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Harmful Traditional Vaginal Practices Worldwide: An Overview

Many societies and cultures worldwide have significant traditional practices that alter or modify women's vaginas. These practices are often harmful, pose health risks and violate girls' and women's rights. Traditional vaginal practices play a significant role in many societies and cultures worldwide. Many of these practices are harmful, posing health risks and violating women's human rights. Putting a stop to these practices demands attention, analysis, and action on a global scale. Although some communities worldwide have made great strides in abandoning some practices, in many places, they remain entwined with local gender norms, sexual scripts, and standards of beauty and marriagability. The following are brief overviews of some of these harmful practices, including where they are practiced, their prevalence rates, and their consequences for individual and public health.

Female Genital Mutilation

Female genital mutilation (FGM), also called female genital cutting (FGC) or female circumcision (FC), refers to "the cutting and removal of tissues of genitalia of young girls to conform to social expectations."1 The process varies widely in how it is conducted, ranging from a symbolic nicking of the clitoris to removal of the entire clitoris, labia majora, and labia minora, as well as the partial closure of the vaginal opening.2 FGM is practiced for a variety of reasons including: to control women's sexuality; as an initiation into womanhood; for hygienic reasons because the natural vagina is believed to be dirty or unclean; and for health reasons based in the belief that FGM will increase fertility or child survival. In many countries, FGM is wrongly thought to be a religious requirement.3 FGM is a common practice in many communities in African (including Benin, Cameroon, Djibouti, Somalia, and Sudan) and Middle-Eastern countries (including Iraq, Jordan, Saudi Arabia, Syria, and Yemen).4 FGM prevalence among women ages 15-49 years of age in African countries varies from 5 percent in Niger (1998) to 99 percent in Guinea (1999).5 FGM prevalence in northeastern Africa (Egypt, Eritrea, Ethiopia, and northern Sudan) ranges from 80 to 97 percent, while that of eastern Africa (Kenya and Tanzania) ranges from 18 to 38 percent.6

Young women who undergo FGM can suffer from a number of medical consequences including-but not limited to-death, psychological distress, shock, hemorrhage, infection, excessive scarring, damage to perineum, prolapse,7 painful sex, infertility, obstructed labor, and difficult urination.8 Women's health advocates have long denounced FGM as violence against women, and more recently, the international community has recognized the practice violates women's human rights. Although there are no laws against FGM in most countries where it is prevalent, public campaigns by non-government agencies have attempted to raise awareness and pressure governments to make the practice illegal.9 According to Amnesty International, "a human rights perspective also sets FGM in the context of women's social and economic powerlessness. Recognizing that civil, political, social, economic and cultural rights are indivisible and interdependent is a crucial starting point for addressing the whole range of underlying factors behind the perpetuation of FGM."10

RESOURCES:

Reports/Books:

Erin Gruenbaum, The Female Circumcision Controversy: An Anthropological Perspective, 2001. Philadelphia, Pennsylvania : University of Pennsylvania Press.

P. Yoder, N. Abderrahim, & A. Zhuzhuni, DHS Comparative Reports 7- Female Genital Cutting in the Demographic and Health Surveys: A Critical and Comparative Analysis, 2004. Calverton, Maryland : ORC Macro.

Videos:

Female Circumcision: Beliefs and Misbeliefs: Filmed in Africa, this film shows FGM being performed in city streets and rural areas and features interviews with villagers about the social and religious meaning of FGM, and also profiles several educational efforts to abandon FGM. Published by the Inter African Committee (IAC), to order write to IAC, PO Box 3001, Addis Ababa, Ethiopia or visit IAC on-line at http://www.iac-ciaf.org/index.php?option=com_frontpage&Itemid=44.

Fire Eyes: Soraya Mire, a Somalian woman who's undergone FGM at thirteen, directs and writes this documentary exploring the socio-economic, psychological, and medical consequences of this ancient custom that affects more than 80 million women worldwide. Available to buy or rent on-line at http://www.filmakers.com/indivs/FireEyes.htm.

