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154-708: Female genital mutilation ( FGM ) (also known as female genital cutting , female genital mutilation/cutting ( FGM/C ) and female circumcision ) is the cutting or removal of some or all of the vulva for non-medical reasons. FGM prevalence varies worldwide, but is majorly present in some countries of Africa, Asia and Middle East, and within their diasporas. As of 2024, UNICEF estimates that worldwide 230 million girls and women (144 million in Africa, 80 million in Asia, 6 million in Middle East, and 1-2 million in other parts of

308-583: A "cultureless people" since prior to this time there had been no indigenous African writing system for his language. N'ko first gained a strong user base around the Maninka-speaking area of Kante's hometown of Kankan, Guinea and disseminated from there into other Manding-speaking parts of West Africa. N'ko and the Arabic script are still in use for Bambara, although only the Latin-based orthography

462-521: A "self-enforcing social convention " to which families feel they must conform to avoid uncut daughters facing social exclusion. Ellen Gruenbaum reported that, in Sudan in the 1970s, cut girls from an Arab ethnic group would mock uncut Zabarma girls with Ya, ghalfa! ("Hey, unclean!"). The Zabarma girls would respond Ya, mutmura! (A mutmura was a storage pit for grain that was continually opened and closed, like an infibulated woman.) But despite throwing

616-426: A 1988 poem as the "three feminine sorrows": the procedure itself, the wedding night when the woman is cut open, then childbirth when she is cut again. Despite the evident suffering, it is women who organize all forms of FGM. Anthropologist Rose Oldfield Hayes wrote in 1975 that educated Sudanese men who did not want their daughters to be infibulated (preferring clitoridectomy) would find the girls had been sewn up after

770-430: A child's sex by eliminating external traces of androgyny," Janice Boddy wrote in 2007. "The female body is then covered, closed, and its productive blood bound within; the male body is unveiled, opened, and exposed." In communities where infibulation is common, there is a preference for women's genitals to be smooth, dry and without odour, and both women and men may find the natural vulva repulsive. Some men seem to enjoy

924-522: A direct impact on the medical treatment of vulvar melanomas. Signs and symptoms of vulvar cancer can include: itching , or bleeding ; skin changes including rashes, sores, lumps or ulcers , and changes in vulvar skin coloration. Pelvic pain might also occur especially during urinating and sex. However, a significant proportion remains asymptomatic in early disease stages, often delaying its diagnosis. As such, 32% of women with vulvar melanoma already have regional involvement or distant metastases at

1078-494: A joint statement in 1997 defining FGM as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons". The procedures vary according to the ethnicity and individual practitioners; during a 1998 survey in Niger, women responded with over 50 terms when asked what was done to them. Translation problems are compounded by

1232-513: A large and varied group of women showed clearly that there is much variation. Other variations of the vulva include the appearance of Fordyce spots and clitoral phimosis (when the clitoral hood cannot retract past the glans). Researchers from the Elizabeth Garret Anderson Hospital, London, measured multiple genital dimensions of 50 women between the ages of 18 and 50, with a mean age of 35.6: In week three of

1386-571: A much slower rate if an orgasm has not occurred. The vagina and its opening return to their normal relaxed state, and the rest of the vulva returns to its normal size, position and color. The distance between the clitoral frenulum and the urinary meatus located above the vaginal opening is called the clitoral-urinary meatus distance or CUMD. In the 1920s, Marie Bonaparte conducted surveys among women to find out whether they get an orgasm during coitus . The causes of lack of sexual arousal were known to be aversion or psychological inhibitions. Among

1540-456: A number of physical changes in the vulva. During arousal, the Bartholin's glands produce more vaginal lubrication . Vulval tissue is highly vascularised ; arterioles dilate in response to sexual arousal and the smaller veins will compress after arousal, so that the clitoris and labia minora increase in size. Increased vasocongestion in the vagina causes it to swell, decreasing the size of

1694-423: A pouch for the girl to wear. A single hole of 2–3 mm is left for the passage of urine and menstrual fluid. 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. If

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1848-410: A remnant called the hymen. The newborn 's vulva may be swollen or enlarged as a result of having been exposed, via the placenta , to her mother's increased levels of hormones. The labia majora are closed. These changes disappear over the first few months. During childhood before puberty, the lack of estrogen can cause the labia to become sticky and to ultimately join firmly together. This condition

2002-532: 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. Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue) involving nerves that supplied

2156-524: A significant percentage of infibulated women and girls reported a less severe type. In 2017, during an international meeting of 98 FGM experts, which included physicians, social scientists, policymakers, and activists from 23 countries, a majority of the participants advocated for the revision of FGM/C classifications proposed by the WHO and other UN agencies. The experts agreed on legal prohibition of reinfibulation and ritual pricking. They also expressed worry over

2310-452: A single chancre, a firm, painless, non-itchy ulcer, but there may be multiple sores; and gonorrhea that very often presents no symptoms but can result in discharge. Viral infections include human papillomavirus infection (HPV) – this is the most common STI and has many types. Genital HPV can cause genital warts . There have been links made between HPV and vulvar cancer, though HPV most often causes cervical cancer . Genital herpes

2464-500: A study by Nigerian physician Mairo Usman Mandara, over 30 percent of women with gishiri cuts were found to have vesicovaginal fistulae (holes that allow urine to seep into the vagina). FGM harms women's physical and emotional health throughout their lives. It has no known health benefits. The short-term and late 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

2618-527: A total number of 21 vowels (the letters approximate their IPA equivalents). Writing with the Latin alphabet began during the French colonization, and the first orthography was introduced in 1967. Literacy is limited, especially in rural areas. Although written literature is only slowly evolving (due to the predominance of French as the "language of the educated"), there exists a wealth of oral literature , which

2772-451: Is inverse psoriasis in which red patches can appear in the skin folds of the labia. The vulvar region is at risk for trauma during childbirth . During childbirth, the vagina and vulva must stretch to accommodate the baby's head (approximately 9.5 cm (3.7 in)). This can result in tears known as perineal tears in the vaginal opening, and other structures within the perineum . An episiotomy (a pre-emptive surgical cutting of

2926-461: Is subject–object–verb (SOV). Take the phrase, n t'a lon (I don't know [it]). n is the subject (I), a is the object (it), and [ta] lon is the verb ([to] know). The t' is from the negative present tense marker té , bé being the affirmative present tense marker ( n b'a don would mean "I know it"). Like many SOV languages, Bambara uses postpositions rather than prepositions - their role being similar to English prepositions but placed after

3080-455: Is vulvovaginal-gingival syndrome , which can lead to narrowing of the vagina, or vulva destruction. Many types of infection and other diseases including some cancers may cause irritation. Vulvar organs and tissues can become affected by different infectious agents such as bacteria and viruses , or infested by parasites such as lice and mites . Over thirty types of pathogen can be sexually transmitted , and many of these affect

