The guidelines were developed based on a systematic review of the best available evidence on health interventions for women living with FGM. The signals will go to the ovaries in females, and the testes in males. Puberty may be considered precocious if it starts before the age of 7 to 8 years in girls and before 9 years in boys. Having the support of family members and friends is very important at this time. In response, the ovaries and testes produce a range of hormones that stimulate growth and change in various parts of the body, including the reproductive organs, breasts, skin, muscles, bones, hair, and the brain. The breasts start to grow, often starting with a small and sometimes painful lump just below the nipple The hips widen, the waist becomes proportionally smaller, and extra fat will develop on the stomach and buttocks The arms, legs, hands, and feet may grow faster than other parts of the body. In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Both males and females have estradiol, but levels rise earlier in girls than in boys, and women have higher levels than men. More than 3 million girls are estimated to be at risk for FGM annually.
A blood test can reveal any hormonal problems. Religious leaders take varying positions with regard to FGM: This type of early puberty is thought to be a combination of genetics, environment, and individual factors, such as weight. Sometimes it has started as part of a wider religious or traditional revival movement. The voice box, or larynx, gets bigger, the muscles or vocal cords grow, and the voice will "break" or "crack," and eventually become deeper. Where FGM is a social convention social norm , the social pressure to conform to what others do and have been doing, as well as the need to be accepted socially and the fear of being rejected by the community, are strong motivations to perpetuate the practice. Psychological and social changes also take place. The most commonly cited reasons are: These are the changes that will lead to adulthood, and the ability to have children. Since , great efforts have been made to counteract FGM, through research, work within communities, and changes in public policy. If the emotional changes become too strong, a doctor may be able to provide medication or suggest lifestyle changes that can help, such as regular physical exercise to help reduce the effects of premenstrual tension PMT or premenstrual syndrome PMS. Cultural and social factors for performing FGM The reasons why female genital mutilations are performed vary from one region to another as well as over time, and include a mix of sociocultural factors within families and communities. Late puberty As children approach their early teens, puberty begins. Female development depends mostly on estrogen and estradiol. In , WHO together with 9 other United Nations partners, issued a statement on the elimination of FGM to support increased advocacy for its abandonment, called: Testosterone produces the changes related to virilization, or "becoming male," including a deeper voice, facial hair, and muscle development. The skin becomes more oily, and there will be more sweat, because the oil and sweat glands are growing. Involuntary erections can also occur at this time. FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male. Where it is believed that being cut increases marriageability, FGM is more likely to be carried out. Both boys and girls may need support at this time, for example, an older family member or a friend to talk to about the changes and how to manage them. This is because the oil and sweat glands are developing. FGM is often motivated by beliefs about what is considered acceptable sexual behaviour. WHO efforts to eliminate female genital mutilation focus on: Early puberty Research suggests that puberty is starting earlier now. When a vaginal opening is covered or narrowed type 3 , the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage extramarital sexual intercourse among women with this type of FGM. In , WHO published a "Global strategy to stop health care providers from performing female genital mutilation" in collaboration with other key UN agencies and international organizations.
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