What to Do for Health Problems 465
Emergency: If an infibulated girl or woman 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 disinfected first (see page 526). If you have to cut someone, get her to a health
worker who knows how to repair the cut right after the birth.
To cut the scars open (deinfibulation):
1. Put 1 or 2 fingers under the band of scar tissue.
2. Inject local anesthesia if you know how.
(use 1 or 2
3. Cut the old scar open by snipping the bands of scar
tissue until you can see the woman’s urine hole. The
vagina will probably now stretch enough to let the baby
4. After birth the opening will need repair. This might be a good
time to explain to the woman or girl that it would be safer not to be infibulated
again—it will cause more scarring and can block the urine tube and vagina. A
trained health worker can repair the genitals without closing the opening.
5. To prevent infection, give antibiotics: doxycycline, 100 mg 2 times a day for one day,
or erythromycin, 500 mg 4 times a day for 7 days.
Leaking urine and stool
During a blocked birth, the lining of the vagina, bladder
or rectum can tear, causing urine or stool to leak out of
If a couple has anal sex because the woman’s vaginal
opening is too small, the anus may become stretched or
torn. Stool may leak out of the anus.
Leaking urine and stool are terrible problems to live
with. Many young 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.
Infection can cause scarring of the womb and tubes,
which make it difficult for a woman to get pregnant. If you
think there may be an infection caused by a sexually transmitted
infection, see the chapter on “STIs and Other Infections of the
Genitals,” page 260. If you think there are problems with scarring
in the womb or tubes from blocked flow of monthly bleeding, see
a trained health worker about making the opening larger.
Where Women Have No Doctor 2012