EVALUATION OF THE EFFECTS OF FEMALE GENITAL MUTILATION ON THE SEXUAL QUALITY OF LIFE OF WOMEN IN CAMEROON

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Female genital mutilation/cutting (FGM/C) represents a prevalent harmful traditional practice observed in numerous countries across Africa, the Middle East, and various other parts of the world (Sweileh, 2016). The World Health Organisation (WHO) has characterised it as “all procedures that lead to partial or complete excision of the external female genitalia or other forms of injury to the female genital organs for non-medical causes” (WHO, 2017). As noted by UNICEF (2020), despite the comprehensive prohibition of this practice, the incidence of FGM/C among women aged 15 to 49 was recorded at 92% (Mahmoud, 2017). This detrimental practice often serves as an attempt to regulate a girl's sexual life and diminish her sexual desire, promoting ideals of innocence, virginity, and fidelity (Mahmoud, 2017).

The World Health Organisation identifies four distinct categories of female genital mutilation/cutting (WHO, 2017). Type I: Clitoridectomy involves the partial or complete removal of the clitoris and/or the prepuce. Type II: Involves the excision, either partial or complete, of the clitoris and labia minora, which may occur with or without the removal of the labia majora. Type III: Infibulation involves the constriction of the vaginal opening, achieved through the excision and rearrangement of the labia minora and/or labia majora, which may occur with or without the excision of the clitoris. Type IV encompasses various detrimental practices involving the genitalia, including pricking, piercing, incising, scraping, and cauterisation.

The repercussions of FGM reach well beyond the immediate physical challenges, leaving enduring effects on the sexual quality of life for those impacted. The World Health Organisation (WHO) recognises FGM as a practice that leads to immediate health risks, including intense pain, infection, and haemorrhage, as well as enduring complications such as chronic pain, infertility, heightened risk of childbirth complications, and psychological trauma (WHO, 2021). The long-term consequences of this practice are significant, especially regarding sexual health. It can hinder sexual function, diminish sexual satisfaction, and lead to enduring sexual dysfunction.

The sexual quality of life pertains to a person's comprehensive contentment and wellness concerning sexual functioning, encompassing aspects such as sexual desire, arousal, orgasm, and overall sexual satisfaction. Studies indicate that women who have experienced FGM frequently report decreased sexual pleasure, discomfort during intercourse, and a waning interest in sexual activities, all of which lead to a diminished sexual quality of life (Berg et al., 2014) as referenced in Mahmoud, (2017). This holds significant importance in the realm of marriage and intimate relationships, as sexual dissatisfaction may result in strained connections, emotional turmoil, and psychological challenges. The World Health Organisation (2024) indicates that female genital mutilation adversely affects anatomical structures integral to female sexual function, consequently impacting women's sexual health and overall well-being. The excision or impairment of delicate genital tissue, particularly the clitoris, can significantly impact sexual sensitivity and result in various sexual difficulties. These may include diminished sexual desire and pleasure, discomfort during intercourse, challenges with penetration, reduced lubrication, and a lower frequency or complete absence of orgasm. The formation of scars, along with pain and the traumatic memories linked to the procedure, may contribute to these issues (WHO, 2024).

The psychological ramifications of FGM on a woman's sexual quality of life are significant and warrant careful consideration. A significant number of women who have experienced FGM express feelings of anxiety, depression, and post-traumatic stress disorder (PTSD) associated with their experiences (Vloeberghs et al., 2012) as referenced in Mahmoud, (2017). The interplay of these psychological factors exacerbates the adverse effects on sexual functioning, highlighting the essential influence of mental health on sexual desire and satisfaction. Moreover, societal norms and pressures related to sexuality in communities where FGM is practiced frequently result in women experiencing feelings of shame or hesitance in pursuing assistance for their sexual health issues.

In Cameroon, the practice of FGM is primarily observed in the northern and southwestern regions, where specific ethnic groups maintain it as a cultural tradition. Even with national legislation against FGM, its occurrence continues to be a pressing issue in these areas, largely due to deeply rooted cultural practices and insufficient understanding of its detrimental consequences (Biglu, 2018). The Cameroon Demographic and Health Survey (CDHS, 2018) indicates that the prevalence of FGM is notably higher in rural regions, where there is restricted access to education and healthcare services. This limitation poses significant challenges in efforts to combat the practice and mitigate its long-term repercussions. The various forms of FGM observed in Cameroon differ significantly, with certain types exhibiting greater severity than others. Type I (clitoridectomy) and Type II (excision) represent the predominant forms, each entailing the surgical removal of the clitoris and/or labia. The excision of these delicate tissues markedly diminishes a woman's capacity to attain sexual pleasure, given that these tissues play a crucial role in sexual arousal and orgasm (Pashaei et al., 2012) as referenced in Biglu, (2018). Women who have experienced more extreme variations of FGM, particularly Type III (infibulation), which involves the constriction of the vaginal opening through sealing, frequently encounter further complications, such as discomfort during sexual relations and challenges during the birthing process.

