Female Genital Mutilation (FGM): Types, Health Effects & Treatment

What Is Female Genital Mutilation (FGM)?

Female Genital Mutilation (FGM) refers to all procedures that intentionally alter or injure the female genital organs for non-medical reasons. The World Health Organization classifies FGM into four types, ranging from partial removal of the clitoris to narrowing of the vaginal opening. FGM has no health benefits and is recognized internationally as a human rights violation.

Female Genital Mutilation, sometimes also called female genital cutting or female circumcision, encompasses a range of procedures that deliberately harm the female genitalia without any medical justification. The practice is deeply rooted in cultural traditions and social norms in certain communities, but it is important to understand that it causes significant harm and violates the fundamental rights of girls and women.

According to the World Health Organization (WHO), FGM is defined as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons." This definition is crucial because it distinguishes FGM from medically necessary gynecological procedures. The key characteristic of FGM is that it serves no medical purpose - there are no health benefits, only potential for harm.

The consequences of FGM can be both immediate and long-lasting. Some women and girls experience severe complications during or shortly after the procedure, including excessive bleeding, severe pain, and infections. Long-term consequences can affect physical health, sexual function, mental health, and childbirth outcomes. However, it is also important to note that the physical impact varies significantly depending on the type and extent of FGM - some women may not have visible physical changes or significant physical symptoms, while still experiencing psychological effects.

Regardless of the type of FGM experienced, every woman deserves access to compassionate healthcare and support. Medical professionals are trained to provide non-judgmental care, and treatment options are available for many of the complications that can result from FGM.

Understanding the terminology

Various terms are used to describe this practice, and the choice of terminology can carry different implications. "Female Genital Mutilation" is the term most commonly used by health organizations and human rights bodies because it clearly communicates the harmful nature of the practice. Some communities prefer the term "female genital cutting" or use cultural terms in their own languages. Healthcare providers often use whatever terminology helps them communicate effectively and respectfully with their patients.

It is important to distinguish FGM from male circumcision, which is a different procedure with different medical and cultural considerations. FGM and male circumcision are not equivalent procedures and should not be compared directly.

What Are the Different Types of FGM?

The WHO classifies FGM into four types: Type 1 (clitoridectomy) involves partial or total removal of the clitoris; Type 2 (excision) removes the clitoris and inner labia; Type 3 (infibulation) narrows the vaginal opening by creating a seal; Type 4 includes all other harmful procedures. The severity and health consequences vary by type.

The World Health Organization has developed a classification system that divides FGM into four main types. This classification helps healthcare providers understand what procedures a patient may have undergone, which is important for providing appropriate medical care. However, it is worth noting that in practice, the procedures performed often do not fit neatly into these categories, and there can be significant variation within each type.

Understanding the different types is important not only for healthcare providers but also for women who have experienced FGM. Knowing which type of procedure you have undergone can help you understand potential health implications and communicate more effectively with healthcare providers. However, a medical examination is often necessary to accurately assess the extent of any anatomical changes.

Type 1: Clitoridectomy

Type 1 FGM involves the partial or total removal of the clitoris and/or the prepuce (the fold of skin surrounding the clitoris). The clitoris is a highly sensitive organ with thousands of nerve endings, and its removal or damage can significantly affect sexual sensation and pleasure. Some women with Type 1 FGM may experience reduced sexual sensation, while others may still be able to experience sexual pleasure.

The clitoris has both external and internal portions. Even when the external portion has been removed, internal clitoral tissue may remain, which is why some women who have undergone Type 1 FGM can still experience sexual pleasure and orgasm. The extent of the impact depends on how much tissue was removed and how the healing process occurred.

Type 2: Excision

Type 2 FGM involves the partial or total removal of the clitoris and the labia minora (the inner lips of the vulva), with or without removal of the labia majora (the outer lips). This type results in more extensive changes to the genital anatomy than Type 1 and can lead to more significant long-term complications.

Women who have undergone Type 2 FGM may experience complications including chronic pain, recurrent infections, difficulties with menstruation, and sexual dysfunction. The psychological impact can also be significant, as the visible changes to the body may affect body image and self-esteem. However, with appropriate medical care and support, many of these issues can be addressed.

