Hesperian Health Guides
What to Do for Health Problems
HealthWiki > Where Women Have No Doctor > Chapter 30: Female Genital Cutting > What to Do for Health Problems
Contents
Heavy bleeding and shock
Heavy bleeding from a deep cut or tear can happen quickly and is very dangerous. Someone who loses too much blood 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 someone over age 10, or more than 140 beats per minute for a child 2 to 10 years old)
- fast breathing (more than 30 breaths per minute)
- confusion or loss of consciousness (fainting)
TRANSPORT!
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 the person lying down while you take them to medical help.
- Help them drink as much as they can.
- If the person is unconscious and you live far from health services, give rectal fluids before going for help.
Infection
Signs of infection can begin any time during the first 2 weeks after the cutting.
If a cutting tool is not cleaned properly (sterile) before each use, germs can cause an infection such as tetanus, HIV, or hepatitis.
Signs:
- 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.
- of an infection in the blood (sepsis): fever and other signs of infection, confusion, and shock.
For signs of HIV or hepatitis, see Chapter 17, âHIVâ and Chapter 16, âSexually Transmitted Infections.â
TRANSPORT!
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| Cutting is even more dangerous for girls who have not had a tetanus vaccination. All children should be vaccinated |
What to do for infection:
- Give an antibiotic, such as cephalexlin, dicloxacillin, doxycycline, or erythromycin.
- Keep watching for warning signs of tetanus, sepsis, and shock. If they have not yet had a tetanus vaccination, they should get one immediately.
- Give modern or traditional 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.
More Information
bladder and kidney infectionUrine problems
Female genital cutting increases the chances a person will have frequent bladder or kidney infections. And because cutting often causes severe pain when passing urine, some girls try to hold their urine back, another cause of 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:
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- Run clean water over the genitals when passing urine. Drinking more liquids will also help. This makes the urine less acid, so it causes less pain.
- Pour water into a bucket or pan. The sound of running water sometimes helps the person start to pass urine.
TRANSPORT!
- Put a towel soaked in warm water on the genitals to lessen 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. Go to a trained health worker immediately who can put a tube (a catheter) into the bladder to drain the urine. Do not give her more liquid to drink, because this will put more pressure on the bladder and kidneys.
Problems with menstrual periods
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 menstrual bleeding can be blocked. This can cause:
- very painful menstrual periods.
- long periods, lasting 10 to 15 days.
- no menstrual bleeding because the vaginal opening is blocked and the blood cannot get out.
- trapped blood that can lead to pelvic inflammatory disease (PID) and scarring in the womb and tubes. This can cause infertility.
What to do:
- Put a towel soaked in hot water on the lower abdomen to relieve pain. (Not so hot as 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 sex and sexual health
If someone who has had their genitals cut has none of the health problems described in this chapter, they may be able to enjoy sex. But many women who have been cut, especially those who have been infibulated, find sex difficult.
All wounds should be completely healed before having sex.
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 the first time she has penis-in-vagina 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 getting HIV and other sexually transmitted infections (STIs).
During sex, a person who has had their clitoris removed may find it difficult to feel pleasure and become aroused.
Encourage couples to talk about how female genital cutting affects having sex together.
What to do for problems with sex:
You can talk with your partner about finding ways to become more sexually aroused, and you can explain that you may need more time to get sexually excited.
Also talk about ways to make sex less painful. Having enough wetness (lubrication) can make sex safer and hurt less.
Problems with birth
Blocked births are more common in young bodies that 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 babyâs head can pass through. This is called âdeinfibulationâ (see the box below). 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 birth, since scarred skin does not stretch easily. Heavy bleeding may result.
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If someone lives far from emergency services, having a baby at home may be dangerousâ especially if they have 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 birth. By the second half of pregnancy, try to see a trained midwife or other health worker trained in helping those who have had their genitals cut give birth. The midwife can tell you what the risks are of complications or if the vaginal opening should be made larger. If there are risks, make plans ahead of time to have skilled help during the birth.
Emergency:
If someone who has been infibulated is giving birth and the baby will not come out (a blocked birth), the scars must be cut so the baby can be born. If possible, this should be done by a trained health worker. But if there is no health worker nearby, wash your hands well with soap and clean water before you begin, and wear clean rubber or plastic gloves or bags on your hands. The cutting tool must be cleaned and sterilized first. If you have to cut someone, get them to a health worker who knows how to repair the cut right after the birth.
hole
To cut the scars open (deinfibulation):
- Put 1 or 2 fingers under the band of scar tissue.
- Inject local anesthesia if you know how.
- Cut the old scar open by snipping the bands of scar tissue until you can see the urine hole. The vagina will probably now stretch enough to let the baby come out.
- After birth, the opening will need repair. This is a good time to explain that it would be safer not to be infibulated againâit will cause more scarring and can block the urine tube and vagina. A trained health worker can repair the genitals without closing the opening.
- To prevent infection, give erythromycin, 500 mg 4 times a day for 7 days.
Leaking urine and stool
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During a blocked birth, the vagina, bladder, or rectum can be injured, forming a fistula and causing urine or stool to leak out of the vagina.
Leaking urine and stool are terrible problems to live with. Many 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.
Infertility
More Information
infertilityInfection can cause scarring of the womb and tubes, which make it difficult to get pregnant. If you think there are problems with scarring in the womb or tubes from blocked flow of menstrual blood, see a trained health worker about making the vaginal opening larger.
Mental health problems
Someone who had female genital cutting done to them can become overwhelmed with pain, anxiety, sadness, or anger. When done in the presence of trusted family or others, it may destroy the ability to ever trust anyone. It can be worse if someone is cut against their will or with no preparation.
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Chronic (ongoing) pain and suffering can cause other lasting mental health problems, such as deep sadness, flashbacks, feelings of helplessness and worthlessness, and isolation. Pain with sex and other problems can also cause severe strain between partners.
What to do:
- Encourage the person to talk about how they feel.
- If someone seems withdrawn and unable to do daily activities, see ways to help.
The medicalization of female genital cutting
Doctors and nurses who serve immigrants from places where female genital cutting happens can earn a lot of money by continuing this harmful practice in the cities or new countries where people have settled. Because they have medical education and access to safe tools and medicines, they claim no one will die or be injured by the cutting. But there is no medical reason for this practice, and these people still harm the bodies and minds of those they cut. Health workers should not participate in female genital cutting.