3234-487: Is Standard Bamara, which has significant influence from Maninkakan. Bambara has many local dialects: Kaarta, Tambacounda (west); Beledugu, Bananba, Mesekele (north); Jitumu, Jamaladugu, Segu (center); Cakadugu, Keleyadugu, Jalakadougu, Kurulamini, Banimɔncɛ, Cɛmala, Cɛndugu, Baninkɔ, Shɛndugu, Ganadugu (south); Kala, Kuruma, Saro, dialects to the northeast of Mopti (especially Bɔrɛ); Zegedugu, Bɛndugu, Bakɔkan, Jɔnka (southeast). Since 1967, Bambara has mostly been written in

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3388-456: Is a variety of a group of closely related languages called Manding , whose native speakers trace their cultural history to the medieval Mali Empire . Varieties of Manding are generally considered (among native speakers) to be mutually intelligible – dependent on exposure or familiarity with dialects between speakers – and spoken by 9.1 million people in the countries Burkina Faso , Senegal , Guinea-Bissau , Guinea , Liberia , Ivory Coast and

3542-431: Is a white substance formed from a combination of dead cells, skin oils, moisture and naturally occurring bacteria , that forms in the genitalia. In females, this thickened secretion collects around the clitoris and labial folds. It can cause discomfort during sexual activity as it can cause the clitoral glans to stick to the hood, and is easily removed by bathing. Aliphatic acids known as copulins are also secreted in

3696-499: Is also a belief that infibulation increases hygiene. Common reasons for FGM cited by women in surveys are social acceptance, religion, hygiene, preservation of virginity, marriageability and enhancement of male sexual pleasure. In a study in northern Sudan, published in 1983, only 17.4 percent of women opposed FGM (558 out of 3,210), and most preferred excision and infibulation over clitoridectomy. Attitudes are changing slowly. In Sudan in 2010, 42 percent of women who had heard of FGM said

3850-590: Is also known in Arabic as khafḍ or khifaḍ . Communities may refer to FGM as "pharaonic" for infibulation and " sunna " circumcision for everything else; sunna means "path or way" in Arabic and refers to the tradition of Muhammad , although none of the procedures are required within Islam. The term infibulation derives from fibula , Latin for clasp; the Ancient Romans reportedly fastened clasps through

4004-438: Is caused by another ectoparasite, the mite Sarcoptes scabiei , giving intense irritation. Malignancies can develop in the glabrous and hair-bearing parts of the vulva. Based on the cellular origin and histology , vulvar cancers are classified into squamous cell carcinomas , melanomas , basal cell carcinomas , adenocarcinomas , sarcomas and invasive extramammary Paget's disease . Squamous cell carcinomas represent

4158-491: Is characterised by painful cysts that can ulcerate, and recur, and can become chronic lasting for many years. Chronic cases can develop into squamous cell carcinomas . An asymptomatic skin disorder of the vulval vestibule is vestibular papillomatosis , which is characterised by fine, pink projections from either the epithelium of the vulva or from the labia minora. Dermatoscopy can distinguish this condition from genital warts. A subtype of psoriasis , an autoimmune disease ,

4312-570: Is chronic pain in the vulvar region. There is no single identifiable cause. A subtype of this is vulvar vestibulitis but since this is not thought to be an inflammatory condition it is more usually referred to as vestibulodynia . Vulvar vestibulitis usually affects pre-menopausal women. Pudendal nerve entrapment can cause sharp pain or numbness in the vulva. This condition can be caused by activities such as cycling , giving birth, or prolonged sitting. A number of skin disorders such as lichen sclerosus , and lichen simplex chronicus can affect

4466-578: Is common, the practice's many variants are reflected in dozens of terms, often alluding to purification. In the Bambara language , spoken mostly in Mali, it is known as bolokoli ("washing your hands") and in the Igbo language in eastern Nigeria as isa aru or iwu aru ("having your bath"). A common Arabic term for purification has the root t-h-r , used for male and female circumcision ( tahur and tahara ). It

4620-656: Is concentrated in northeastern Africa, particularly Djibouti, Eritrea, Somalia, and Sudan. In surveys in 2002–2006, 30 percent of cut girls in Djibouti, 38 percent in Eritrea, and 63 percent in Somalia had experienced Type III. There is also a high prevalence of infibulation among girls in Niger and Senegal, and in 2013 it was estimated that in Nigeria three percent of the 0–14 age group had been infibulated. The type of procedure

4774-406: Is formed by attaching a vocalic suffix -u , most often with a low tone (in the orthography, -w ) to nouns or adjectives. In urban areas, many Bamanankan conjunctions have been replaced in everyday use by French borrowings that often mark code-switches . The Bamako dialect makes use of sentences like: N taara Kita mais il n'y avait personne là-bas.  : I went to Kita [Bamanankan ] but there

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4928-625: 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 infections and

5082-430: Is known as labial fusion and is rarely found after puberty when estrogen production has increased. Puberty is the onset of the ability to reproduce, and takes place over two to three years, producing a number of changes. The structures of the vulva become proportionately larger and may become more pronounced. Pubarche , the first appearance of pubic hair develops, firstly on the labia majora, and later spreads to

5236-442: Is mostly asymptomatic but can present with small blisters that break open into ulcers . HIV/AIDS is mostly transmitted through sexual activity, and the vulva in some cases can be affected by sores. A highly contagious viral infection is molluscum contagiosum , which is transmissible on close contact and causes water warts . Parasitic infections include trichomoniasis , pediculosis pubis , and scabies . Trichomoniasis

5390-631: Is officially recognized in Mali. Additionally, a script known as Masaba or Ma-sa-ba was developed for the language beginning in 1930 by Woyo Couloubayi ( c.  1910 -1982) of Assatiémala . Named for the first characters in Couloubayi's preferred collation order, Masaba is a syllabary which uses diacritics to indicate vowel qualities such as tone , length , and nasalization . Though not conclusively demonstrated to be related to other writing systems, Masaba appears to draw on traditional Bambara iconography and shares some similarities with

5544-766: Is often linked to ethnicity. In Eritrea, for example, a survey in 2002 found that all Hedareb girls had been infibulated, compared with two percent of the Tigrinya , most of whom fell into the "cut, no flesh removed" category. FGM is mostly found in what Gerry Mackie called an "intriguingly contiguous" zone in Africa—east to west from Somalia to Senegal, and north to south from Egypt to Tanzania. Nationally representative figures are available for 27 countries in Africa, as well as Indonesia, Iraqi Kurdistan and Yemen. Over 200 million women and girls are thought to be living with FGM in those 30 countries. The highest concentrations among

5698-494: Is often tales of kings and heroes. This oral literature is mainly passed on by the griots ( Jeliw in Bambara) who are a mixture of storytellers , praise singers, and human history books who have studied the trade of singing and reciting for many years. Many of their songs are very old and are said to date back to the old empire of Mali. Each consonant represents a single sound with some exceptions: The basic sentence structure