Websites:

Female Genital Mutilation- A Human Rights Information Pack
http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm

The Female Genital Mutilation Education and Networking Project
http://www.fgmnetwork.org/index.php

Virginity Testing

The age-old practice of virginity testing is undergoing a resurgence in several countries where it is thought to be a way to curb women's sexual activity, keep them "pure" until marriage, and prevent the spread of HIV.11 Although methods vary, a virginity test usually involves an examination to see if the hymen is intact, even though evidence has long shown that an intact hymen is not a good indicator of whether or not a girl has had sexual intercourse. Hymens can break in many ways-riding a bike or falling down, for example-and many girls are born without a hymen.12 In addition, many young women are survivors of sexual assault and rape, but these tests make no distinction between hymens broken due to consensual or non-consensual "sexual activity." Girls who "fail" a virginity test, regardless of the reason, face being ostracized by their communities and families.13

Widely practiced in Haiti, India, Malawi, South Africa, Swaziland, Turkey, Uganda, and Zimbabwe, these tests are frequently conducted in schools on girls as young as six.14 Nearly one million South African girls in the Kwa-Zulu Natal province underwent virginity tests between 1993 and 2001 alone, and there are reports that tens of thousands of girls undergo monthly examinations to prove their virginity in other rural South African communities.15 A traditional practice that violates internationally recognized human rights, virginity testing infringes on girls' right to privacy, constitutes gender discrimination, and violates the right to bodily integrity.16 In addition, the myth, common in some Southern and Eastern African communities, that having sex with a virgin will "cleanse" HIV-positive men put those who "pass" the virginity test at an added risk of being raped and contracting HIV.17

RESOURCES:

Reports/Books:

F. Scorgie, " Virginity Testing and the Politics of Sexual Responsibility: Implications for AIDS Intervention," African Studies, 61.1 (2002):55-76.

Edwidge Danticat, Breath, Eyes, Memory, 1994. New York, Soho Press.

Website:

Virginty Testing-Can It Be Done?
http://www.health24.com/sex/Contraception/1253-1266,32521.asp

Hymen Repair

Hymen repair, also referred to as hymenoplasty or hymenorraphy is a procedure in which remnants of the hymen are surgically attached in order to "restore a woman's virginity." In societies where females are condemned, ostracized, or even killed for having sexual intercourse before marriage, many women perceive this surgical procedure to be necessary for their social status and happiness18 despite the fact that many women are born without a hymen and that hymens may rupture from ways other than sexual intercourse.19 Hymen repair occurs most often in the Middle East, Latin America, and some African nations, and among immigrant communities in industrialized nations. Though illegal in most Arab nations, hymen repair is nonetheless common.20

RESOURCES:

Books/Reports:

Marjane Satrapi, Embroideries, 2005. New York : Pantheon Books.

Sara-Paterson Brown, " Commentary: Education About the Hymen is Needed," BMJ, 1998 ; 316:461, available at http://bmj.bmjjournals.com/cgi/content/full/316/7129/461.

13 Peter Kandela,, " Cairo : Egypt 's trade in Hymen Repair," The Lancet 347.9015 (June 1996), 1615

Amy Chozick, "U.S. Women Seek a Second First-time with Hymen Surgery," Pittsburgh Post-Gazette, December 15, 2005, available at http://www.post-gazette.com/pg/pp/05349/622923

