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Female Genital Mutilation

by Alicia R. Pekarsky, MD

Female genital mutilation is practiced routinely in parts of Africa (usually northern or central Africa), where it is deeply ingrained as part of some cultures. It is also done in some parts of the Middle East. It 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 yr, and mutilation is done without anesthesia. There are four main types of female genital mutilation defined by the WHO:

  • Type I: Clitoridectomy—Partial or total removal of the clitoris and, in very rare cases, only the fold of skin surrounding the clitoris (the prepuce)

  • Type II: Excision—Partial or total removal of the clitoris 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 to create a seal except for a small opening for menses and urine

  • 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)

With infibulation, the legs are often bound together for weeks afterward. Traditionally, infibulated females are cut open on their wedding night.

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 hemorrhage during childbirth. Psychologic sequelae 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.

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