5852-617: Is particularly common when using French words which have a meaning not traditionally found in Mali. For example, the Bamanankan word for snow is niegei , based on the French word for snow neige . As there has never been snow in Mali, there was no unique word in Bamanankan to describe it. N I bɛ AUX . positive bamanankan Bambara mɛn hear dɔɔni-dɔɔni small-small N bɛ bamanankan mɛn dɔɔni-dɔɔni I AUX. positive Bambara hear small-small I understand/hear

6006-400: Is produced in large quantities during pregnancy and this causes the vulva to become enlarged. The vaginal opening and the vagina are also enlarged. After childbirth , a vaginal discharge known as lochia is produced and continues for about ten days. During menopause , hormone levels decrease, which causes changes in the vulva known as vulvovaginal atrophy . The decreased estrogen affects

6160-479: Is removed; Type III is equivalent to the UNICEF category "sewn closed"; and Type IV describes miscellaneous procedures, including symbolic nicking. Type I is "partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans)". Type Ia involves removal of

6314-401: Is satisfactory or whether more is to be cut off. After the clitoris has been satisfactorily amputated ... 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

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6468-411: 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. ... 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

6622-400: Is the center of heightened sensation. Cavernous nerves from the uterovaginal plexus supply the erectile tissue of the clitoris. These are joined underneath the pubic arch by the dorsal nerve of the clitoris. The pudendal nerve enters the pelvis through the lesser sciatic foramen and continues medial to the internal pudendal artery. The point where the nerve circles the ischial spine

6776-417: Is the location where a pudendal block of local anesthetic can be administered to inhibit sensation to the vulva. A number of smaller nerves split off from the pudendal nerve. The deep branch of the perineal nerve supplies the muscles of the perineum and a branch of this supplies the bulb of the vestibule. There is a great deal of variation in the appearance of the vulva. Much of this variation lies in

6930-415: Is transmitted by a parasitic protozoan and is the most common non-viral STI. Most cases are asymptomatic but may present symptoms of irritation and a discharge of unusual odor . Pediculosis pubis , commonly called crabs , is a disease caused by the crab louse an ectoparasite . When the pubic hair is infested, the irritation produced can be intense. Scabies , also known as the "seven year itch",

7084-404: Is used specifically for females. The labia minora are the small inner pair of skin folds that protect the openings. The large outer pair of folds are the labia majora , which contain and protect the labia minora and other structures of the vulva. The labia majora meet at the front of the mons pubis, and meet posteriorly at the urogenital triangle (the anterior part of the perineum ) below

7238-551: Is usually initiated and carried out by women, who see it as a source of honour, and who fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion . Adverse health effects depend on the type of procedure; they can include recurrent infections, difficulty urinating and passing menstrual flow, chronic pain , the development of cysts , an inability to get pregnant, complications during childbirth, and fatal bleeding. There are no known health benefits. There have been international efforts since

7392-408: Is via the external and internal pudendal veins . The organs and tissues of the vulva are drained by a chain of superficial inguinal lymph nodes located along the blood vessels . The ilioinguinal nerve originates from the first lumbar nerve and gives branches that include the anterior labial nerves , which supply the skin of the mons pubis and the labia majora. The perineal nerve is one of

7546-464: The Kono people of Sierra Leone , who in 1992 underwent clitoridectomy as an adult during a Sande society initiation, argued in 2000 that it is a male-centred assumption that the clitoris is important to female sexuality. African female symbolism revolves instead around the concept of the womb. Infibulation draws on that idea of enclosure and fertility. "[G]enital cutting completes the social definition of

7700-524: The Latin script , using some additional phonetic characters from the Africa Alphabet . The vowels are a, e, ɛ (formerly è ) , i, o, ɔ (formerly ò ) , u ; accents can be used to indicate tonality. The former digraph ny is now written ɲ when it designates a palatal nasal; the ny spelling is kept for the combination of a nasal vowel with a subsequent oral palatal glide. Following

7854-574: The UNICEF , international FGM rates have risen significantly in recent years, rising from an estimated 200 million in 2016 to 230 million in 2024, with progress towards its abandonment stalling or reversing in many effected countries. Aid agencies define the prevalence of FGM as the percentage of the 15–49 age group that has experienced it. These figures are based on nationally representative household surveys known as Demographic and Health Surveys (DHS), developed by Macro International and funded mainly by

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8008-593: The United States Agency for International Development (USAID); and Multiple Indicator Cluster Surveys (MICS) conducted with financial and technical help from UNICEF. These surveys have been carried out in Africa, Asia, Latin America, and elsewhere roughly every five years since 1984 and 1995 respectively. The first to ask about FGM was the 1989–1990 DHS in northern Sudan. The first publication to estimate FGM prevalence based on DHS data (in seven countries)

8162-644: The Vai syllabary of Liberia and with Arabic-derived secret alphabets used in Hodh (now Hodh El Gharbi and Hodh Ech Chargui Regions of Mauritania ). As of 1978, Masaba was in limited use in several communities in Nioro Cercle for accounting, personal correspondence, and the recording of Muslim prayers; the script's current status and prevalence is unknown. It uses seven vowels a, e, ɛ, i, o, ɔ and u, each of which can be nasalized, pharyngealized and murmured, giving

8316-410: The anus . The labia minora are often pink or brownish black, relevant to the person's skin color. The grooves between the labia majora and minora are called the interlabial sulci , or interlabial folds. The labia minora meet posteriorly as the frenulum ( fourchette ). Located at the anterior junction of the labia minora is the clitoris , a highly erogenous sexual organ. The visible portions of

8470-420: The clitoral hood only. This is rarely performed alone. The more common procedure is Type Ib ( clitoridectomy ), the complete or partial removal of the clitoral glans (the visible tip of the clitoris) and clitoral hood. The circumciser pulls the clitoral glans with her thumb and index finger and cuts it off. Type II (excision) is the complete or partial removal of the inner labia , with or without removal of

8624-454: The inner labia (2-a); and removal of the inner and outer labia and closure of the vulva (type 3). In this last procedure, known as infibulation , a small hole is left for the passage of urine and menstrual fluid , the vagina is opened for intercourse and opened further for childbirth. The practice is rooted in gender inequality , attempts to control female sexuality , religious beliefs and ideas about purity, modesty, and beauty. It

8778-431: The pudendal nerve , perineal nerve , ilioinguinal nerve and their branches. Blood and nerve supply to the vulva contribute to the stages of sexual arousal that are helpful in the reproduction process. Following the development of the vulva, changes take place at birth, childhood , puberty , menopause and post-menopause. There is a great deal of variation in the appearance of the vulva, particularly in relation to

8932-400: The shaft engorged. The glans contains many nerve endings, which makes it highly sensitive. The only known function of the clitoris is to focus on sexual feelings. The clitoral hood is a protective fold of skin and it may partially or completely cover the shaft and glans. The hood may be partially or completely hidden within the pudendal cleft . The area between the labia minora where

