According to Caldwell et. al. (1997:1190), since 1977, there has been increasing international awareness of the health complications of the practice of female circumcision. Several international conferences such as the International Conference on Population and Development in Cairo in 1995 and the Fourth World Conference on Women in Beijing recognised the danger to women‟s reproductive well- being and violation of their rights (Gollaher, 2000:194-195). It has been documented that several complications can arise from undergoing female circumcision. However, it should be noted that these documented health complications do not make mention of the type of female circumcision (as different types of female circumcision may result in different complications). Nevertheless, the following health complications have been noted as resulting from the practice of female circumcision.
3.8.1 Immediate Complications
According to Koso Thomas (1987:25-26), the immediate complications arising from female circumcision are as follows:
Pain due to lack of local anaesthesia
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Shock due to sudden blood loss and severe pain
Haemorrhage from the major blood vessels, for example the dorsal artery of the clitoris
Acute urinary retention
Tetanus resulting from using unsterilized equipment and lack of proper wound dressings
Wound infections and urinary tract infection
Septicaemia (blood poisoning) due to the procedure being performed in unhygienic conditions, use of unsterilized equipment and the application of herbs and ashes to the wound
Death due to shock, haemorrhage, tetanus and lack of availability of medical services
Fractures of the clavicle, femur, or humurus, due to strong pressure applied to the struggling girl
3.8.2 Intermediate Complications
Koso Thomas (1987:25-26) highlights the intermediate complications as follows:
Delay in healing due to infection, anaemia and malnutrition
Pelvic infection due to infection of the uterus and vagina from the infected genital wound
Dysmenorrhoea (a tight circumcision or keloid scar obstructing the vaginal orifice or pelvic infection)
Cysts and abscesses due to the edges of incision being turned inwards and damaging the Bartholin‟s duct. The duct‟s mucous secretions accumulate forming cysts that later become infected and form abscesses on the vulva. This is commonly found in infibulated women
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Keloid scars resulting from slow and incomplete healing of the wound and infection after the procedure. This leads to the production of excess connective tissues in the scar
Dyspareunia or painful intercourse, due to a tight vaginal opening
Pelvic injury to the vulva area caused by vigorous sexual act
3.8.3 Late Complications
As for the late complications post female circumcision, Koso Thomas (1987:25-26) summarizes them up as follows:
Haematocolpos, which is the closure of the vaginal opening by the scar tissue.
This results in the menstrual blood accumulating over many months in the vagina and uterus, and appears as a bluish bulging membrane on vaginal examination
Infertility due to chronic pelvic infection blocking both fallopian tubes
Vaginal and rectal fistula cause frequent miscarriage and makes it difficult to bear children
Recurrent urinary tract infection. This occurs because the urinary opening becomes covered by scar tissue or flap of the skin, due to inadequate treatment at the time of circumcision and lack of medical facilities. Urine remains in the bladder due to the inability to completely evacuate the bladder
Difficulty in urinating due to damaged urethral opening and scarring over this opening at excision and infibulations
Calculus/stone formation due to scar tissue obstructing urethral opening and status of urine coupled with bacterial infection
Hypersensitivity (the development of neuroma on the dorsal nerve of the clitoris)
Anal incontinence and fissure resulting from rectal intercourse when vaginal intercourse is not possible due to the vaginal opening being too small
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3.9 The Severity of Complications Accompanying Different Types of Female Circumcision
The severity of the complications depends on the type of cutting involved in female circumcision. For example, Dareer (1982:48) reporting on her extensive survey in Sudan emphasises that the less severe procedures do not pose the same complications as infibulations and points out the following:
The pattern of complications suggests that intermediate and pharonic circumcisions are almost the same as regards the tissue excised and the aperture left, although complications are more prevalent among those who have been pharonically circumcised. The Sunna type presents considerably less complications.
In the South African context, it is mostly during childbirth that the gynecologists encounter such complications with pharonically circumcised women. According to Smith (1999:9), gynaecologists at the Obstetrics and Gynecology Unit at Johannesburg Hospital, acknowledged the fact that the numbers of circumcised women who were coming to government hospitals for ante-natal care were steadily increasing.
A gynaecologist, who had worked at the Coronation Hospital in the Gauteng area for many years, was able to successfully de-infibulate a newly married woman from Sudan. In the past, she had delivered babies of circumcised women from various countries in Africa. The aforementioned hospital caters for many immigrants and refugees concentrated in the Mayfair area in the Gauteng Province. From the
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interviews conducted in 2003 by the writer of this thesis, she gathered that about two to three circumcised women would come to the Coronation Hospital on a weekly basis to deliver their babies.
The writer of this thesis also acknowledges the fact that a female gynaecologist who had been working at Cape Town‟s Groote Schuur Hospital told her in 2004 that during the past 3 years she had also delivered babies from women who had been infibulated and fromanother eleven who had undergone a milder form of circumcision. She also found that women who had undergone the less severe types of procedures did not experience obstructed labour or any other complications during the delivery of their babies.