FGM/C is invariably traumatic and lacks any recognised health advantages (WHO, 2017; UNICEF, 2020). The complications can be categorized into physical, which may include bleeding, infection, or even death; psychological, encompassing anxiety and post-traumatic stress; and sexual issues (Kentenich, 2018; Momoh, 2022). The current body of research lacks clarity regarding the impact of FGM/C on sexual function and desire (Horita et al., 2022; Biglu, 2017; Reisel & Creighton, 2015). Numerous studies conducted in Africa have challenged the adverse impact of FGM on sexual quality of life. Nonetheless, there is a growing body of evidence indicating that FGM adversely affects sexual function, which seems reasonable considering the harm inflicted on a sexually sensitive organ like the clitoris (Reisel & Creighton, 2015). Berg and Denison performed a meta-analysis examining the sexual consequences of FGM/C, synthesising a total of 15 studies from seven countries (Berg & Denison, 2012) as referenced in Biglu (2017). The available studies exhibited considerable heterogeneity and differences in methodological quality. This research aims to assess the impact of FGM on the sexual quality of life among women in Cameroon.

1.2 Statement of the Problem

The practice of Female Genital Mutilation (FGM), which entails the partial or complete excision of the external female genitalia, carries significant consequences for the physical and mental health of women. This phenomenon is widely observed across diverse cultures and communities globally, especially in regions of Africa, such as Cameroon. In spite of worldwide initiatives aimed at eliminating FGM, it continues to be intricately woven into social and cultural practices, impacting millions of women and girls (World Health Organisation, 2020). In Cameroon, the occurrence of FGM exhibits considerable variation across various regions and ethnic communities, with estimates suggesting that around 25% of women have experienced this practice (United Nations Children’s Fund, 2016).

The impact of FGM on women's health is complex, involving various physical issues including chronic pain, infections, and complications during childbirth (El-Gibaly et al., 2002). Furthermore, the psychological consequences can be profound, resulting in disorders such as post-traumatic stress disorder, depression, and anxiety (Morris et al., 2014). Nonetheless, a significant yet insufficiently examined domain is the impact of FGM on the sexual quality of life (SQL) of women who have experienced this procedure.

The quality of one's sexual life includes multiple dimensions, such as sexual function, sexual satisfaction, and the overall state of sexual health. Studies show that women who have experienced FGM frequently face sexual dysfunction, which may present as pain during intercourse, reduced libido, and a decline in sexual pleasure (Hassan et al., 2017). Moreover, these concerns regarding sexual health may lead to difficulties in relationships, diminished self-worth, and an unfavourable perception of one's body (Roushdy et al., 2017). In Cameroon, the discourse on female sexuality and reproductive health is frequently clouded by stigma, and the difficulties encountered by women following FGM are intensified by cultural taboos and insufficient healthcare resources (Boulware et al., 2020).

Although there is an expanding collection of studies highlighting the detrimental impacts of FGM, a notable deficiency exists in research that specifically focusses on the SQL of women in Cameroon. The intricate cultural dynamics associated with FGM add layers of complexity to the discussion, as numerous women might experience societal pressure to adhere to expectations, even when it negatively impacts their sexual health. This situation prompts essential enquiries regarding the impact of FGM on women's sexual experiences and their overall quality of life. Furthermore, current research frequently neglects the interplay of various factors, including age, education, and socioeconomic status, which could further impact the SQL of women impacted by FGM (Satti et al., 2019). In the absence of a thorough understanding, efforts to enhance women's sexual health and overall quality of life in Cameroon may prove inadequate. This study seeks to address the existing gap by assessing the impact of FGM on the sexual quality of life among women in Cameroon.

1.3 Objectives of the study

The primary objective of this study is to critically evaluate the effects of Female Genital Mutilation (FGM) on the sexual quality of life (SQL) of women in Cameroon. Specific objectives of this study are to:

1. To assess the impact of Female Genital Mutilation on sexual function among women in Cameroon

2. To assess the impact of Female Genital Mutilation on sexual satisfaction among women in Cameroon

3. To assess the impact of Female Genital Mutilation on sexual health among women in Cameroon

4. To assess the psychological impact of FGM on sexual quality of life among women in Cameroon.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the impact of Female Genital Mutilation on sexual function among women in Cameroon?

