Editing Female genital mutilation (section)

====Type III{{anchor|Type III}}====
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* [https://web.archive.org/web/20180207062846/https://smw.ch/resource/jf/jimg/780/780/ratio/journal/file/view/article/smw/en/smw.2011.13137/smw_2011_13137_fig_01_conv.jpg/ Type IIIb (virgin)]
* [https://web.archive.org/web/20180207010148/https://smw.ch/resource/jf/jimg/780/780/ratio/journal/file/view/article/smw/en/smw.2011.13137/smw_2011_13137_fig_02_conv.jpg/ Type IIIb (sexually active)]
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|source= — ''[[Swiss Medical Weekly]]''{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}}}}

''Type III'' ([[infibulation]] or pharaonic circumcision), the "sewn closed" category, is 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.{{efn|WHO 2014: "Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).{{pb}}"Type IIIa, removal and apposition of the labia minora; Type IIIb, removal and apposition of the labia majora."<ref name=WHO2014/>}} Type III is found largely in northeast Africa, particularly Djibouti, Eritrea, Ethiopia, Somalia, and Sudan (although not in South Sudan). According to one 2008 estimate, over eight million women in Africa are living with Type III FGM.{{efn|USAID 2008: "Infibulation is practiced largely in countries located in northeastern Africa: Djibouti, Eritrea, Ethiopia, Somalia, and Sudan.&nbsp;... Sudan alone accounts for about 3.5 million of the women.&nbsp;... [T]he estimate of the total number of women infibulated in [Djibouti, Somalia, Eritrea, northern Sudan, Ethiopia, Guinea, Mali, Burkina Faso, Senegal, Chad, Nigeria, Cameroon, and Tanzania, for women 15–49 years old] comes to 8,245,449, or just over eight million women."{{sfn|Yoder|Khan|2008|loc=13–14}}}} According to UNFPA in 2010, 20 percent of women with FGM have been infibulated.<ref name=UNFPATypeIIIestimate>[http://www.unfpa.org/resources/promoting-gender-equality "Frequently Asked Questions on Female Genital Mutilation/Cutting"] {{Webarchive|url=https://web.archive.org/web/20150104112106/http://www.unfpa.org/resources/promoting-gender-equality |date=4 January 2015 }}, United Nations Population Fund, April 2010.</ref> In Somalia, according to [[Edna Adan Ismail]], the child squats on a stool or mat while adults pull her legs open; a local anaesthetic is applied if available:

{{blockquote|The element of speed and surprise is vital and the circumciser immediately grabs the clitoris by pinching it between her nails aiming to amputate it with a slash. The organ is then shown to the senior female relatives of the child who will decide whether the amount that has been removed is satisfactory or whether more is to be cut off.

After the clitoris has been satisfactorily amputated&nbsp;... the circumciser can proceed with the total removal of the labia minora and the paring of the inner walls of the labia majora. Since the entire skin on the inner walls of the labia majora has to be removed all the way down to the perineum, this becomes a messy business. By now, the child is screaming, struggling, and bleeding profusely, which makes it difficult for the circumciser to hold with bare fingers and nails the slippery skin and parts that are to be cut or sutured together.&nbsp;...

Having ensured that sufficient tissue has been removed to allow the desired fusion of the skin, the circumciser pulls together the opposite sides of the labia majora, ensuring that the raw edges where the skin has been removed are well approximated. The wound is now ready to be stitched or for thorns to be applied. If a needle and thread are being used, close tight sutures will be placed to ensure that a flap of skin covers the vulva and extends from the mons veneris to the perineum, and which, after the wound heals, will form a bridge of scar tissue that will totally occlude the vaginal introitus.<ref name=Ismail2016p12>{{harvnb|Ismail|2016|loc=12}}.</ref>}}

The amputated parts might be placed in a pouch for the girl to wear.{{sfn|El Guindi|2007|loc=[https://books.google.com/books?id=8VQxt634pfcC&pg=PA43 43]}} A single hole of 2–3&nbsp;mm is left for the passage of urine and menstrual fluid.{{efn|Jasmine Abdulcadir (''Swiss Medical Weekly'', 2011): "In the case of infibulation, the urethral opening and part of the vaginal opening are covered by the scar. In a virgin infibulated woman the small opening left for the menstrual fluid and the urine is not wider than 2–3&nbsp;mm; in sexually active women and after the delivery the vaginal opening is wider but the urethral orifice is often still covered by the scar."{{sfn|Abdulcadir|Margairaz|Boulvain|Irion|2011}}}} The vulva is closed with surgical thread, or [[agave]] or [[acacia]] thorns, and might be covered with a poultice of raw egg, herbs, and sugar. To help the tissue bond, the girl's legs are tied together, often from hip to ankle; the bindings are usually loosened after a week and removed after two to six weeks.{{sfn|Ismail|2016|loc=14}}{{sfn|Kelly|Hillard|2005|loc=491}} If the remaining hole is too large in the view of the girl's family, the procedure is repeated.{{sfn|Abdalla|2007|loc=[https://books.google.com/books?id=8VQxt634pfcC&pg=PA190 190]}}

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.{{sfn|Abdalla|2007|loc=[https://books.google.com/books?id=8VQxt634pfcC&pg=PA190 190–191], [https://books.google.com/books?id=8VQxt634pfcC&pg=PA198 198]}} 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.{{sfn|Ismail|2016|loc=14}}{{anchor|defibulation|deinfibulation|reinfibulation}} The woman is opened further for childbirth (''defibulation'' or ''deinfibulation''), and closed again afterwards (''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.{{efn|Elizabeth Kelly, Paula J. Adams Hillard (''Current Opinion in Obstetrics and Gynecology'', 2005): "Women commonly undergo reinfibulation after a vaginal delivery. In addition to reinfibulation, many women in Sudan undergo a second type of re-suturing called El-Adel, which is performed to recreate the size of the vaginal orifice to be similar to the size created at the time of primary infibulation. Two small cuts are made around the vaginal orifice to expose new tissues to suture, and then sutures are placed to tighten the vaginal orifice and perineum. This procedure, also called re-circumcision, is primarily performed after vaginal delivery, but can also be performed before marriage, after cesarean section, after divorce, and sometimes even in elderly women as a preparation before death."{{sfn|Kelly|Hillard|2005|loc=491}}}}{{sfn|El Dareer|1982|loc=56–64}} Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the 1980s about sexual intercourse with Type III:

{{blockquote|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.&nbsp;... 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.<ref>{{harvnb|Lightfoot-Klein|1989|loc=380}}; also see {{harvnb|El Dareer|1982|loc=42–49}}.</ref>}}