Type IV & FGM

Hymenotomies are incisions made to the hymen. In some communities, they are performed on girls for non-medical reasons. The practice should not be confused with hymenotomies performed surgically as treatment for women or girls with an unperforated hymen causing abdominal pain.

In Niger, the practice known as dangouria (Hausa language) or haabize (Zarma) involves two procedures.

1. Removal of the hymen from newborn girls, usually within 10 days of birth, when a small part of the hymen is visible outside the vulva. It is usually performed by traditional barbers, wanzam, or midwives, unguzoma, with a razor blade. 
2. The second procedure is performed on girls who marry before their bodies are fully mature, usually between the ages of 9 and 15, and consists of making an incision in the vaginal opening to facilitate sexual intercourse. (UNICEF, Ouedraogo, 2017).

A study of the links between angurya cuts and fistula in Niger showed that all cuts were not performed as a “passing of age ritual” (like other types of FGM), but as a preventive “treatment” for dyspareunia (painful sexual intercourse), lack of interest in or refusal to have sex, and female behaviour deemed culturally inappropriate by spouses, parents or in-laws. 

There is a belief in Niger that a girl can be born with a seed in her genitals (gurya translates as cottonseed) that can grow over time and lead to sexual dysfunction. The study found that it was practiced on women who were victims of child/forced marriages and who were experiencing non-consensual sex or physical/sexual violence from their husbands. (Ouedraogo, 2017)

FGM is widespread in Nigeria, with practices ranging from infibulation to excision to type IV cuts without removing flesh. Type IV genital mutilation includes Angurya and Gishiri cuts. Their inclusion in the definition of FGM by some States in 2008 and then by the country as a whole in 2013 led to an increase in the prevalence rate recorded compared to previous years. (DHS, 2013 and DHS, 2008).

Similar to the practice in Niger, Angurya cuts in Nigeria involve excision of the hymen (hymenotomy or scraping of the tissue surrounding the vaginal opening) when it is considered too thick. It is usually performed on babies soon after birth. It is believed that its practice will facilitate penetration when a husband and wife consummate their marriage, with the cultural understanding that a woman will not have premarital sex. (Obianwu, 2019) 

In Nigeria, this practice is more common among women from the Islamic community (54%), those from the Fulani and Hausa ethnic groups (87% each) and those living in the North-Western zone (84%). Women with no education (70%) and those in the poorest quantile (76%) are most likely to have had an angurya cut. (DHS, 2013)

Another type of FGM type IV practiced in Nigeria and Niger, the Gishiri cuts. They consist of an incision in the anterior or posterior vaginal wall using a razor blade or a penknife. 5% of women in Nigeria have undergone this procedure, mainly in the northwestern zone (DHS 2013). It is performed as a “therapeutic” operation to prevent a range of conditions including childbirth difficulties, infertility, amenorrhea (absence of menstruation), vulvar itching (Obianwu, 2019, Ouedraogou, 2017). 

“Among the Hausa of northern Nigeria, there is a cultural belief in a gynecological condition called gishiri. Gishiri is the Hausa word for “salt” and it refers to the common salt used in cooking, and to the chemical salts deposited at the bottoms of water jars as their contents evaporate. (…) The accumulation of “salt” in the vagina is thought to cause various ill-defined gynecological complaints.“ (Ouedraogo, 2017, p. 367) 

In Nigeria, the DHS also reports use of corrosive substances, an unclassified type of harmful female genital practice, which is most common among Catholic women and women in the Ijaw/Izon ethnic group. (DHS, 2013)