      2. What is the impact of Female Genital Mutilation on sexual satisfaction among women in Cameroon?

      3. What is the impact of Female Genital Mutilation on sexual health among women in Cameroon?

      4. What is the psychological impact of FGM on sexual quality of life among women in Cameroon?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: Female Genital Mutilation has no significant impact on sexual function among women in Cameroon.

Ha: Female Genital Mutilation has a significant impact on sexual function among women in Cameroon.

1.6 Significance of the study

The research is of considerable relevance to a range of stakeholders, such as healthcare professionals, policymakers, advocates for women's rights, and the communities impacted by this practice.

The findings will serve as a valuable resource for those in positions of authority as they strive to formulate impactful strategies and legislation to eliminate FGM. The findings of this research can guide public health strategies and educational efforts aimed at understanding the cultural foundations of FGM while advocating for alternative practices that support women's health and rights. By comprehending the societal perspectives on FGM, decision-makers can develop focused strategies that align with community values and foster discussions regarding the detrimental effects of the practice.

The findings will be of significant importance to organisations and advocates dedicated to advancing women's rights in their fight against FGM. The research will yield empirical data that can strengthen advocacy initiatives, contributing to the elevation of awareness regarding the detrimental effects of FGM on women's health and sexual quality of life. By emphasising individual stories and firsthand experiences, the results can inspire community involvement and promote grassroots initiatives focused on transforming perceptions and actions related to FGM.

The study will also provide advantages to community members, encompassing families and local leaders. The study has the potential to ignite discussions regarding the health implications linked to FGM, prompting communities to reflect upon and question entrenched customs. The educational initiatives arising from this research can equip women and girls with essential knowledge regarding their bodies, encouraging informed decision-making and cultivating an atmosphere that prioritises women's health and independence.

This research will provide significant insights to the current understanding of the health consequences of FGM, especially concerning sexual quality of life. Comprehending the effects of FGM on women's sexual function, satisfaction, and overall well-being is crucial for those in the healthcare profession. This understanding will empower them to provide more knowledgeable care and customised interventions for women who have experienced FGM. Enhanced clinical guidelines and support frameworks have the potential to significantly elevate health outcomes and overall quality of life for these women.

Ultimately, the ramifications of this research reach far beyond the specific circumstances of Cameroon. The results could potentially provide a framework for analogous studies in other nations confronting the challenge of FGM. Through its contribution to the worldwide conversation surrounding women's health and rights, the study holds the potential to shape international policies and initiatives focused on eliminating detrimental practices and advancing gender equity.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate the effects of Female Genital Mutilation (FGM) on the sexual quality of life (SQL) of women in Cameroon. Empirically, the study will explore the impact of Female Genital Mutilation on sexual function among women in Cameroon, the impact of Female Genital Mutilation on sexual satisfaction among women in Cameroon, the impact of Female Genital Mutilation on sexual health among women in Cameroon and the psychological impact of FGM on sexual quality of life among women in Cameroon.

Geographically, the study will be carried out in Mayo-Louti Division, Cameroon

1.8 Limitations of the study

Throughout the investigation, the investigators meticulously examined the intrinsic limitations that exist within all human behaviours. A significant obstacle encountered was the insufficient depth of academic inquiry into the topic. An important aspect that influenced the situation was the scarcity of data concerning evaluation of the effects of Female Genital Mutilation (FGM) on the sexual quality of life (SQL) of women in Cameroon. In light of the undertaking, it proved to be quite challenging to locate the necessary materials, texts, or information and to systematically arrange the data, necessitating a considerable allocation of time and effort.

Furthermore, the conclusions drawn from the study may be limited by the relatively small sample size and the narrow focus of the research, which predominantly centres on Mayo-Louti Division, Cameroon. Consequently, the results of the study possess restricted practical significance, underscoring the necessity for additional investigation.

Furthermore, the individual faced considerable limitations stemming from financial restrictions. As an individual pursuing academic excellence with constrained financial means, they had to meticulously manage these limitations during their educational journey. The high transportation costs at the research site presented a considerable obstacle in fulfilling the financial commitments associated with travel expenses.

Furthermore, the individual had a busy agenda due to their academic commitments, which included attending lectures and engaging in various educational activities.

1.9 Definition of terms

Genitalia: Genitalia The male or female reproductive organs. The genitalia include internal and external structures. The female internal genitalia are the ovaries, Fallopian tubes, uterus, cervix, and vagina. The female external genitalia are the labia minora and majora (the vulva) and the clitoris

Mutilation: Mutilation is an act or instance of destroying, removing, or severely damaging a limb or other body part of a person or animal.

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