What is female genital cutting?

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Female genital mutilation or cutting (FGM/C), sometimes called female circumcision, is a cultural practice that involves cutting – or sometimes entirely removing – female genital organs for non-medical reasons and without any health benefit.

FGM/C is usually practiced on young girls between infancy and age 15. The World Health Organization estimates that over 200 million girls and women around the world have undergone FGM/C.

In many countries, FGM/C is illegal and considered a violation of human rights. Like many health organizations, the ISSM does not support female genital cutting. For more information, please see this ISSM public policy statement

The World Health Organization categorizes FGM/C into four types:

Type 1 – Clitoridectomy. The clitoris is partially or completely removed.
Type 2 – Excision. The labia minora (the inner folds of the vulva) are removed, along with part or all of the clitoris. The labia majora (outer folds) may also be removed.
Type 3 – Infibulation. The vaginal opening is partially covered with cut labia tissue or closed with stitches, leaving small openings for urine and menstrual blood to flow out. Sometimes, the clitoris is removed.
Type 4 – Related procedures may include piercing, cutting, scraping, pricking, or cauterizing the area.

How much genitalia is cut depends on local custom.

FGM/C is common in western, eastern, and northeastern Africa and some parts of Asia and the Middle East. Some immigrant communities in Europe, North America, and Australia also practice FGM/C.

In the United States, three-fifths of the women and girls who have either undergone FGM/C or are at risk for it live in eight states – California, Maryland, Minnesota, New Jersey, New York, Texas, Virginia, and Washington – according to a March 2019 report by Medscape Ob/Gyn.

Why is FGM/C done? In many cultures, it is a tradition. Many parents choose to have their daughters cut as a rite of passage that makes them more accepted by the community.

There are other reasons as well:

Sexual purity. Some cultures believe that FGM/C reduces a woman’s libido and helps to maintain her virginity, modesty, and purity.
Marriage. Girls may have better marriage prospects if they have been cut. In some countries, FGM/C is a requirement for marriage.
Reputation. A girl’s good reputation (and that of her family) may depend on her being cut.
Religion. Some FGM/C advocates claim that the practice is a religious rite, although no religion supports it.

Female genital cutting (FGM/C) can have serious complications. The procedure is often done with unsterilized equipment, such as scissors, knives, or razor blades. Many girls are not given anesthesia beforehand or pain medication afterward; hence the practice is extremely painful. Common risks are wound infection, tetanus, bleeding, hemorrhaging, shock, and sepsis (blood poisoning).

As the girls grow up, there can be long-term complications, such as infections, cysts, abscesses, and fistulas (abnormal openings between the urethra and vagina) as well as problems with urination, menstruation, and childbirth. Intercourse can be painful, and sexual satisfaction is often poor.

Girls who have had their vaginas stitched shut will need to have another procedure to open it when they’re ready for intercourse and childbearing. Infertility is another risk.

Babies born to women who have had FGM/C are at higher risk for low birth weight, infection, and stillbirth.

Psychological problems, such as depression, anxiety, body image issues and post-traumatic stress disorder (PTSD) are also possible.

Some girls die as a result of FGM/C.

In some cases, FGM/C procedures can be reversed.

Defibulation is a procedure that opens the vaginal opening in women who have had it covered or shut.

Clitoral reconstruction re-exposes part of the remaining of the clitoris. (Note: The clitoris is a larger organ than it seems, and only a small portion of it is visible.) This type of surgery is considered experimental.

Psychotherapy can help cut women improve their sexual quality of life and their chances to reach an orgasm.

Resources

International Society for Sexual Medicine

“Female Genital Cutting” (Public Policy Statement)

https://www.issm.info/who-we-are/public-policy/female-genital-cutting/

Medscape Ob/Gyn

Cassoobhoy, Arefa MD, MPH, et al.

“Under the Radar: Female Genital Mutilation in the United States”

(March 6, 2019)

https://www.medscape.com/viewarticle/909508

U.S. Department of Health & Human Services

Office on Women’s Health