9086-427: The urethra opening may still be obstructed by scar tissue. Vesicovaginal or rectovaginal fistulae can develop (holes that allow urine or faeces to seep into the vagina). This and other damage to the urethra and bladder can lead to infections and incontinence, pain during sexual intercourse and infertility . Painful periods are common because of the obstruction to the menstrual flow , and blood can stagnate in

9240-426: The vaginal introitus and the urinary meatus (openings of the vagina and urethra respectively) are located is the vestibule . The meatus is below the clitoris and atop the introitus. The introitus is sometimes partly covered by a membrane called the hymen . The hymen will usually rupture during the first episode of vigorous sex, and the blood produced by this rupture has been seen to signify virginity . However,

9394-708: The 15–49 age group are in Somalia (98 percent), Guinea (97 percent), Djibouti (93 percent), Egypt (91 percent), and Sierra Leone (90 percent). As of 2013, 27.2 million women had undergone FGM in Egypt, 23.8 million in Ethiopia, and 19.9 million in Nigeria. There is a high concentration in Indonesia, where according to UNICEF Type I (clitoridectomy) and Type IV (symbolic nicking) are practised; the Indonesian Ministry of Health and Indonesian Ulema Council both say

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9548-478: The 1966 Bamako spelling conventions, a velar nasal " ŋ " is written as " ŋ ", although in early publications it was often transcribed as ng or nk . The N'Ko ( N'Ko : ߒߞߏ ) alphabet is a script devised by Solomana Kante in 1949 as a writing system for the Manding languages of West Africa; N’Ko means 'I say' in all Manding languages. Kante created N’Ko in response to what he felt were beliefs that Africans were

9702-478: The 1970s by Betty Dodson , the sexual arousal of the woman during vaginal intercourse is to be ensured by the woman independently stimulating her clitoris continuously with her hands or possibly with a vibrator . According to Kim Wallen, the CUMD says nothing about a happy sex life, rather that a large gap gives couples an opportunity "to be a bit more inventive in how they have sex". Irritation and itching of

9856-466: The 1970s to persuade practitioners to abandon FGM, and it has been outlawed or restricted in most of the countries in which it occurs, although the laws are often poorly enforced. Since 2010, the United Nations has called upon healthcare providers to stop performing all forms of the procedure, including reinfibulation after childbirth and symbolic "nicking" of the clitoral hood. The opposition to

10010-572: The 1980s, FGM was widely known in English as "female circumcision", implying an equivalence in severity with male circumcision . From 1929 the Kenya Missionary Council referred to it as the sexual mutilation of women, following the lead of Marion Scott Stevenson , a Church of Scotland missionary. References to the practice as mutilation increased throughout the 1970s. In 1975 Rose Oldfield Hayes , an American anthropologist, used

10164-518: The African Khoikhoi and Rwanda cultures, the labia minora are purposefully stretched by repeated pulling on them and sometimes by attaching weights. Labia stretching is a recognised, familial cultural practice in parts of Eastern and Southern Africa. This is a desired and encouraged practice by the women (starting at puberty) in order to promote better sexual satisfaction for both parties. The achieved extensions can hang down below

10318-405: The CUMD was 2.5 cm; 21% measured 2.75 to 3.5 cm. All the women with a large gap stated that they did not experience satisfying pleasure from penile penetration, although some were very sensitive to "precise stroking by the man". Bonaparte concluded from this an anatomical causal connection between a large CUMD and "vaginal frigidity" explaining why only women with the clitoral glans close to

10472-977: The FGM status of all their living daughters. The highest concentrations among girls aged 0–14 were in Gambia (56 percent), Mauritania (54 percent), Indonesia (49 percent for 0–11) and Guinea (46 percent). The figures suggest that a girl was one third less likely in 2014 to undergo FGM than she was 30 years ago. According to a 2018 study published in BMJ Global Health , the prevalence within the 0–14 year old group fell in East Africa from 71.4 percent in 1995 to 8 percent in 2016; in North Africa from 57.7 percent in 1990 to 14.1 percent in 2015; and in West Africa from 73.6 percent in 1996 to 25.4 percent in 2017. If

10626-476: The French word for yellow, they often use joni .) However, one could also say: I ka kulosi ye nɛrɛmukuman ye , also meaning "your skirt is yellow." The original Bamanankan word for yellow comes from " nɛrɛmuku ," being flour ( muku ) made from néré (locust bean), a seed from a long seed pod. Nɛrɛmuku is often used in sauces in Southern Mali. Most French loan words are suffixed with the sound 'i'; this

10780-559: The Fulani in Chad, while in Nigeria the Fulani are the only large ethnic group in the country not to practise it. In Sierra Leone, the predominantly Christian Creole people are the only ethnicity not known to practice FGM or participate in Bondo society rituals. Kenyan FGM ceremony  — Stephanie Welsh, Newhouse News Service Dahabo Musa, a Somali woman, described infibulation in

10934-568: The Gambia . Manding is part of the larger Mandé family of languages. Bambara is spoken throughout Mali as a lingua franca. The language is most widely spoken in the areas east, south, and north of Bamako, where native speakers and/or those that identify as members of the Bambara ethnic group are most densely populated. These regions are also usually considered to be the historical geographical origin of Bambara people, particularly Ségou , after diverging from other Manding groups. The main dialect

11088-471: The WHO in 1995 included gishiri cutting and angurya cutting, found in Nigeria and Niger. These were removed from the WHO's 2008 definition because of insufficient information about prevalence and consequences. Angurya cutting is excision of the hymen , usually performed seven days after birth. Gishiri cutting involves cutting the vagina's front or back wall with a blade or penknife, performed in response to infertility, obstructed labour, and other conditions. In

11242-405: The canal is blocked off by a plate of tissue, the vaginal plate. This tissue develops and lengthens during the third to fifth months and the lower part of the vaginal canal is formed by a process of desquamation or cell shedding. The end of the vaginal canal is blocked off by an endodermal membrane, which separates the opening from the vestibule. In the fifth month, the membrane degenerates but leaves

11396-601: 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). Common short-term complications include swelling, excessive bleeding, pain, 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

11550-402: The child squats on a stool or mat while adults pull her legs open; a local anaesthetic is applied if available: 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

11704-426: The clitoral glans and outer labia . Type IIa is removal of the inner labia; Type IIb, removal of the clitoral glans and inner labia; and Type IIc, removal of the clitoral glans, inner and outer labia. Excision in French can refer to any form of FGM. — Swiss Medical Weekly Type III ( infibulation or pharaonic circumcision), the "sewn closed" category, is the removal of the external genitalia and fusion of

11858-402: The clitoris (Type IV), experience immediate complications, although the risks increased with Type III. The review also suggested that there was under-reporting. Other short-term complications include fatal bleeding, anaemia , urinary infection , septicaemia , tetanus , gangrene , necrotizing fasciitis (flesh-eating disease), and endometritis . It is not known how many girls and women die as