Douching

Douching is washing or cleaning out the vagina with water or other mixtures of fluids. Douching is common among women in the United States, with approximately 20 to 40 percent of all women ages 15-44 douching regularly. Prevalence is extremely high among African-American women; 66 percent of African-American women douche regularly.21 Douching is also more common among in the southern United States and among Caucasian women of lower socio-economic status. Reasons for douching vary among ethnic groups, although most women do so to create a feeling of cleanliness and many have concerns that a bad odor would be detectable if they did not use douching products. Both Caucasian and African-American women report douching after menstruation. Additionally, African-American women are more likely than other groups to practice douching after sex, to treat minor infections or before gynecologic visits.22 Women also douche out of a concern that men will reject them if they have vaginal odor or their vaginas do not smell "clean" or "fresh." Despite the large amount of douching products marketed to African-American women, research suggests that the media has little influence and instead douching practices are largely due to the influence of mothers and other female relatives. Lower class Caucasian women, however, cite the media as being a big influence on their belief that douching is a normal and necessary part of feminine hygiene.23 Public health experts agree that douching is not only unnecessary- vaginas are naturally "self-cleaning"-but potentially harmful. Douching changes the balance of natural bacteria in the vagina, making a woman more prone to vaginal infections and can spread existing vaginal infections up into the uterus, ovaries, and fallopian tubes.24 Douching is also linked to ectopic pregnancies, vaginal irritation, pelvic inflammatory disease, and makes women more prone to acquiring sexually transmitted infections and HIV.25 In fact, some experts state that the disproportionate use of douching among African-American women has lead to higher rates of ectopic pregnancies and bacterial infections among African-American women than among the general population.26

RESOURCES:

Reports/Articles:

Jenny L. Martino and Sten H. Vermund, " Vaginal Douching: Evidence for Risks or Benefits to Women's Health," Epidemiologic Reviews, 24:109-124 (2002).

Laura Jones, "Douching Is Bad for You," The Body (September/October 2000), available at http://www.thebody.com/tpan/septoct_00/douching.html.

Websites:

National Black Nurse's Association, Inc.
http://www.nbna.org/news/pap_reproduce.htm

U.S. Department of Health and Human Services, Womenshealth.gov
http://www.4woman.gov/faq/douching.htm

Vaginal Drying

Vaginal drying is the use of herbs and other substances in order to dry and tighten the vagina for "dry sex." Herbs, powders, cloth, commercial products, or ground stones are inserted in the vagina either on a regular basis or before sexual intercourse. Men in cultures where this is practiced have expressed that they find dry sex more pleasurable and have also reported that they dislike vaginal fluids and believe them to be unclean27 Dry sex practices are identified in Cameroon, Costa Rica, Haiti, Indonesia, Kenya, Malaysia, Malawi, Nigeria, Saudi Arabia, Senegal, South Africa, Zaire, Zambia, and Zimbabwe. Little is known about the prevalence of vaginal drying in these countries, but in communities where it exists, rates appear to be high. In Zimbabwe, for example, 93% of health clinic attendees and 80% of nurses had used a vaginal drying agent at least once.28 In South Africa, 80% of sex workers in Kwazulu Natal practice dry sex.29 Consequences of vaginal drying include increased risk of acquiring sexually transmitted infections and HIV due to genital irritation and inflammation.30

RESOURCES:

Reports:

Karen E. Kun, " Vaginal Drying Agents and HIV Transmission," International Family Planning Perspectives, Volume 24, Number 2, June 1998.

Ray, S. et al, " Local Voices: What Some Harere Men Say About Preparation for Sex," Reproductive Health Matters, Volume 7:34-45 (May 1996).

Website:

Harmful Health Practices: Overview and Lessons Learned
http://www.rho.org/html/hthps_overview.htm#drysex

