Female Genital Mutilation

Female genital mutilation is a traditional practice in some cultures in parts of Africa (usually northern or central Africa). It is also done in some parts of the Middle East and in other areas of the world as well. In cultures where it is practiced, it is often regarded as providing benefits regarding female hygiene, fertility, and chastity and male sexual pleasure and may be required for marriageability. Female genital mutilation may be decreasing due to the influence of religious leaders who have spoken out against the practice and growing opposition in some communities.

The practice has many potential complications and no health benefits.

The average age of girls who undergo mutilation is 7 years, and mutilation is typically done without anesthesia.

There are four main types of female genital mutilation defined by the World Health Organization (WHO):

• Type I: Clitoridectomy—Partial or total removal of the clitoral glans (visible part of the clitoris) and/or the prepuce (the fold of skin surrounding the clitoris)

• Type II: Excision—Partial or total removal of the clitoral glans and the labia minora, with or without removal of the labia majora

• Type III: Infibulation—Narrowing of the vaginal opening by cutting and repositioning the labia minora or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce/clitoral hood and glans

• Type IV: Other—All other harmful procedures done to the female genitals for nonmedical purposes (such as pricking, piercing, carving [incising], scraping, and cauterizing the genital area)

(See also the WHO's Female genital mutilation fact sheet.)

Sequelae of genital mutilation may include operative or postoperative bleeding and infection (including tetanus). For infibulated females, recurrent urinary and/or gynecologic infection and scarring are possible. Females who become pregnant after female genital mutilation may have significant perineal lacerations or hemorrhage during childbirth. Psychologic sequelae may be severe.

Medical care for women who have undergone infibulation includes using a culturally sensitive approach and sometimes a deinfibulation procedure (1), preferably prior to initiating sexual activity or antenatally prior to vaginal delivery. Women should be referred to a specialist experienced with this care.