Hesperian Health Guides
What to Do for Health Problems
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Heavy bleeding and shock
Heavy bleeding from a deep cut or tear can happen quickly and is very dangerous. If a girl loses too much blood, she can go into shock and die.
Warning signs of shock
(one or more of the following):
- severe thirst
- pale, cold, and damp skin
- weak and fast pulse (more than 100 beats per minute for a girl over 10, or over 140 beats per minute for a girl 2 to 10 years old.)
- fast breathing (more than 30 breaths per minute)
- confusion or loss of consciousness (fainting)
What to do:
- Get help immediately. Shock is an emergency.
- Press firmly on the bleeding spot right away. Use a clean, small cloth that will not soak up a lot of blood. Keep her lying down while you take her to get medical help.
- Help her drink as much as she can.
- If she is unconscious and you live far from health services, you may need to give her rectal fluids before taking her for help.
Signs of infection can begin any time during the first 2 weeks after the cutting.
If the cutting tool is not cleaned properly (disinfected) before and after each use, germs can cause a wound infection, tetanus, HIV, or hepatitis.
- of wound infection: fever, swelling in the genitals, pus or a bad smell from the wound, pain that gets worse.
- of tetanus: tight jaw, stiff neck and body muscles, difficulty swallowing and convulsions.
- of shock (see the list above).
- of an infection in the blood (sepsis): fever and other signs of infection, confusion and shock.
For signs of HIV or hepatitis, see the chapters on “HIV and AIDS”
and “Sexually Transmitted Infections and Other Infections of the Genitals.”
|Cutting is even more dangerous
for girls who have not had a
tetanus vaccination. All girls
should be vaccinated.
What to do for infection:
- Give an antibiotic, such as cephalexlin, dicloxacillin, or erythromycin.
- Keep watching for warning signs of tetanus, sepsis, and shock. If she has not yet had a tetanus vaccination, she should get one immediately.
- Give modern or plant medicines for pain.
- Keep the genitals very clean. Wash them with water that has been boiled and cooled and has a little salt in it.
Since female genital cutting often causes severe pain when a girl passes urine, some girls try to hold their urine back. This can cause infection and damage to the urine tubes, bladder, and kidneys.
Holding back urine frequently can cause stones to form in the bladder.
What to do:
More Informationbladder and kidney infection
- Run clean water over the genitals when passing urine. This makes the urine less acid, so it causes less pain. Drinking more liquids will also help.
- Pour water into a bucket or pan. The sound of the running water sometimes helps the person start to pass urine.
- Apply a damp towel soaked in warm water to the genitals. This may help relieve the pain.
- Watch for signs of bladder and kidney infection.
If a girl has not been able to pass urine for more than a day or night, and her lower belly feels tight and full over the bladder, it is an emergency. She must see a trained health worker immediately who can put a tube in the bladder to drain the urine. Do not give her more liquid to drink, because this will add pressure on her bladder and kidneys.
Problems with monthly bleeding
If the vaginal hole that is left after infibulation is too small, or if it is blocked by scarring inside the body, the flow of a girl’s monthly bleeding can be blocked. This can cause:
- very painful monthly bleeding.
- long monthly bleeding, lasting 10 to 15 days.
- no monthly bleeding because the vaginal opening is blocked and the blood cannot get out.
- trapped blood that can lead to serious pelvic inflammatory disease (PID) and scarring in the womb and tubes. This can cause infertility.
What to do:
- Apply a towel soaked in hot water to the lower abdomen to relieve pain. (Be careful not to burn the skin.)
- It may help to walk around and do light work or exercise.
If the problems are severe, the vaginal opening may need to be made larger. This should be done by a skilled health worker to prevent harm to the reproductive parts inside.
Problems with sexual relations and sexual health
All wounds must be healed completely before having sex
If a woman who has had her genitals cut has none of the health problems described in this chapter, she may be able to enjoy sex. But many women who have been cut, especially those who have been infibulated, find sex difficult.
In some communities, young women have their genitals cut and are married on the same day. Or a woman who has had her genitals cut at a young age may have her vaginal opening made larger just before first sex in marriage. If she is expected to have sex before the wound has healed, sex will be very painful and dangerous, and the wound may take longer to heal. Open wounds also increase her risk of catching HIV or sexually transmitted infections (STIs).
During sex, a woman may find it difficult to become aroused, since the clitoris has been cut off.
If you can encourage married couples to talk to one another, it will be easier for them to talk about how female genital cutting affects their sexual relations.
What to do for problems with sex:
A woman can talk with her partner about finding ways to become more sexually aroused, and explain that she may need more time to feel aroused. She can also talk about ways to make sex less painful. Having enough wetness (lubrication) can make sex safer and hurt less.
Problems with childbirth
Blocked births are more common in young girls whose bodies are not fully grown.
With some types of female genital cutting, there is a greater risk that the baby will have difficulty getting out of the vagina (blocked birth). If the hole left after infibulation is very small, it must be opened so the baby’s head can pass through. This is called ‘deinfibulation’ (see the following box on deinfibulation for more information). If the person who does the opening is not skilled, it can cause other complications.
Scarring from female genital cutting can also cause the genitals to tear more during childbirth, since scarred skin does not stretch easily. Heavy bleeding may result.
If a woman lives far from emergency services, having a baby at home may be dangerous—especially if she has been infibulated.
Some traditional midwives have had special training for helping women who have had their genitals cut have safe births, and for problems from infibulation.
What to do:
Plan in advance for childbirth. During the second half of pregnancy, a pregnant woman should try to see a trained midwife or other health worker trained in helping women who have had their genitals cut give birth. The midwife can tell her if there is a risk of complications, or if the vaginal opening should be made larger. If there are risks, a woman can make plans for getting medical care ahead of time.
Leaking urine and stool
During a blocked birth, the lining of the vagina, bladder or rectum can tear, causing urine or stool to leak out of the vagina.
If a couple has anal sex because the woman’s vaginal opening is too small, the anus may become stretched or torn. Stool may leak out of the anus.
Leaking urine and stool are terrible problems to live with. Many young women have been rejected by their partners because of the smell and because they cannot control the leaking. Seek medical help as soon as the problem is discovered.
Infection can cause scarring of the womb and tubes, which make it difficult for a woman to get pregnant. If you think there may be an infection caused by a sexually transmitted infection, see the chapter on “STIs and Other Infections of the Genitals.” If you think there are problems with scarring in the womb or tubes from blocked flow of monthly bleeding, see a trained health worker about making the opening larger.
Mental health problems
A girl who has had her genitals cut can become overwhelmed with fear, worry (anxiety), or sadness. When female genital cutting is done in front of women that a girl knows and trusts to protect her from harm, she may feel that she can no longer trust anyone. It is worse if the girl did not wish to have her genitals cut.
Chronic pain and suffering can cause other lasting mental health problems, such as deep sadness (depression), and feelings of helplessness and worthlessness. Sexual problems can also cause severe strain between a woman and her partner. A woman may feel she is unable to please him because the pain makes her afraid of sex.
What to do:
- Encourage her to talk about her feelings.
- If she seems withdrawn, distant, and unable to do daily activities, see trauma and helping women with reactions to trauma.