result of the practice, because complications may not be recognized or reported. The practitioners' use of shared instruments is thought to aid the transmission of [[hepatitis B]], [[hepatitis C]] and [[HIV]], although no epidemiological studies have shown this.{{sfn|Reisel|Creighton|2015|loc=50}}

===Long term===
Late complications vary depending on the type of FGM.{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}} They include the formation of scars and [[keloid]]s that lead to [[Stenosis|strictures]] and obstruction, [[epidermoid cyst]]s that may become infected, and [[neuroma]] formation (growth of nerve tissue) involving nerves that supplied the clitoris.{{sfn|Kelly|Hillard|2005|loc=491–492}}{{sfn|Dave|Sethi|Morrone|2011}} An infibulated girl may be left with an opening as small as 2–3&nbsp;mm, which can cause prolonged, drop-by-drop [[urination]], [[dysuria|pain while urinating]], and a feeling of needing to urinate all the time. Urine may collect underneath the scar, leaving the area under the skin constantly wet, which can lead to infection and the formation of small stones. The opening is larger in women who are sexually active or have given birth by vaginal delivery, but the [[urethra]] opening may still be obstructed by scar tissue. [[Vesicovaginal fistula|Vesicovaginal]] or [[rectovaginal fistula]]e can develop (holes that allow urine or faeces to seep into the vagina).{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}}{{sfn|Rushwan|2013|loc=132}} This and other damage to the urethra and bladder can lead to infections and incontinence, [[dyspareunia|pain during sexual intercourse]] and [[infertility]].{{sfn|Kelly|Hillard|2005|loc=491–492}}

[[Dysmenorrhea|Painful periods]] are common because of the obstruction to the [[Menstruation|menstrual flow]], and blood can stagnate in the vagina and uterus. Complete obstruction of the vagina can result in [[hematocolpos]] and [[hematometra]] (where the vagina and uterus fill with menstrual blood).{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}} The swelling of the abdomen and lack of menstruation can resemble pregnancy.{{sfn|Rushwan|2013|loc=132}} [[Asma El Dareer]], a Sudanese physician, reported in 1979 that a girl in Sudan with this condition was killed by her family.{{sfn|El Dareer|1982|loc=37}}

===Pregnancy, childbirth===
[[File:Teaching_communities_about_FGM-C_(12345176104).jpg|thumb|Materials used to teach communities in [[Burkina Faso]] about FGM]]
FGM may place women at higher risk of problems during pregnancy and childbirth, which are more common with the more extensive FGM procedures.{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}} Infibulated women may try to make childbirth easier by eating less during pregnancy to reduce the baby's size.<ref name=RashidRashid2007/>{{rp|99}} In women with vesicovaginal or rectovaginal fistulae, it is difficult to obtain clear urine samples as part of prenatal care, making the diagnosis of conditions such as [[pre-eclampsia]] harder.{{sfn|Kelly|Hillard|2005|loc=491–492}} Cervical evaluation during labour may be impeded and labour prolonged or obstructed. Third-degree [[laceration]] (tears), [[Human anus|anal-sphincter]] damage and emergency [[caesarean section]] are more common in infibulated women.{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}}<ref name=RashidRashid2007>{{harvnb|Rashid|Rashid|2007|loc=97}}.</ref>

[[Perinatal mortality#Neonatal mortality|Neonatal mortality]] is increased. The WHO estimated in 2006 that an additional 10–20 babies die per 1,000 deliveries as a result of FGM. The estimate was based on a study conducted on 28,393 women attending delivery wards at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan. In those settings all types of FGM were found to pose an increased risk of death to the baby: 15 percent higher for Type I, 32 percent for Type II, and 55 percent for Type III. The reasons for this were unclear, but may be connected to genital and [[urinary tract infection]]s and the presence of scar tissue. According to the study, FGM was associated with an increased risk to the mother of damage to the [[perineum]] and [[postpartum bleeding|excessive blood loss]], as well as a need to [[Cardiopulmonary resuscitation|resuscitate]] the baby, and [[stillbirth]], perhaps because of a long [[Childbirth#Second stage: fetal expulsion|second stage of labour]].{{sfn|Banks|Meirik|Farley|Akande|2006}}<ref>[http://www.who.int/mediacentre/news/releases/2006/pr30/en/index.html "New study shows female genital mutilation exposes women and babies to significant risk at childbirth"] {{Webarchive|url=https://web.archive.org/web/20190502223749/https://www.who.int/reproductivehealth/publications/fgm/fgm-obstetric-study-en.pdf?ua=1 |date=2 May 2019 }}, World Health Organization, 2 June 2006.</ref>

===Psychological effects, sexual function===
According to a 2015 [[systematic review]] there is little high-quality information available on the psychological effects of FGM. Several small studies have concluded that women with FGM develop anxiety, depression, and [[post-traumatic stress disorder]].{{sfn|Reisel|Creighton|2015|loc=50}} Feelings of shame and betrayal can develop when women leave the culture that practices FGM and learn that their condition is not the norm, but within the practicing culture, they may view their FGM with pride because for them it signifies beauty, respect for tradition, chastity and hygiene.{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}} Studies on sexual function have also been small.{{sfn|Reisel|Creighton|2015|loc=50}} A 2013 [[meta-analysis]] of 15 studies involving 12,671 women from seven countries concluded that women with FGM were twice as likely to report no sexual desire and 52 percent more likely to report [[dyspareunia]] (painful sexual intercourse). One-third reported reduced sexual feelings.<ref>{{harvnb|Berg|Denison|2013}}; {{harvnb|Reisel|Creighton|2015|loc=51}}; {{harvnb|Sibiani|Rouzi|2008}}</ref>