Female Circumcision: What Is Female Genital Mutilation?

Female genital mutilation (FGM) refers to any procedure that intentionally alters or injures female genital organs for non-medical reasons. The World Health Organization classifies FGM into four types, ranging from partial removal of the clitoris to the narrowing of the vaginal opening by stitching tissue together. Practiced in parts of Africa, the Middle East, and Southeast Asia, FGM affects tens of millions of women and girls alive today, with consequences that span physical, sexual, psychological, and reproductive health.

How FGM Is Classified

The WHO recognizes four types of FGM, each subdivided into further subtypes based on the extent and location of the cutting.¹ In practice, the types matter because the severity of health consequences rises sharply with more extensive procedures.

Type I: Partial or total removal of the clitoral glans, or just the clitoral hood (the fold of skin surrounding the clitoris).
Type II: Partial or total removal of the clitoral glans and the inner labia, with or without removal of the outer labia. This is sometimes called excision.
Type III: Narrowing of the vaginal opening by creating a seal from repositioned tissue, often involving stitching the inner or outer labia together. This is called infibulation and is the most severe form.
Type IV: All other harmful procedures to the female genitalia for non-medical purposes, including pricking, piercing, incising, scraping, and cauterization.

Types I and II are the most common worldwide. Type III, while less frequent in absolute numbers, accounts for a disproportionate share of the most serious complications. The distinction between types is not always clean in real life, and women who underwent FGM as young children may not know exactly what was done to them.

How Many Women and Girls Are Affected

A large systematic review and meta-analysis covering 30 countries found that roughly 37% of women aged 15 to 49 had undergone FGM, though this pooled figure masks enormous variation from country to country. Prevalence ranged from over 99% in Somalia to under 1% in Uganda.² Among younger girls aged 0 to 14, the pooled prevalence was about 8%, suggesting a decline in some regions, though rates in certain countries remain extremely high. Mali, for example, showed a prevalence above 70% even in the youngest age group.

These figures are almost certainly underestimates. FGM is illegal in many countries, so families may underreport it. Survey data also miss girls in remote areas who are harder for researchers to reach. The numbers do, however, confirm that the practice is concentrated in a band across sub-Saharan Africa, along with pockets in the Middle East and parts of Southeast Asia.

Immediate Physical Consequences

FGM is typically performed without anesthesia, often by traditional practitioners using unsterilized instruments. The most common immediate complications are excessive bleeding, urine retention, and genital tissue swelling.³ Systematic reviews of observational studies report bleeding rates ranging from 5% to 62% and urinary infections in 8% to 53% of cases, depending on the type of FGM and the study setting.⁴ Fever, wound infection, and sepsis are also documented, and deaths from hemorrhage or septic shock do occur, though reliable mortality data are scarce because many procedures happen outside any health system.

Women who undergo Type III FGM face the highest risk of immediate and long-term complications, because the procedure involves the most tissue removal and the creation of a near-complete seal over the vaginal opening.⁵ Even less invasive types, however, carry real risks of bleeding and infection when performed without sterile equipment or medical training.

Long-Term Urological and Gynecological Problems

The health effects of FGM do not end once the wound heals. Roughly 20% to 30% of women who have undergone FGM develop urological complications over time.⁶ The most frequently reported are recurrent urinary tract infections, difficulty emptying the bladder, and urogenital fistula, which is an abnormal opening between the urinary tract and the genital tract that causes chronic leaking of urine. These problems hit hardest in women with Type III FGM, where the sealed tissue obstructs normal urine flow and creates a breeding ground for bacteria.⁷

The altered anatomy can also make routine medical procedures harder. Something as basic as inserting a urinary catheter becomes difficult when scarring or tissue fusion has changed the landmarks a clinician would normally use.⁸ Chronic pain, cysts at the site of the cut, and keloid scarring are other common long-term issues that can affect daily life for years.

Effects on Pregnancy and Childbirth

FGM is linked to a range of obstetric complications. A systematic review and meta-analysis found that women who had undergone FGM faced significantly higher risks of prolonged labor, obstetric tears, instrumental delivery, hemorrhage after birth, and difficult delivery overall.⁹ The risks are most pronounced with Types II and III, where more tissue has been removed or the vaginal opening has been narrowed.¹⁰

A more recent review reinforced and expanded these findings, reporting increased risks of cesarean birth, postpartum hemorrhage, episiotomy, fetal distress, extended hospital stays, neonatal asphyxia, and stillbirth or neonatal death among women with FGM compared with those without.¹¹ In settings where emergency obstetric care is limited, these complications can be fatal for both mother and baby. Women with infibulation often require a surgical opening of the scar tissue (called defibulation) before or during labor in order to deliver safely.