12012-438: The clitoris are the glans and frenulum . Typically, the glans is roughly the size and shape of a pea , and can vary in size from about 6 mm to 25 mm (less than an inch). The size can also vary when the clitoris is erect , which happens when two regions of erectile tissue known as the corpora cavernosa (along with the bulbs and crura , which both constitute the root of the clitoris) fill with blood , making

12166-595: The clitoris should not be cut. The prevalence rate for the 0–11 group in Indonesia is 49 percent (13.4 million). Smaller studies or anecdotal reports suggest that various types of FGM are also practised in various circumstances in Colombia , Jordan , Oman , Palestine , Saudi Arabia , Malaysia , the United Arab Emirates , India, and among Kurdish communities in Iran but there are no representative data on

12320-463: The clitoris. An infibulated girl may be left with an opening as small as 2–3 mm, which can cause prolonged, drop-by-drop urination , 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

12474-625: The countries for which national figures were available in 2000–2010, most girls had been cut by age five. Over 80 percent (of those cut) are cut before the age of five in Nigeria, Mali, Eritrea, Ghana and Mauritania. The 1997 Demographic and Health Survey in Yemen found that 76 percent of girls had been cut within two weeks of birth. The percentage is reversed in Somalia, Egypt, Chad, and the Central African Republic, where over 80 percent (of those cut) are cut between five and 14. Just as

12628-536: The country a national prevalence of eight percent. The practice is sometimes an ethnic marker, but it may differ along national lines. For example, in the northeastern regions of Ethiopia and Kenya, which share a border with Somalia, the Somali people practise FGM at around the same rate as they do in Somalia. But in Guinea all Fulani women responding to a survey in 2012 said they had experienced FGM, against 12 percent of

12782-579: 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. Studies on sexual function have also been small. 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. According to

12936-527: The current rate of decline continues, the number of girls cut will nevertheless continue to rise because of population growth, according to UNICEF in 2014; they estimate that the figure will increase from 3.6 million a year in 2013 to 4.1 million in 2050. Surveys have found FGM to be more common in rural areas, less common in most countries among girls from the wealthiest homes, and (except in Sudan and Somalia) less common in girls whose mothers had access to primary or secondary/higher education. In Somalia and Sudan

13090-483: The data. FGM's origins in northeastern Africa are pre-Islamic, but the practice became associated with Islam because of that religion's focus on female chastity and seclusion. According to a 2013 UNICEF report, in 18 African countries at least 10 percent of Muslim females had experienced FGM, and in 13 of those countries, the figure rose to 50–99 percent. Vulva In mammals , the vulva ( pl. : vulvas or vulvae ) comprises mostly external, visible structures of

13244-440: The development of the embryo , mesenchyme cells from the primitive streak migrate around the cloacal membrane . Early in the fifth week, the cells form two swellings called the cloacal folds. The cloacal folds meet in front of the cloacal membrane and form a raised area known as the genital tubercle . The urorectal septum fuses with the cloacal membrane to form the perineum . This division creates two areas one surrounded by

13398-412: The development of the secondary sex characteristics. This contributes to the maturation of the vulva with increases in the size of the mons pubis, and the labia majora and the enlargement of the labia minora. In pregnancy , the vulva and vagina take on a bluish coloring due to venous congestion. This appears between the eighth and twelfth week and continues to darken as the pregnancy continues. Estrogen

13552-497: The effort of penetrating an infibulation. The local preference for dry sex causes women to introduce substances into the vagina to reduce lubrication, including leaves, tree bark, toothpaste and Vicks menthol rub . The WHO includes this practice within Type IV FGM, because the added friction during intercourse can cause lacerations and increase the risk of infection. Because of the smooth appearance of an infibulated vulva, there

13706-415: The female genitalia leading into the interior of the female reproductive tract , starting at the vaginal opening . For humans, it includes the mons pubis , labia majora , labia minora , clitoris , vestibule , urinary meatus , vaginal introitus, hymen , and openings of the vestibular glands ( Bartholin's and Skene's ). The folds of the outer and inner labia provide a double layer of protection for

13860-425: The female, hormones stimulate further development and the genital tubercle bends and forms the clitoris. The urogenital sinus persists as the vulval vestibule, vestibular glands and urethra. The urethral folds form the labia minora and the labioscrotal swellings form the labia majora. The uterovaginal canal or genital canal, forms in the third month of the development of the urogenital system. The lower part of

14014-439: The fetus. Instead of being seen as a normal variant it is proposed that premature pubarche may be seen as a marker for these later endocrine disorders. Apocrine sweat glands secrete sweat into the pubic hair follicles. This is broken down by bacteria on the skin and produces an odor, which some consider to act as an attractant sex pheromone . The labia minora may grow more prominent and undergo changes in color. At puberty,

14168-420: The first monthly period known as menarche marks the onset of menstruation . In prepubertal girls, the skin of the vulva is thin and delicate, and its neutral pH makes it prone to irritation. The production of the female sex hormone estradiol (an estrogen ) at puberty, causes the perineal skin to thicken by keratinising , and this reduces the risk of infection. Estrogen also causes the laying down of fat in

14322-416: The following: (1) cut, no flesh removed (symbolic nicking); (2) cut, some flesh removed; (3) sewn closed; or (4) type not determined/unsure/doesn't know. The most common procedures fall within the "cut, some flesh removed" category and involve complete or partial removal of the clitoral glans. The World Health Organization (a UN agency) created a more detailed typology in 1997: Types I–II vary in how much tissue

14476-546: The foreskins or labia of slaves to prevent sexual intercourse. The surgical infibulation of women came to be known as pharaonic circumcision in Sudan and as Sudanese circumcision in Egypt . In Somalia , it is known simply as qodob ("to sew up"). The procedures are generally performed by a traditional cutter ( exciseuse ) in the girls' homes, with or without anaesthesia. The cutter is usually an older woman, but in communities where

14630-572: The genitals. Most STIs do not produce symptoms or symptoms may be mild and not be indicative of an STI. The practice of safe sex can greatly reduce the risk of infection from many sexually transmitted pathogens. The use of condoms (either male or female condoms ) is one of the most effective methods of protection. Bacterial infections include: chancroid – characterised by genital ulcers known as chancres ; granuloma inguinale showing as inflammatory granulomas often described as nodules; syphilis –the primary stage classically presents with

14784-490: The glans) is the human female's most sensitive erogenous zone and generally the primary anatomical source of human female sexual pleasure. Sexual stimulation of the clitoris (by a number of means) can result in widespread sexual arousal and, if maintained, can result in orgasm . Stimulation to vulvar orgasm is optimally achieved by a massaging sensation, such as oral sex ( cunnilingus ), fingering , and tribadism (two women rubbing vulvas together). Sexual arousal results in

