Female Genital Mutilation

The female external genitals include the clitoris (a small bump on the female genitals that is sensitive to sexual stimulation), the labia (the fleshy folds or lips of tissue that enclose and protect the genital organs), and the hymen (a thin membrane that encircles the opening of the vagina).

Female genital mutilation is a traditional practice in some cultures in parts of Africa (usually northern or central Africa). Mutilation is also practiced 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:

• Clitoridectomy: Partial or total removal of the clitoris and/or the fold of skin surrounding the clitoris (called the prepuce or clitoral hood)

• Excision: Partial or total removal of the clitoris and the labia minora (small labia), with or without removal of the labia majora (large labia)

• 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 clitoris or clitoral hood

• 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)

Consequences of genital mutilation include bleeding and infection (including tetanus). Females who have been infibulated may possibly have recurring urinary and gynecologic infections and scarring. Females who become pregnant after mutilation may have severe injury to the external pelvic area or bleeding (hemorrhage) during childbirth. Psychologic problems may be severe.

Women who have undergone infibulation need to be cared for by a health care practitioner who is culturally sensitive. Sometimes women want or need a deinfibulation procedure, which is often done before engaging in sexual activity or before giving birth vaginally. Women should receive care from a specialist who is experienced with this procedure.