What is female genital mutilation (FGM)?

Female Genital Mutilation (FGM): Definition and Medical Implications

Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. 1 This practice has no health benefits and causes significant physical and psychological harm.

Types of FGM

FGM is classified into four main types:

1. Type I (Clitoridectomy): Partial or total removal of the clitoris and/or the prepuce
2. Type II (Excision): Partial or total removal of the clitoris and labia minora, with or without excision of the labia majora
3. Type III (Infibulation): Narrowing of the vaginal opening by creating a covering seal, formed by cutting and repositioning the labia minora and/or labia majora, with or without removal of the clitoris
4. Type IV: All other harmful procedures to female genitalia for non-medical purposes (pricking, piercing, incising, scraping, and cauterizing) 2

Prevalence and Distribution

• Over 200 million girls and women worldwide have undergone some form of FGM 1
• More than 3 million girls are at risk annually 1
• Primarily practiced in countries across Africa, the Middle East, and Asia
• Due to migration patterns, FGM is now encountered in Western countries including the United States 3
• An estimated 500,000+ girls and women in the United States have undergone or are at risk for FGM 4

Medical Complications

FGM causes numerous serious health consequences that increase with the severity of the procedure:

Immediate Complications:

• Severe pain and bleeding
• Shock
• Infections (including sepsis)
• Urinary retention
• Fractures (from restraint during the procedure) 2

Long-term Complications:

• Chronic infections (urinary tract, reproductive system)
• Painful urination and menstruation
• Keloid scarring
• Sexual dysfunction and pain during intercourse
• Infertility
• Psychological trauma (PTSD, anxiety, depression)
• Obstetric complications (difficult labor, increased risk of cesarean section, postpartum hemorrhage)
• Increased risk of maternal and infant mortality 2

Cultural Context

While often defended as a cultural practice, FGM is not tied to any specific religion, ethnicity, or race 4. Common justifications include:

• Controlling female sexuality
• Maintaining cultural identity
• Ensuring marriageability
• Perceived hygiene benefits
• Initiation into womanhood 3

Legal and Ethical Considerations

• FGM is recognized internationally as a violation of human rights 5
• The practice is illegal in many countries, including the United States
• Medical professionals are prohibited from performing FGM (medicalization of FGM)
• Healthcare providers have legal and ethical obligations to report suspected cases 4

Management Approach for Healthcare Providers

1. Recognition: Include examination of external female genitalia during routine health examinations
2. Documentation: Accurately record findings
3. Treatment: Address physical and psychological complications
4. Prevention: Provide education to at-risk communities
5. Reporting: Follow mandatory reporting requirements for child abuse 4

Culturally Sensitive Communication

When discussing FGM with patients or families:

• Use neutral terminology (some communities may not recognize terms like "mutilation")
• Acknowledge cultural context while emphasizing health implications
• Focus on health consequences rather than moral judgments
• Provide resources for psychological support 3

FGM is a harmful practice with no medical benefits that causes significant physical and psychological harm. Healthcare providers play a crucial role in identifying, managing, and preventing this practice through education, culturally sensitive care, and appropriate reporting.