Type 3: Infibulation

Type 3 FGM, also known as infibulation, is the most severe form. It involves narrowing the vaginal opening by creating a covering seal, formed by cutting and repositioning the labia minora or labia majora, sometimes through stitching, with or without removal of the clitoris. This leaves only a small opening for the passage of urine and menstrual blood.

Infibulation causes the most severe immediate and long-term health consequences. Women with Type 3 FGM often experience significant difficulties with urination, menstruation, sexual intercourse, and childbirth. The narrow opening can cause urine and menstrual blood to be retained, leading to chronic infections and pain. Sexual intercourse may be extremely painful or impossible without surgical intervention to open the sealed tissue (a procedure called deinfibulation).

Childbirth can be particularly dangerous for women with Type 3 FGM. The inelastic scar tissue cannot stretch as normal tissue would during delivery, which can lead to prolonged labor, severe tearing, excessive bleeding, and increased risk of complications for both mother and baby. For these reasons, deinfibulation before or during pregnancy is often recommended.

Type 4: Other harmful procedures

Type 4 includes all other harmful procedures performed on the female genitalia for non-medical purposes. This category encompasses a wide range of practices including pricking, piercing, incising, scraping, and cauterizing the genital area. While these procedures may not involve tissue removal, they still cause harm and carry risks of complications including infection and psychological trauma.

What Are the Health Effects of FGM?

FGM causes both immediate and long-term health consequences. Immediate risks include severe pain, excessive bleeding, shock, and infections. Long-term effects include chronic pain, recurrent infections, menstrual problems, sexual dysfunction, complications during childbirth, and psychological issues such as PTSD, anxiety, and depression.

Female Genital Mutilation can cause a wide range of health problems, both at the time of the procedure and throughout a woman's life. The severity and type of complications depend on several factors, including the type of FGM performed, the conditions under which it was done, the skill of the person performing it, and the individual's overall health. Understanding these potential health effects is important for both women who have experienced FGM and healthcare providers.

It is crucial to emphasize that not all women who have undergone FGM will experience all or even most of these complications. Some women may have minimal physical symptoms, while others may face significant health challenges. Whatever your experience, healthcare providers can help assess your individual situation and provide appropriate care.

Immediate complications

The immediate complications of FGM typically occur during or shortly after the procedure. These can be life-threatening, particularly when the procedure is performed in non-medical settings without proper sterile equipment or access to emergency care. Even when immediate complications are survived, they can set the stage for long-term health problems.

Severe pain is universal, as FGM is often performed without anesthesia. The genital area has numerous nerve endings, making any cutting or injury extremely painful. This pain can be traumatic and may contribute to long-term psychological effects. Excessive bleeding (hemorrhage) is another common immediate complication, which can occur because the genital area has a rich blood supply. Severe blood loss can lead to shock and can be fatal without prompt medical intervention.

Infection is a major risk, especially when unsterile instruments are used or when the same instrument is used on multiple girls. Infections can spread to the urinary tract, reproductive organs, and bloodstream (sepsis), which can be life-threatening. Tetanus is also a risk if instruments are contaminated. Other immediate complications include urinary retention due to pain, swelling, or fear of urinating on open wounds; damage to surrounding structures including the urethra, vagina, or rectum; and shock from blood loss, pain, or psychological trauma.

Long-term physical complications

Many women who have undergone FGM experience long-term physical health problems. These chronic conditions can significantly impact quality of life and may require ongoing medical care. Understanding these potential complications can help women recognize symptoms that should prompt a visit to a healthcare provider.

Chronic pain is common, particularly in the genital area. This may be constant or occur during specific activities such as urination, menstruation, or sexual intercourse. Scar tissue formation can contribute to pain and may also cause problems with urination or menstruation if it affects the urinary or vaginal openings.

Recurrent urinary tract infections and other infections are frequent complications. The altered anatomy may make it more difficult to properly clean the genital area, and in Type 3 FGM, the narrow opening may cause urine to be retained, creating an environment where bacteria can grow. Menstrual problems are also common, especially with Type 3 FGM. Blood may be unable to flow freely from the body, causing painful buildup, prolonged menstruation, or blood collecting inside the body.

