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. 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. Mutilation may be limited to partial clitoral excision. Infibulation, the most extreme form, is removal of the clitoris and labia, usually followed by suturing the remaining tissue closed except for a 1- to 2-cm opening for menses and urine. 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 or gynecologic infection and scarring are possible; they have increased susceptibility to AIDS, and childbirth may result in fatal hemorrhage. 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.

Last full review/revision December 2009 by Ann S. Botash, MD