14938-546: The grandmothers arranged a visit to relatives. Gerry Mackie has compared the practice to footbinding . Like FGM, footbinding was carried out on young girls, nearly universal where practised, tied to ideas about honour, chastity, and appropriate marriage, and "supported and transmitted" by women. FGM practitioners see the procedures as marking not only ethnic boundaries but also gender differences. According to this view, male circumcision defeminizes men while FGM demasculinizes women. Fuambai Ahmadu , an anthropologist and member of

15092-408: The harm presented by "the lawfulness of both female genital cosmetic surgeries and male circumcision" in the negation of FGM/C prevention campaigns. The participants, however, differed in their views on the ban of female genital cosmetic surgeries and regular vulvar checkups of female children. Standard questionnaires from United Nations bodies ask women whether they or their daughters have undergone

15246-434: 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. Type IV is "[a]ll other harmful procedures to the female genitalia for non-medical purposes", including pricking, piercing, incising, scraping and cauterization. It includes nicking of the clitoris (symbolic circumcision), burning or scarring the genitals, and introducing substances into

15400-403: The hymen may also rupture spontaneously during exercise or be stretched by normal activities such as the use of tampons and menstrual cups , or be so minor as to be unnoticeable, or be absent. In some rare cases, the hymen may completely cover the introitus, requiring a surgical procedure called a hymenotomy . Two greater vestibular glands known as Bartholin's glands open into either side of

15554-458: The idea that it may be more hygienic, or originating in prostitution and pornography. Hair removal may include all, most, or some of the hair. French waxing leaves a small amount of hair on either side of the labia or a strip directly above and in line with the pudendal cleft called a landing strip . Islam teaching includes Muslim hygienical jurisprudence a practice of which is the removal of pubic hair. Bambara language Bambara

15708-659: The insult back, the Zabarma girls would ask their mothers, "What's the matter? Don't we have razor blades like the Arabs?" Because of poor access to information, and because practitioners downplay the causal connection, women may not associate the health consequences with the procedure. Lala Baldé, president of a women's association in Medina Cherif, a village in Senegal, told Mackie in 1998 that when girls fell ill or died, it

15862-408: The introitus and secrete a mucous vaginal lubricant . The openings of the lesser vestibular glands, known as Skene's glands , are found on either side of the urethral meatus. Pelvic floor muscles help to support the vulvar structures. The voluntary, pubococcygeus muscle , part of the levator ani muscle partially constricts the vaginal opening. Other muscles of the urogenital triangle support

16016-478: The labia majora for up to seven inches. Children in the African diaspora practise this too, so it occurs within immigrant communities in, for example, Britain, where a BBC News report labelled it a hidden form of child abuse . The girls are subject to familial and social pressure to conform. In some cultures, including modern Western culture, women have shaved or otherwise removed the hair from part or all of

16170-412: The labia minora. The vulva can be affected by many disorders, which may often result in irritation . Vulvovaginal health measures can prevent many of these. Other disorders include a number of infections and cancers . There are several vulval restorative surgeries known as genitoplasties , and some of these are also used as cosmetic surgery procedures . Different cultures have held different views of

16324-702: The male barber has assumed the role of health worker, he will also perform FGM. When traditional cutters are involved, non-sterile devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks, and fingernails. According to a nurse in Uganda, quoted in 2007 in The Lancet , a cutter would use one knife on up to 30 girls at a time. In several countries, health professionals are involved; in Egypt, 77 percent of FGM procedures, and in Indonesia over 50 percent, were performed by medical professionals as of 2008 and 2016. The WHO, UNICEF, and UNFPA issued

16478-465: The mons pubis, and sometimes to the inner thighs and perineum. Pubic hair is much coarser than other body hair, and is considered a secondary sex characteristic . Pubarche can occur independently of puberty. Premature pubarche may sometimes indicate a later metabolic - endocrine disorder seen at adolescence. The disorder sometimes known as a polyendocrine disorder is marked by elevated levels of androgen , insulin , and lipids , and may originate in

16632-415: The mons, the labia, and the vaginal opening and can cause pale, itchy, and sore skin. Other visible changes are a thinning of the pubic hair, a loss of fat from the labia majora, a thinning of the labia minora, and a narrowing of the vaginal opening. This condition has been renamed by some bodies as the genitourinary syndrome of menopause as a more comprehensive term. The vulva has a major role to play in

16786-576: The more extensive FGM procedures. Infibulated women may try to make childbirth easier by eating less during pregnancy to reduce the baby's size. 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. Cervical evaluation during labour may be impeded and labour prolonged or obstructed. Third-degree laceration (tears), anal-sphincter damage and emergency caesarean section are more common in infibulated women. Neonatal mortality

16940-481: The most common variant of vulvar cancers and account for approximately 75%. These are usually found in the labia, particularly the labia majora. The second most common vulvar cancer is basal cell carcinoma , which rarely spreads to regional lymph nodes or distant organs. The third most common subtype is vulvar melanoma . Studies have shown that vulvar melanomas appear to have a different tumor biology and mutational characteristics compared to skin melanomas , which has

17094-421: The noun. The language has two (mid/standard and high) tones ; e.g. sa 'die' vs. sá 'snake.' The typical argument structure of the language consists of a subject, followed by an aspectival auxiliary, followed by the direct object, and finally a transitive verb. Bambara does not inflect for gender. Gender for a noun can be specified by adding a suffix, -cɛ or -kɛ for male and -muso for female. The plural

17248-462: The outer third of the vagina, as well as the uterus and anus. Contractions become less intense and more randomly spaced as the orgasm continues. The number of contractions that accompany an orgasm vary depending on its intensity. An orgasm may be accompanied by female ejaculation , causing liquid from the Skene's glands to be expelled through the urethra. The pooled blood begins to dissipate, although at

17402-404: The perineum) is sometimes performed to facilitate delivery and limit tearing. A tear takes longer to heal than an incision. Tears and incisions may be repaired using sutures that may be layered. Among the methods of hair removal evaluated for pre-surgeries, pubic hair shaving known as prepping , was seen to increase the risk of surgical site infections. No advantages have been demonstrated in

17556-419: The practice is not without its critics, particularly among anthropologists , who have raised questions about cultural relativism and the universality of human rights. According to the UNICEF, international FGM rates have risen significantly in recent years, from an estimated 200 million in 2016 to 230 million in 2024, with progress towards its abandonment stalling or reversing in many affected countries. Until

17710-401: The practice should continue. In several surveys since 2006, over 50 percent of women in Mali, Guinea, Sierra Leone, Somalia, the Gambia, and Egypt supported FGM's continuance, while elsewhere in Africa, Iraq, and Yemen most said it should end, although in several countries only by a narrow margin. Against the argument that women willingly choose FGM for their daughters, UNICEF calls the practice