Keloids (raised scars) and cysts may develop at the site of the FGM. These can be painful and may require surgical treatment. Cysts can form when glands are covered by scar tissue, preventing normal secretions from draining. These cysts can become infected or grow large enough to cause discomfort.

Sexual health effects

FGM can significantly affect sexual health and function. The removal of sensitive tissue, particularly the clitoris, can reduce or eliminate sexual sensation and the ability to experience sexual pleasure. Scar tissue may make sexual intercourse painful (dyspareunia), and in cases of infibulation, the narrow vaginal opening may make penetration difficult or impossible without surgical intervention.

However, it is important to note that sexual experience varies greatly among women who have undergone FGM. Some women are still able to experience sexual pleasure and orgasm, while others find sexual activity painful or unsatisfying. Open communication with a partner and, if needed, guidance from a healthcare provider or sexual health specialist can help address these issues.

Complications during pregnancy and childbirth

FGM, particularly Type 3, significantly increases the risks associated with pregnancy and childbirth. The inelastic scar tissue cannot stretch as normal tissue would during delivery, which can lead to a range of complications. Studies have shown that women with FGM have higher rates of cesarean section, postpartum hemorrhage, prolonged labor, and episiotomy (surgical cut to enlarge the vaginal opening during delivery).

For women with Type 3 FGM, deinfibulation (surgical opening of the sealed tissue) is often recommended either before becoming pregnant or during the antenatal period. This procedure can be done safely and can significantly reduce the risk of childbirth complications. It is important to discuss FGM with your prenatal healthcare provider early in pregnancy so that appropriate plans can be made.

The risks to the baby during delivery can also be increased, including higher rates of fetal distress and need for resuscitation. Proper prenatal care and delivery planning can help minimize these risks and ensure the best possible outcomes for both mother and baby.

Psychological effects

The psychological impact of FGM can be profound and long-lasting. Many women who have undergone FGM experience psychological symptoms including post-traumatic stress disorder (PTSD), anxiety, depression, and difficulties with body image and self-esteem. The traumatic nature of the experience, combined with the ongoing physical complications and the intimate nature of the affected body part, can create significant psychological distress.

Some women may have suppressed memories of the event, while others have vivid and distressing recollections. Feelings of betrayal, particularly if trusted family members arranged or performed the procedure, can complicate relationships and emotional healing. Cultural factors may also play a role - some women may feel conflicted between their cultural identity and the recognition that they have been harmed.

Psychological support and counseling can be extremely beneficial for women dealing with the emotional aftermath of FGM. Professional mental health providers with experience in trauma and cultural sensitivity can help women process their experiences and develop coping strategies. Support groups connecting women with others who have had similar experiences can also be valuable.

When and Where Should You Seek Medical Care?

Women who have experienced FGM should seek medical care if they have any physical symptoms such as pain, difficulty urinating, menstrual problems, or infections. Care is also available for those wishing to discuss treatment options, pregnancy planning, or psychological support. Healthcare providers are trained to provide compassionate, confidential, non-judgmental care.

If you have experienced FGM and have any health concerns - whether physical or emotional - you have every right to seek medical care. Many healthcare systems have developed specialized services for women affected by FGM, staffed by professionals who understand the unique needs of this population. Even if specialized services are not available in your area, general healthcare providers can help address your concerns.

Some women hesitate to seek care because they feel ashamed, fear being judged, or worry about how they will be treated. It is important to know that healthcare providers are trained to provide compassionate, non-judgmental care. Your medical information is confidential, and seeking care is a positive step toward protecting your health and wellbeing.

Reasons to seek medical care

There are many valid reasons to seek healthcare related to FGM. You may want to have a general health check and assessment to understand your anatomy and any potential health implications. If you are experiencing any symptoms such as chronic pain, difficulty or pain when urinating, recurrent infections, menstrual problems, or pain during sexual activity, medical evaluation and treatment are available.

If you are planning to become pregnant or are currently pregnant, it is important to discuss your FGM with your healthcare provider so that appropriate prenatal care and delivery planning can be arranged. If you have Type 3 FGM and are considering deinfibulation surgery, a healthcare provider can discuss the procedure, its benefits, and what to expect.

