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Female Genital Mutilation

By Alicia R. Pekarsky, MD, Assistant Professor of Pediatrics, State University of New York Upstate Medical University, Upstate Golisano Children's Hospital

Female genital mutilation is ritual removal of part or all of the external genitals.

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

Female genital mutilation is practiced routinely in parts of Africa (usually northern or central Africa), where it is deeply ingrained in some cultures. Mutilation is also practiced in some parts of the Middle East. This practice is reportedly done because women who experience sexual pleasure are considered impossible to control, are shunned, and cannot be married.

The average age of girls who undergo mutilation is 7 years, and mutilation is 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, in very rare cases, only the fold of skin surrounding the clitoris (called the prepuce)

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

  • Infibulation: Removal of the clitoris and labia, usually followed by sewing the remaining tissue closed except for a small opening for menses and urine

  • 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)

Infibulation is the most extreme form, and the legs are often bound together for weeks afterward. Traditionally, infibulated females are cut open on their wedding night.

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 bleeding (hemorrhage) during childbirth. Psychologic problems may be severe.

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.