The local terminology used to describe the various types of female circumcision varies from country to country. In the literature from Sudan, the term Sunnah (referring to the religious tradition) is used for circumcision while infibulation is referred to as a pharonic practice. The practice of infibulation is commonly referred to as “excision” in literature associated with French-speaking Africa, while the term
“circumcision” is commonly used in English-speaking Africa (Rahman and Toubia, 2000:6).
The main types of female circumcision that are described in medical literature and which are classified according to the severity of the procedure are discussed hereunder.
3.3.1 Clitoridectomy
This practice is considered to be the mildest form of female circumcision and consists of the removal of the prepuce of the clitoris only, preserving the clitoris itself and the posterior larger parts of the labia minora (Abdalla, 1982:7). This is also referred to as Type 1 circumsicion which entails the cutting off of the prepuce with or without excision of a part or the entire clitoris (Rahman and Toubia, 2000:7). This type of circumcision is popularly known as Sunnah by Muslim writers and Muslim communities who practice it (Abdalla, 1982:8). Jamal Badawi (1999:50), the renowned Muslim scholar who resides in Canada, postulates that although the term Sunnah is used by many for female circumcision, the Prophet of Islam nevertheless only used the term Sunnah, in reference to male circumcision and hence it is incorrect to use the aforementioned term for female circumcision.
42 3.3.2 Excision
This type of cutting is regarded as more severe and consists of the partial or total excision of the prepuce or hood of the clitoris, partial or total removal of the clitoris, together with the adjacent tissues of the labia minora, and sometimes the whole of the labia minora except the labia majora, without the closure of the vulva (Abdalla, 1982:8).
3.3.3 Infibulation or Pharonic Circumcision
This is viewed as the most severe form of circumcision. It involves excision and infibulation, where the clitoris, the labia minora, and inner walls of the labia majora (or at least the anterior two thirds), and the two sides of the vulva are attached to each other by thorns or silk threads. This reduces the size of the orifice of the vulva, with a very small opening remaining at the lower end, to allow for the passage of urine and menstrual flow (Abdalla, 1982:10). The result is a flattened vulva, with no labia, and a midline scar, stretching almost to the perineum. The urethra is hidden under this flap of scar tissue, and the normal urinary and vaginal openings are replaced by a small opening (Elchalal et. al., 1997:104).
A Somali immigrant who immigrated to Atlanta, Georgia, in the United States, provides a description of infibulation as recorded by Saran (1998:173): “In Mogadishu, health workers in the hospital do it and stitchery. They cut labia majora and minora, cut clitoris, cut all the meat out, and sew remaining lips together.”
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3.3.4 The Intermediate Type of Circumcision
The Intermediate type is chiefly practiced in Sudan. It varies in different degrees between the Type 1 and the Pharonic type of circumcision. It was invented after legislation in 1946, which forbade the practice of the Pharonic type of circumcision.
The Sudanese found it very difficult to suddenly change from the Pharonic to the type I, which they regard as no circumcision at all. Thus, this intermediate type was invented by trained midwives as a compromise and is replacing the Pharonic circumcision (infibulation) (Dareer, 1982:3). This procedure consists of the removal of the clitoris, anterior parts or whole of the labia minora, and part of the labia majora. The two sides are then stitched together leaving an opening of various sizes.
Thus this intermediate type has different grades. The mildest form that is wrongly termed “Sunnah” has two names, the Sunnah Magatia (covered Sunnah) and Sunnah Kashfa (uncovered Sunnah). In the former type, the clitoris is removed and the surface of the labia minora roughened to enable stitching, whilst in the other only the tip of the clitoris or half of it is removed, the labia minora are intact and there is no stitching. The most extreme form is the same as the Pharonic type. The different grades have come about due to the midwife following the instructions of the girls‟
relatives on the amount of genitalia that she should remove (Dareer, 1982:6).
Dareer found that the Shanabla tribe from Kordufan performed a more severe kind than the Pharonic. In this procedure an additional V-shaped cut is made downwards of the vaginal orifice. The sides are then stitched together, moving from the top to the bottom, resulting in a very small hole. The reason for resorting to this type of procedure was to afford protection to the girl while she was looking after the sheep since both boys and girls looked after the livestock (Dareer, 1982:7).In some countries, like Malaysia and Indonesia, the practice ranges from a prick of the clitoris
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to remove only a drop of blood to removing a little of the clitoris and labia minora (Hosken, 1982:239).
3.3.5 De-circumcision (De-infibulation) and Re-circumcision (Re-infibulation)
De-circumcision or de-infibulation is the reverse of circumcision and infibulation. It consists of making a short incision to separate the fused labia minora at the time of marriage. In Somalia this is done either by the midwife or by the husband. At childbirth a further incision is made to enable the baby to be delivered. After the birth of every child the women are stitched again. This is known as re-circumcision or re- infibulation (Rahman and Toubia, 2000:60. The aim is to make the vaginal opening as tight as that of the original circumcision (Abdalla, 1982:7).