Emotional and psychological support is also a valid reason to seek care. If you are experiencing anxiety, depression, PTSD symptoms, or other psychological effects related to FGM, mental health professionals can provide effective treatment and support.

What to expect at a medical appointment

Many women feel anxious about medical appointments, especially gynecological examinations. Knowing what to expect can help reduce this anxiety. Healthcare providers who work with women affected by FGM are trained to be sensitive and to put patients at ease.

At your appointment, the healthcare provider will typically begin by taking a medical history, asking about your symptoms, concerns, and what type of FGM you may have experienced. You can request a female healthcare provider if that makes you more comfortable. A physical examination may be offered, but you are always in control of what happens to your body - you can decline or stop an examination at any time. The provider should explain what they are doing and why, and get your consent before proceeding.

The provider can then discuss any findings with you, explain treatment options if applicable, and answer your questions. They may also refer you to specialists if needed, such as a psychologist for emotional support or a surgeon for reconstructive procedures.

How Is FGM Treated?

Treatment for FGM depends on the type and specific complications. Options include deinfibulation surgery to open fused tissue in Type 3 FGM, treatment for infections and cysts, pain management, and reconstructive surgery. Psychological counseling is an important component of comprehensive care. Treatment should be individualized based on each woman's needs and preferences.

While FGM cannot be completely reversed, medical treatment can address many of its complications and significantly improve quality of life. Treatment should be individualized - not every woman needs or wants the same interventions. The goal of treatment is to address your specific concerns and help you achieve the best possible health and wellbeing.

It is important to approach treatment decisions thoughtfully and with complete information. Healthcare providers should explain all options, including the benefits, risks, and alternatives, so that you can make informed decisions about your own body. You should never feel pressured to undergo any procedure.

Deinfibulation surgery

Deinfibulation is a surgical procedure to open the fused labia in women who have undergone Type 3 FGM (infibulation). The procedure involves cutting the scar tissue that covers the vaginal opening to create a normal opening. Deinfibulation can relieve many of the complications of infibulation, including difficulties with urination and menstruation, and enables normal sexual intercourse and vaginal childbirth.

The procedure is relatively simple and can often be performed under local anesthesia in an outpatient setting. Recovery typically takes several weeks, during which time the surgical area heals. After deinfibulation, many women report significant improvement in their symptoms and quality of life.

For pregnant women with Type 3 FGM, deinfibulation is often recommended to facilitate safe vaginal delivery. This can be performed during pregnancy or during labor, depending on the individual situation and healthcare provider recommendations. Performing deinfibulation before labor allows time for healing and may reduce delivery complications.

Treatment for specific complications

Various treatments are available for the specific complications that can result from FGM. Recurrent urinary tract infections may be treated with antibiotics and preventive measures. Cysts and keloids may be surgically removed if they are causing pain or other problems. Chronic pain may be addressed through pain management strategies, which can include medications, physical therapy, and other approaches.

For women experiencing sexual health problems, various interventions may help. These can include the use of lubricants, specific positions that minimize discomfort, physical therapy, and counseling. A healthcare provider or sexual health specialist can discuss options based on your specific situation.

Reconstructive surgery

Reconstructive surgery aims to restore the appearance and, in some cases, function of the genitalia after FGM. One type of reconstructive surgery, clitoral reconstruction (clitoroplasty), involves exposing the remaining portion of the clitoris that lies beneath the surface. Because the clitoris extends internally beyond what is visible externally, some women who have undergone clitoridectomy may still have clitoral tissue that can be exposed through surgery.

The outcomes of reconstructive surgery vary, and not all women experience improved sensation or sexual function after these procedures. It is important to have realistic expectations and to understand both the potential benefits and limitations before deciding to proceed. A thorough discussion with a surgeon experienced in these procedures can help you make an informed decision.

Psychological support

Psychological support is an essential component of comprehensive care for women affected by FGM. Mental health professionals, including psychologists, psychiatrists, and counselors, can provide various types of therapy to address the emotional and psychological effects of FGM. Cognitive-behavioral therapy (CBT), trauma-focused therapy, and other evidence-based approaches can be effective in treating PTSD, anxiety, and depression.