Impact on Sexual Health

Research consistently shows that FGM harms sexual function. In a study of women in Nigeria, those who had undergone FGM reported significantly more pain and bleeding during vaginal penetration and a significantly lower rate of orgasm compared with women who had not been cut.¹² Similar findings emerged from a study among women in the Kurdistan region, where FGM was associated with reduced scores across every domain of sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain.¹³

These results make anatomical sense. The clitoris contains thousands of nerve endings and is the primary source of sexual pleasure for most women. Removing or damaging it, or enclosing it under scar tissue, disrupts its function. That said, some women with FGM do report orgasm and satisfying sexual lives, partly because the internal structures of the clitoris extend well beneath the visible surface and may not be entirely destroyed. The variation is real, but the direction of the evidence is clear: FGM reduces sexual function on average and increases pain.

Psychological Consequences

The mental health toll of FGM is significant and often under-recognized. In one study, about a third of women with FGM scored above the clinical threshold for mood or anxiety disorders, and roughly 18% showed scores consistent with post-traumatic stress disorder.¹⁴ A separate study found that the more invasive forms of FGM (Types II and III) were associated with greater vulnerability to PTSD symptoms and a phenomenon called shutdown dissociation, along with elevated symptoms of depression and anxiety.¹⁵

Part of the psychological damage stems from the procedure itself, which is often experienced as a sudden, violent betrayal by trusted family members. Part of it comes from the ongoing physical complications and sexual difficulties that follow. And part of it emerges later, when women who migrate to countries where FGM is not practiced begin to understand what was done to them and what was taken. Mental health support for affected women remains scarce, especially in the regions where prevalence is highest.

Why the Practice Persists

FGM is not driven by a single motive. Research across multiple countries reveals a web of interconnected social norms, religious beliefs, and gender-based ideas about women’s sexuality and social worth. In Guinea, ethnographic interviews found that communities practice FGM primarily to control girls’ sexual behavior, based on the belief that an uncut clitoris would give girls an “insatiable sexual appetite.” Families feared that daughters who were not cut would be promiscuous, damaging the family’s honor.¹⁶ Interestingly, many of the same participants noted that FGM does not actually prevent “sexual misconduct,” which became part of their reasoning for questioning the practice.

The specific justifications vary by culture. Among Sundanese and Sasak communities in Indonesia, FGM is framed around producing a “pure body.” Among the Amhara in Ethiopia, it aims to create a “tame” body, and among the Maasai in Kenya, it marks the transition to an “adult body.”¹⁷ In Ethiopia’s Somali region, research found that respondents distinguished between FGM as a perceived religious requirement and infibulation as a cultural one. For girls and women, FGM was framed around social acceptance; for boys and men, it was seen as a marriage requirement that allows families to control girls’ sexuality.¹⁸

A common thread across all these settings is that FGM functions as a social norm. Families who refuse to cut their daughters risk social exclusion, difficulty arranging marriages, and stigma. Individual opposition often collapses under collective pressure, which is why many prevention programs focus on shifting community-wide norms rather than persuading individual families.

The Medicalization Debate

In some countries, trained health professionals perform FGM in clinical settings, a trend often called medicalization. Proponents argue this reduces harm by providing sterile instruments and pain management. Critics, including the WHO and most major medical associations, argue that medicalization legitimizes FGM and may even increase its prevalence by making it seem safer.¹⁹

Research into the motivations of health professionals who perform FGM reveals a mix of reasons: a genuine belief that their involvement is less harmful than having a traditional practitioner do it, cultural beliefs that the practice is justified, financial incentives, and community pressure.²⁰ In Malaysia, a survey of doctors found that 76% of those who practiced FGM cited religion as their primary reason, while 16% cited health-related justifications. Among doctors who refused, the most common reason was simply having no training in the procedure.²¹ The international medical consensus is that no form of FGM is safe and that clinicians should not perform it, but enforcement and cultural attitudes vary widely by country.