17864-593: 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 excessive blood loss , as well as a need to resuscitate the baby, and stillbirth , perhaps because of a long second stage of labour . 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 . Feelings of shame and betrayal can develop when women leave

18018-583: The prevalence in these countries. As of 2023, UNICEF reported that "The highest levels of support for FGM can be found in Mali, Sierra Leone, Guinea, the Gambia, Somalia, and Egypt, where more than half of the female population thinks the practice should continue". Prevalence figures for the 15–19 age group and younger show a downward trend. For example, Burkina Faso fell from 89 percent (1980) to 58 percent (2010); Egypt from 97 percent (1985) to 70 percent (2015); and Kenya from 41 percent (1984) to 11 percent (2014). Beginning in 2010, household surveys asked women about

18172-548: The remaining hole is too large in the view of the girl's family, the procedure is repeated. 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. 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. The woman is opened further for childbirth ( defibulation or deinfibulation ), and closed again afterwards ( reinfibulation ). Reinfibulation can involve cutting

18326-399: The reproductive system. It provides entry to, and protection for the uterus, and the right conditions in terms of warmth and moisture that aids in its sexual and reproductive functions. The vulva is richly innervated and provides pleasure when properly stimulated. The mons pubis provides cushioning against the pubic bone during intercourse. A number of different secretions are associated with

18480-443: The risks of these surgeries. They refer to the lack of data relevant to their safety and effectiveness and to the potential associated risks such as infection , altered sensation, dyspareunia , adhesions , and scarring . There is also a percentage of people seeking cosmetic surgery who may be suffering from body dysmorphic disorder and surgery in these cases can be counterproductive. In some cultural practices , particularly in

18634-728: The routine shaving of pubic hair prior to childbirth. Genitoplasties are plastic surgeries that can be carried out to repair, restore or alter vulvar tissues, particularly following damage caused by injury or cancer treatment . These procedures include vaginoplasty and vulvoplasty , which can also be performed as a cosmetic surgery . Other cosmetic surgeries to change the appearance of external structures include labiaplasties . Some of these procedures, vaginoplasties and vulvoplasties, are also carried out as sex reassignment surgeries . The use of cosmetic surgeries has been criticized by clinicians. The American College of Obstetricians and Gynecologists recommends that women be informed of

18788-481: The significant differences in the size, shape, and color of the labia minora. Though called the smaller lips, they can often be of considerable size and may protrude outside the labia majora. This variation has also been evidenced in a large display of 400 vulval casts called the Great Wall of Vagina created by Jamie McCartney to fill the lack of information of what a normal vulva looks like. The casts taken from

18942-413: The situation was reversed: in Somalia, the mothers' access to secondary/higher education was accompanied by a rise in prevalence of FGM in their daughters, and in Sudan, access to any education was accompanied by a rise. FGM is not invariably a rite of passage between childhood and adulthood but is often performed on much younger children. Girls are most commonly cut shortly after birth to age 15. In half

19096-444: 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. The amputated parts might be placed in

19250-408: 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. ... Those men who do manage to penetrate their wives do so often, or perhaps always, with

19404-832: The term female genital mutilation in the title of a paper in American Ethnologist , and four years later Fran Hosken called it mutilation in her influential The Hosken Report: Genital and Sexual Mutilation of Females . The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children began referring to it as female genital mutilation in 1990, and the World Health Organization (WHO) followed suit in 1991. Other English terms include female genital cutting (FGC) and female genital mutilation/cutting (FGM/C), preferred by those who work with practitioners. In countries where FGM

19558-415: The terminal branches of the pudendal nerve and this branches into the posterior labial nerves to supply the labia. The pudendal nerve branches include the dorsal nerve , which gives sensation to the clitoris. The clitoral glans is seen to be populated by a large number of small nerves, a number that decreases as the tissue changes towards the urethra. The density of nerves at the glans indicates that it

19712-407: The test subjects, there were women who, with a man they loved and desired, "felt the greatest pleasure at certain tender touches", but were nevertheless not sufficiently aroused during coitus. Bonaparte examined the distance between the clitoris and the vagina in 200 women. In 69% of the women, the CUMD was 1.25 to 2.25 cm, most of whom experienced the sexual act as satisfying. In 10% of the women,

19866-464: The time of diagnosis, which significantly impacts prognosis. Surgery (with or without removal of regional lymph nodes) is usually the primary treatment modality. Typically, a wide-local excision is performed, in which the tumor is excised including a safety-margin of healthy tissue to ensure its entire removal, which is confirmed by a pathologist. In more advanced disease, a (partial) vulvectomy may need to be performed in order to remove some or all of

20020-569: The tools to make their own decisions. In 1997, using the Tostan program, Malicounda Bambara in Senegal became the first village to abandon FGM. By August 2019, 8,800 communities in eight countries had pledged to abandon FGM and child marriage . Surveys have shown a widespread belief, particularly in Mali, Mauritania, Guinea, and Egypt, that FGM is a religious requirement. Gruenbaum has argued that practitioners may not distinguish between religion, tradition, and chastity, making it difficult to interpret

20174-678: The type of FGM is often linked to ethnicity, so is the mean age. In Kenya, for example, the Kisi cut around age 10 and the Kamba at 16. A country's national prevalence often reflects a high sub-national prevalence among certain ethnicities, rather than a widespread practice. In Iraq, for example, FGM is found mostly among the Kurds in Erbil (58 percent prevalence within age group 15–49, as of 2011), Sulaymaniyah (54 percent) and Kirkuk (20 percent), giving

20328-415: The urethral folds and the other by the anal folds. These areas become the urogenital triangle and the anal triangle. The area between the vulva and the anus is known as the clinical perineum. At the same time, a pair of swellings on either side of the urethral folds known as the genital swellings develop into the labioscrotal swellings . Sexual differentiation takes place, and at the end of week six in

20482-509: The vagina (so that it is continuously touched by the penis) were able to experience "the highest sexual pleasure" during coitus. A study by Carney Landis and colleagues in 1940 includes statements to this effect: "On the physical side orgasm capacity is related to clitoris-meatus distance". (Landis et al. 1940). In 2011, Kim Wallen and Elisabeth Lloyd reviewed Bonaparte's research and confirmed an inverse correlation between CUMD and orgasm through intercourse. In methods taught since

20636-405: The vagina (which leads to the uterus ). Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support. Blood supply to the vulva comes from the three pudendal arteries . The internal pudendal veins give drainage. Afferent lymph vessels carry lymph away from the vulva to the inguinal lymph nodes . The nerves that supply the vulva are

20790-456: The vagina again to restore the pinhole size of the first infibulation. This might be performed before marriage, and after childbirth, divorce and widowhood. Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the 1980s about sexual intercourse with Type III: 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

20944-471: The vagina and uterus. Complete obstruction of the vagina can result in hematocolpos and hematometra (where the vagina and uterus fill with menstrual blood). The swelling of the abdomen and lack of menstruation can resemble pregnancy. Asma El Dareer , a Sudanese physician, reported in 1979 that a girl in Sudan with this condition was killed by her family. FGM may place women at higher risk of problems during pregnancy and childbirth, which are more common with