References

1. E. Gruenbaum, The Female Circumcision Controversy: An anthropological perspective (Philadelphia : University of Pennsylvania Press, 2001), 2.
2. P. Stanley Yoder, Noureddine Abderrahim, and Arlinda Zhuzhuni, DHS Comparative Reports 7- Female Genital Cutting in the Demographic and Health Surveys: A Critical and Comparative Analysis (Calverton, Maryland: ORC Macro, 2004), ix.
3. Child Protection from Violence, Exploitation and Abuse: Female Genital Mutilation, UNICEF, accessed 14 Aug 2006, <http://www.unicef.org/protection/index_genitalmutilation.html>
4. Ibid.
5. Ibid.
6. Ibid.
7. Prolapse occurs when the uterus falls or slides from its normal position in the pelvic cavity down into the vaginal canal, a dropped uterus.
8. Zhuzhuni, DHS Comparative Reports, 10-12.
9. Female Genital Mutilation in Africa : Info by Country (2004), Amnesty International, accessed 14 Aug 2006, <http://www.amnesty.org/ailib/intcam/femgen/fgm9.htm>
10. Female Genital Mutilation: A Human Rights Issue (2004), Amnesty International, accessed 26 June 2006, <http://www.amnesty.org/ailib/intcam/femgen/fgm4.htm>.
11. Women and Global Human Rights- Virginity Testing, Webster University, accessed 5 April 2006, <http://www.webster.edu/~woolflm/virginitytest.html>.
12. Ibid.
13. Stanley Karombo, Virginity Testing Strips Girls of Their Dignity, Inter Press Service Agency, Rights-Zimbabwe (17 February 2004), accessed 6 April 2006 <http://www.ipsnews.net/interna.asp?idnews=22451%20>.
14. Noreen Ramsden, Against Virginity Testing, Children First (November 2000), accessed 6 April 2006, <http://www.childrenfirst.org.za/shownews?mode=content&id=18630&refto=3457>.
15. Betsy Illingworth, The Dangers of Virginity Tests, Planned Parenthood Federation of America, Inc. (24 August 2005), accessed 6 April 2006, <http://www.plannedparenthood.org/pp2/portal/files/
    portal/webzine/globaldispatch/gd-050824-virginity.tests.xml>
16. Virginity Testing: Increasing Health Risks and Violating Human Rights in the Name of HIV-Prevention, SIECUS (September 2004), <http://www.siecus.org/policy/PUpdates/arch04/arch040127.html#VIR>
17. Kathombi Kinoti, Virginity Testing and the War Against AIDS, AWID (24 August 2005), accessed 6 April 2006, <http://www.awid.org/go.php?stid=1515>.
18. Peter Kandela,, Cairo : Egypt 's trade in Hymen Repair, The Lancet 347.9015 (June 1996), 1615.
19. Ibid, Women and Global Human Rights
20. Sara Paterson-Brown, Commentary: Education about the Hymen is Needed, BMJ (7 February 1998), accessed 3 May 2006, <http://bmj.bmjjournals.com/cgi/content/full/316/7129/461>.
21. NBNA Position Papers: Reproductive Health Education Campaign, National Black Nurses Association, Inc., accessed 6 April 2006, <http://www.nbna.org/news/pap_reproduce.htm>.
22. Bronwen Lichtenstein, Tonja Nansel, "Women's Douching Practices and Related Attitudes: Findings from Four Focus Groups," Women & Health 31.2/3 (2000): 117-131
23. Julie Gazmararian, F. Carol Bruce, Juliette Kendrick, Clare Grace, Sylvia Wynn, "Why Do Women Douche? Results from a Qualitative Study," Maternal and Child Health Journal, 5.3 (Sept 2001): 153-160
24. Douching, U.S. Department of Health & Human Services, The National Women's Health Information Center (December 2005), accessed 6 April 2006, http://www.4woman.gov/faq/douching.htm
25. Ibid; NBNA Position Papers
26. Hilary Beard, Don't Douche It !, accessed 26 June 2006, <http://www.niaonline.com/CDS_Templates/print_template/1,1018,2782,00.html>.
27. Harmful Traditional Health Practices, Reproductive Health Outlook, accessed 6 April 2006,
    <http://www.rho.org/html/hthps_overview.htm#drysex>
28. Ibid.
29. A. Baleta, "Concern voiced over 'dry sex' practices in South Africa," Lancet 352 (9136): 1292 (October, 1998).
30. Karen E. Kun, "Vaginal Drying Agents and HIV Transmission," Family Planning Perspectives 24.2 (June 1998): 93-94