Female Circumcision (Female Genital Cutting)

Introduction

• Description: Female circumcision is the removal of part or all of the external genitalia, including the labia majora, labia minora, clitoris, or all three. Female circumcision (female genital mutilation, infibulation, genital mutilation) is generally performed as a ritual process, often without the benefit of anesthesia and frequently under unsterile conditions. The resulting scarring may preclude intromission. The amount and location of tissue removed determine the type of infibulation:

  • Type I—excision of the prepuce, with or without excision of part or the entire clitoris

  • Type II—excision of the clitoris with partial or total excision of the labia minora (most common form)

  • Type III—excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation)

  • Type IV—pricking, piercing, or incising of the clitoris, labia, or both; stretching of the clitoris, labia, or both; cauterization by burning of the clitoris and surrounding tissue

• Other forms of female genital mutilation include the following:

  • Scraping of the tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts)

  • Introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it

  • Any other procedure that falls under the definition given previously

• Prevalence: Approximately 168,000 women in the United States; approximately 96% of women in some African countries (eg, Somalia). United Nations Children’s Fund (UNICEF) found that female circumcision has been performed in at least 200 million females in the 31 countries in Africa and the Middle East.

• Predominant Age: Majority performed during childhood or early teens, typically ages 5–12 years.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Performed as part of ritual or religious beliefs, generally without the permission and often without the cooperation of the young girl herself.

• Risk Factors: Most common in some African and Southeast Asian cultures.

Signs and Symptoms

• Significant scarring and deformity of the external genital structures, often to the point of complete obliteration of vaginal introitus (varies with the type and extent of the procedure performed)

• Chronic or recurring vaginal infections

• Obstruction may be sufficient to result in amenorrhea or dysmenorrhea

• Dyspareunia

• Orgasmic dysfunction

• Libidinal dysfunction

• Obstruction or hindrance to vaginal delivery

Diagnostic Approach