Reconstructive Surgery

Clitoral reconstruction surgery, which aims to restore anatomy and function after FGM, has become increasingly available in some countries. The most widely used technique, developed by the French surgeon Pierre Foldès, involves removing scar tissue and exposing the intact portion of the clitoral shaft that typically remains beneath the surface. A scoping review of 40 studies found that over 7,000 women had undergone some form of reconstruction, with about 94% reporting improvement afterward and a complication rate of roughly 3%.²²

Qualitative interviews with women in Sweden who had the surgery found that several reported reduced genital pain, improvements in their sex lives, and a sense of feeling more empowered. Yet some women experienced aesthetic, functional, or process-related disappointment, underscoring that outcomes vary.²³ A small study comparing women who received reconstructive surgery combined with psychosexual care against those who received psychosexual care alone found higher satisfaction, psychological well-being, sexual response, and genital self-image in the combined group.²⁴ The evidence base is still growing, and researchers stress that surgery alone is not a complete solution. Psychological support is a critical component of care for women considering reconstruction.

Prevention Programs That Show Results

Several community-based programs have demonstrated measurable reductions in FGM. In Senegal, a community education program led to widespread improvements in knowledge and critical attitudes toward FGM among both direct participants and other community members who were exposed to the information indirectly. The prevalence of FGM among daughters aged ten and younger dropped significantly in the intervention villages but not in comparison villages, suggesting the program changed actual family behavior, not just attitudes.²⁵

In Sudan, the Saleema campaign used social marketing to shift norms by promoting a positive identity for uncut girls (the word “saleema” means whole or healthy in Arabic). Evaluation of the campaign found that exposure was associated with reduced support for FGM, and higher doses of campaign exposure corresponded to stronger shifts away from pro-FGM norms.²⁶ Both examples illustrate a key insight from prevention research: because FGM is held in place by collective social expectations, individual education alone is rarely enough. Programs that shift the norms of an entire community, so that families who refuse to cut their daughters are no longer punished socially, have the strongest track record.

Legal Frameworks and Human Rights

FGM is recognized internationally as a violation of human rights, including provisions under the Universal Declaration of Human Rights, the Convention on the Elimination of All Forms of Discrimination Against Women, and the Convention on the Rights of the Child.²⁷ Many countries where FGM is prevalent have enacted laws banning it, and numerous Western nations criminalize the practice as well, including when residents travel abroad to have it performed on their daughters (sometimes called “vacation cutting”).

Enforcement remains inconsistent. In some countries, anti-FGM laws exist on paper but are rarely prosecuted. In others, the legal framework drives the practice underground rather than eliminating it. The evidence suggests that legislation works best when combined with community education and norm-shifting campaigns, not as a standalone tool.

Who Is Most at Risk

Research from Ethiopia using time-to-event analysis highlights several factors associated with higher risk. Girls in rural areas face nearly double the risk of being cut compared with girls in urban areas. Younger mothers, aged 15 to 24, are more likely to have their daughters cut than mothers over 35. Perhaps the most striking factor is education: children born to mothers with no formal schooling face more than five times the risk of FGM compared with children of mothers with higher education, and children of fathers with no education also face significantly elevated risk.²⁸ These findings track with the broader pattern seen in prevention research: education, particularly maternal education, is one of the strongest protective factors against FGM.

Healthcare Challenges in Diaspora Communities

Migration has brought FGM into the clinical experience of health professionals who may never have encountered it before. A qualitative systematic review of healthcare providers’ perspectives found that lack of familiarity with FGM, combined with the cultural sensitivities surrounding it, often leads to silence, stigma, and inaction.²⁹ Clinicians reported not knowing how to raise the topic, feeling uncomfortable during examinations, and being unsure about legal reporting obligations. Patients, meanwhile, described feeling judged, misunderstood, or reduced to their FGM status rather than treated as whole people.

Training programs for healthcare workers in high-income countries are slowly expanding, but gaps remain wide. Women who have undergone FGM and are now living in countries where the practice is uncommon need clinicians who can manage complications, provide sensitive gynecological and obstetric care, and connect them with mental health support without adding to their sense of stigma.

The Economic Toll

Beyond the human suffering, FGM imposes a measurable financial burden on health systems. An analysis of 27 high-prevalence countries estimated the cost of treating FGM-related complications at about $1.4 billion per year as of 2018, projected to rise to over $2.1 billion per year by 2047 if current cutting rates continue. If FGM were fully abandoned, that future annual burden would drop to roughly $0.8 billion by 2047, reflecting the cost of treating complications in women already affected but no longer adding new cases.³⁰ These figures capture only direct healthcare costs and likely underestimate the broader economic impact, which includes lost productivity, reduced educational attainment, and the long-term consequences of chronic pain and psychological distress.