Support groups bring together women who have experienced FGM, providing a safe space to share experiences, receive support, and learn from others. Many women find comfort in connecting with others who understand their experience. Both in-person and online support groups may be available.

What Are the Laws Regarding FGM?

FGM is illegal in all European Union countries, the United States, Canada, Australia, and many other nations. It is also a crime in most countries to take a child abroad for FGM. Many African countries where FGM has been traditionally practiced, including Egypt and Somalia, have enacted laws against it. FGM is internationally recognized as a violation of human rights.

Female Genital Mutilation is increasingly recognized worldwide as a human rights violation and a form of violence against women and girls. International human rights conventions, including the UN Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), affirm that FGM violates fundamental rights including the right to health, the right to freedom from torture and cruel treatment, and the right to physical integrity.

Legal frameworks prohibiting FGM have been established in many countries. These laws serve both to protect girls at risk and to enable prosecution of those who perform or arrange FGM. Understanding the legal situation in your country can be important, whether you are at risk yourself, concerned about someone else, or simply want to understand the broader context of efforts to end this practice.

Laws in various regions

In the European Union, FGM is illegal in all member states. Most European countries have specific laws against FGM, and in countries without specific legislation, existing laws against assault and bodily harm apply. It is also generally illegal to take a child abroad for FGM (sometimes called "vacation cutting"), even if the procedure takes place in a country where it might be legal.

In the United States, federal law prohibits FGM, and most states also have specific state laws against the practice. Similar laws exist in Canada, Australia, New Zealand, and many other countries. In many African countries where FGM has been traditionally practiced, laws prohibiting the practice have been enacted, including in Egypt, Kenya, Nigeria, Senegal, and Somalia. However, enforcement of these laws varies significantly, and the practice continues in many areas despite being illegal.

Reporting concerns

If you are concerned that a girl or woman is at risk of FGM, or that FGM has already occurred, you can report your concerns to appropriate authorities. In many countries, healthcare professionals, teachers, and social workers are legally obligated to report suspected FGM or risk of FGM. Police, child protection services, and specialized helplines can provide guidance on how to help protect someone at risk.

Reporting can help protect potential victims and connect affected individuals with support services. If you are uncertain about whether or how to report, many countries have helplines that can provide confidential guidance.

How Can FGM Be Prevented?

Preventing FGM requires a multi-faceted approach including community education, empowerment of women and girls, engagement of community and religious leaders, healthcare provider training, legal frameworks, and support for families. Global efforts by WHO, UNICEF, and UNFPA are working to eliminate the practice within a generation.

Efforts to prevent FGM are ongoing worldwide, involving governments, international organizations, non-governmental organizations, and communities. The goal is to eliminate the practice entirely while respecting cultural sensitivities and working constructively with affected communities. Significant progress has been made in many regions, with declining rates of FGM among younger generations in several countries.

Prevention approaches recognize that FGM is often maintained by social norms and expectations. Families may arrange FGM for their daughters because they believe it is required by their culture or religion, because they want their daughters to be able to marry, or because they fear social consequences if they do not follow the practice. Effective prevention addresses these underlying factors through education, community engagement, and support for families who choose to abandon the practice.

Community-based approaches

Community-based programs are among the most effective prevention approaches. These programs engage community members in discussions about FGM, its health consequences, human rights, and cultural change. When communities as a whole decide to abandon FGM, individual families are freed from the social pressure to continue the practice.

Religious leaders play an important role, as FGM is sometimes mistakenly believed to be a religious requirement. In fact, FGM is not required by any major religion, and many religious leaders have spoken out against the practice. Engaging religious authorities can help dispel misconceptions and build support for abandonment of FGM.

Supporting those at risk

For girls and young women who are at risk of FGM, various support services may be available. These can include safe houses, educational programs, and legal protection. Healthcare providers, teachers, and social workers can often identify girls at risk and connect them with appropriate services. If you are concerned about someone who may be at risk, reaching out to child protection services or specialized organizations can help ensure that appropriate support is provided.

Frequently Asked Questions