Reproductive Issues & Rights – Vocabulary Review

Female Genital Mutilation (FGM)

• Definition (WHO)- FGM encompasses all procedures involving partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

  • Type I (Clitoridectomy): Partial or total removal of the clitoris and/or the prepuce (clitoral hood).

  • Type II (Excision): Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora.

  • Type III (Infibulation): Narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes stitched, with or without removal of the clitoris (clitoridectomy) and labia minora.

  • Type IV: All other harmful procedures to the female genitalia for non-medical purposes, e.g., pricking, piercing, incising, scraping, and cauterizing the genital area.

• Purported cultural goals- FGM is a deeply rooted cultural practice often performed due to tradition, social pressure, and beliefs about purity, hygiene, and marriageability.

  • Preserve family “honor”: Believed to control female sexuality and ensure premarital virginity and marital fidelity.

  • Suppress female sexual activity: Aims to reduce libido and thus “enhance” male pleasure or prevent promiscuity.

  • Other justifications include aesthetic reasons, religious beliefs (though not endorsed by major religions), and rites of passage.

• Health consequences- FGM has severe immediate and long-term physical, psychological, and sexual health consequences.

  • Acute complications: Severe pain, shock, hemorrhage, tetanus, sepsis, urinary retention, open wounds, death.

  • Chronic complications: Chronic urinary tract infections (UTIs), pelvic infections leading to chronic pain, menstrual problems (dysmenorrhea, amenorrhea), infertility (due to pelvic infections and scarring), recurrent abscesses and cysts, nerve damage, painful intercourse (dyspareunia), obstetric complications (e.g., prolonged labor, postpartum hemorrhage, fetal distress, C-sections, perineal tears), formation of keloids or fibrotic tissue, and psychological trauma (anxiety, depression, PTSD).

• Legal status- Illegal in the United States: Federal laws prohibit FGM, and many states also have specific laws against it, alongside efforts to prevent cross-border procedures. Perpetrators can face significant penalties.

  • Still practiced in several other nations: Predominantly concentrated in 30 countries in Africa and the Middle East, as well as in some Asian and Latin American countries and among immigrant populations in Western countries. An estimated 200 million women and girls worldwide have undergone FGM (previously estimated at \approx 140 million).

  • Global efforts through the UN and WHO advocate for its abandonment, recognized as a violation of human rights.

Contraception

1. Fertility-Awareness Methods (FAM)

• Non-mechanical & non-hormonal; depends on precisely identifying and abstaining from intercourse during the fertile window of the menstrual cycle, which is typically about 6 days (the 5 days leading up to ovulation and the day of ovulation).

• Requirements- Accurate menstrual record-keeping: Requires diligent tracking of cycle length and dates.

  • Regular cycles: Most effective for individuals with consistent and predictable menstrual cycles. Irregular cycles significantly reduce effectiveness.

  • Male-partner cooperation: Both partners must be committed to abstinence or using barrier methods during the fertile window.

• Biology recap- Ovum released: An ovum is typically released approximately 14 days (varies from 12–16 days) before the start of the next menses.

  • Ovum lifespan: A released ovum (egg) remains viable for fertilization for a relatively short period, typically 6–24 hours, though some sources suggest it can be viable up to 3–4 days in optimal conditions, which is less common.

  • Sperm lifespan: Sperm can survive inside the female reproductive tract for 48–72 hours, and in fertile cervical mucus, their lifespan can extend up to 5 days (and sometimes up to 7 days under ideal conditions).

  • Indicators: FAM involves tracking physiological signs such as basal body temperature (BBT) changes (slight rise after ovulation), changes in cervical mucus consistency (becomes clear, stretchy, and slippery like raw egg white during fertile window), and cervical position changes.

• Modern aids: Over-the-counter ovulation predictor kits (OPKs) detect a surge in luteinizing hormone (LH) that precedes ovulation. Digital fertility monitors and smartphone apps are also available to help track cycles and symptoms, even affordable options like those found at “Dollar Tree” can assist in tracking. Some devices even measure core body temperature continuously.

2. Over-the-Counter (OTC) Barriers/Chemicals

• Sponges: Disposable, soft foam devices pre-saturated with spermicide. They are inserted into the vagina before intercourse, covering the cervix and releasing spermicide to kill sperm, and also act as a physical barrier. Effective for up to 24 hours.

• Spermicides (jellies, creams, foams, tablets, suppositories): Nonoxynol-9 is the most common active ingredient. These chemicals destroy sperm cell membranes, making them inactive. They must be inserted into the vagina shortly before intercourse and are often used in conjunction with other barrier methods like diaphragms for increased effectiveness. They offer no protection against STDs.

• Male condoms: Thin sheaths, usually made of latex or polyurethane, worn on the penis during intercourse to physically block sperm from entering the vagina. When used correctly and consistently, male condoms are highly effective at preventing pregnancy and are the only method that also significantly decreases the risk of sexually transmitted disease (STD) transmission (including HIV, gonorrhea, chlamydia, and syphilis) by creating a barrier. Proper use involves placing it on before any genital contact, leaving space at the tip for semen, and withdrawing soon after ejaculation.

• Female condoms: Nitrile or polyurethane pouches inserted into the vagina before intercourse. They cover the vaginal lining and part of the external genitalia, providing a barrier. Less commonly used than male condoms but also offer STD protection.

3. Prescription Methods

• Combined hormonal contraceptives: Contain synthetic estrogen and progestin. These include daily birth-control pills, transdermal patches (applied weekly), vaginal rings like NuvaRing® (inserted monthly), combined hormonal injections (not commonly available), and some types of intrauterine devices (IUDs).

  • Mechanism of action: Primarily inhibit ovulation by suppressing gonadotropin-releasing hormone (GnRH) from the hypothalamus, which then suppresses FSH and LH release from the pituitary, preventing follicular development and egg release. They also thicken cervical mucus, making it difficult for sperm to reach the egg, and thin the endometrial lining, making it less receptive to implantation.

• Progestin-only methods: Includes