21098-455: The vagina is a separate part of the anatomy, it has often been used synonymously with vulva. The human vulva is made up of the following: The mons pubis is a soft mound of fatty tissue in the pubic region covering the pubic bone . Mons pubis is Latin for "pubic mound" and is present in both sexes to act as a cushion during sexual intercourse , and is more pronounced in the female. The variant term mons veneris ('mound of Venus')

21252-444: The vagina to tighten it. Labia stretching is also categorized as Type IV. Common in southern and eastern Africa, the practice is supposed to enhance sexual pleasure for the man and add to the sense of a woman as a closed space. From the age of eight, girls are encouraged to stretch their inner labia using sticks and massage. Girls in Uganda are told they may have difficulty giving birth without stretched labia. A definition of FGM from

21406-417: The vagina. These are believed to act as pheromones . Their fatty acid composition, and consequently their odor changes in relation to the stages of the menstrual cycle . The clitoris and the labia minora are both the most erogenous areas of the vulva. The labia majora are also somewhat erogenous. Local stimulation can involve the clitoris, vagina and other perineal regions. The clitoris (especially

21560-476: The vaginal opening by about 30%. Clitoral erection takes place, which retracts the clitoral hood, causing the glans to appear. The labia majora have swollen from blood flow, and slightly separated, revealing a thick and engorged labia minora. The labia minora sometimes change considerably in color, going from pink to red in lighter skinned women who have not borne a child, or red to dark red in those who have. During orgasm, rhythmic muscle contractions occur in

21714-439: The vulva is called pruritus vulvae . This can be a symptom of many disorders, some of which may be determined by a patch test . The most common cause of irritation is thrush , a fungal infection. Vulvovaginal health measures can help to prevent many disorders including thrush. Infections of the vagina such as vaginosis and of the uterus may produce vaginal discharge , which can be an irritant when it comes into contact with

21868-513: The vulva, including urine (from the urethral opening during urination through control of the external sphincter muscle ), sweat (from the apocrine glands), menses (leaving from the vagina via the introitus), sebum (from the sebaceous glands ), alkaline fluid (from the Bartholin's glands), mucus (from the Skene's glands), vaginal lubrication from the vaginal wall and smegma . Smegma

22022-500: The vulva. Advanced-stage melanomas can be treated with checkpoint inhibitors . Labial fusion , also called labial adhesion , is the fusion of the labia minora. This affects a number of young girls and is not considered unduly problematic. The condition can usually be treated using creams , or it may right itself with the release of hormones at the onset of puberty. Clitoromegaly is an enlarged clitoris caused by either anabolic steroids or an intersex condition. Vulvodynia

22176-399: The vulva. Crohn's disease of the vulva is an uncommon form of metastatic Crohn's disease, which manifests as a skin condition showing as hypertrophic lesions or vulvar abscesses . Papillary hidradenomas are nodules that can ulcerate and are mostly found on the skin of the labia or of the interlabial folds. Another more complex ulcerative condition is hidradenitis suppurativa , which

22330-549: The vulva. Some ancient religions and societies have worshipped the vulva and revered the female as a goddess. Major traditions in Hinduism continue this. In Western societies, there has been a largely negative attitude typified by the medical terminology of pudenda membra , meaning parts to be ashamed of. There has been an artistic reaction to this in various attempts to bring about a more positive and natural outlook, such as work from British, American, and Japanese artists. While

22484-575: The vulva. When high-cut swimsuits became fashionable, women who wished to wear them would remove the hair on either side of their pubic triangles, to avoid exhibiting pubic hair . Other women prefer to retain their vulva hair. The removal of hair from the vulva is a fairly recent phenomenon in the United States, Canada, and Western Europe, usually in the form of bikini waxing or Brazilian waxing , but has been prevalent in many Eastern European and Middle Eastern cultures for centuries, usually due to

22638-422: The vulvar area and they include the transverse perineal muscles , the bulbospongiosus , and the ischiocavernosus muscles. The bulbospongiosus muscle decreases the vaginal opening. They play a role in the vaginal contractions of orgasm by causing the vestibular bulbs to contract. The tissues of the vulva are highly vascularised and blood supply is provided by the three pudendal arteries . Venous return

22792-448: The vulvar tissue. Inflammation as vaginitis , vulvovaginitis and vulvitis can result from this causing irritation and pain. Ingrown hairs resulting from pubic hair shaving can cause folliculitis where the hair follicle becomes infected; or give rise to an inflammatory response known as pseudofolliculitis pubis . A less common cause of irritation is genital lichen planus , another inflammatory disorder. A severe variant of this

22946-499: The women's confusion over which type of FGM they experienced, or even whether they experienced it. Studies have suggested that survey responses are unreliable. A 2003 study in Ghana found that in 1995 four percent said they had not undergone FGM, but in 2000 said they had, while 11 percent switched in the other direction. In Tanzania in 2005, 66 percent reported FGM, but a medical exam found that 73 percent had undergone it. In Sudan in 2006,

23100-452: The world) had been subjected to one or more types of FGM. Typically carried out by a traditional cutter using a blade, FGM is conducted from days after birth to puberty and beyond. In half of the countries for which national statistics are available, most girls are cut before the age of five. Procedures differ according to the country or ethnic group. They include removal of the clitoral hood (type 1-a) and clitoral glans (1-b); removal of

23254-521: The wound. The inner and/or outer labia are cut away, with or without removal of the clitoral glans. 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. According to UNFPA in 2010, 20 percent of women with FGM have been infibulated. In Somalia, according to Edna Adan Ismail ,

23408-498: Was attributed to evil spirits. When informed of the causal relationship between FGM and ill health, Mackie wrote, the women broke down and wept. He argued that surveys taken before and after this sharing of information would show very different levels of support for FGM. The American non-profit group Tostan , founded by Molly Melching in 1991, introduced community-empowerment programs in several countries that focus on local democracy, literacy, and education about healthcare, giving women

23562-478: Was no one there [French]. The sentence in Bamanankan alone would be Ń taara Kita nka mɔkɔ si tun tɛ yen. The French proposition "est-ce que" is also used in Bamanankan ;; however, it is pronounced more slowly and as three syllables, [ɛsikə] . Bamanankan uses many French loan words. For example, some people might say: I ka kurusi ye nere ye : "Your skirt is yellow" (using a derivation of jaune ,

23716-438: Was written by Dara Carr of Macro International in 1997. Questions the women are asked during the surveys include: "Was the genital area just nicked/cut without removing any flesh? Was any flesh (or something) removed from the genital area? Was your genital area sewn?" Most women report "cut, some flesh removed" (Types I and II). Type I is the most common form in Egypt, and in the southern parts of Nigeria. Type III (infibulation)

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