Why Is FGM Performed: Causes, Myths, and Reality

Female genital mutilation (FGM) is performed for a tangle of reasons that vary across communities, but they almost always trace back to deeply rooted social norms rather than any single religious mandate, health benefit, or cultural imperative. A systematic review of the research identified six key factors that sustain the practice: cultural tradition, sexual morals, marriageability, religion, perceived health benefits, and male sexual enjoyment.¹ None of these reasons hold up under medical or ethical scrutiny, and the health consequences are severe and well documented. Yet the practice persists in part because its motivations reinforce each other, creating a web that is difficult to untangle from any one direction.

Social Pressure and Marriageability

In many communities where FGM is practiced, an uncut girl is considered unmarriageable. The logic is circular but powerful: families believe that if their daughter is not cut, no man will want her, and so the cutting continues because everyone else is doing it. This makes FGM a classic social-norm trap, where individual families feel unable to stop even when they privately have doubts, because opting out carries real social costs for their daughters. In parts of sub-Saharan Africa, the Middle East, and Southeast Asia, the practice persists within immigrant diaspora communities in Europe, North America, and Australia as well, with national prevalence exceeding 80% in some of the highest-practicing countries.²

Marriageability is not just about finding a husband. In many settings, marriage is the primary route to economic security and social standing for women. A family that refuses to have their daughter cut risks condemning her to social exclusion, poverty, and stigma. This economic dimension makes the practice harder to abandon than it would be if it were purely ceremonial. Research among the Loita Maasai in Kenya, for instance, found that roughly half the community continued practicing FGM even after exposure to abandonment programs, in part because the practice carried meanings beyond initiation, including concerns about social consequences of not cutting.³

Controlling Female Sexuality

Beneath the language of tradition and marriage lies a more straightforward motive: controlling women’s sexual behavior. The most extreme form of FGM, infibulation, involves removing external genital tissue and narrowing the vaginal opening to a small hole, which physically prevents intercourse until the scar is cut open, usually on the wedding night.⁴ Even less severe forms are often explicitly intended to reduce a woman’s sexual desire and make premarital sex or infidelity less likely.

A study of fathers in Egypt found that many believed uncut women to be promiscuous. FGM was considered important both for securing good marriage prospects and for ensuring fidelity after marriage. In some communities, it helped men maintain polygamy by limiting wives’ sexual autonomy. Men in Guinea similarly viewed FGM as reducing the likelihood of premarital sex.⁵ At its core, the practice functions as a patriarchal mechanism to maintain control over women’s bodies, reinforcing male dominance regardless of how it is framed culturally.⁶

The irony is that many men in these same communities acknowledge the harm. In a study of Egyptian men, almost all 99 participants, including religious leaders from both Muslim and Christian backgrounds, affirmed women’s equal right to enjoy sex. Many complained that their wives’ lack of sexual response after FGM was disturbing or inconvenient. Yet for some, the desire to ensure fidelity or maintain control over the sexual relationship overrode those concerns.⁵

Beliefs About Purity and Hygiene

A common justification for FGM is that uncut genitalia are dirty, smelly, or aesthetically unacceptable. In many practicing communities, cutting is framed as a cleanliness practice, much like bathing or grooming. Research among midwives and traditional excisers in Senegal’s Fouta Toro region revealed contradictory beliefs about female anatomy, purity, and the olfactory differences between excised and unexcised women. Rather than a simple clash between local and biomedical knowledge, people held multiple, seemingly conflicting viewpoints at once, shaped by social identity, embodied manners, and sensory perceptions of their environment.⁷

These beliefs are medically baseless. There is no hygienic benefit to removing healthy genital tissue, and the procedure itself introduces infection risk. But the beliefs are deeply felt and tied to identity, which makes them resistant to straightforward health messaging. Telling a community that their understanding of cleanliness is wrong often triggers defensiveness rather than reflection, especially when that understanding is woven into religious and social identity.

The Religious Justification Myth

FGM is often attributed to Islam, but the practice predates Islam and is not mandated by the Quran. It probably originated in Pharaonic Egypt, where it carried mythological significance, long before the spread of any of the Abrahamic religions.⁸ FGM is practiced by Muslim, Christian, and animist communities alike, and many majority-Muslim countries do not practice it at all. Among doctors in Malaysia, where FGM is widespread and heavily medicalized, about three-quarters cited religion as their primary reason for performing the procedure, yet the religious basis for the practice is a matter of interpretation, not scriptural command.⁹

The danger of the religion myth is twofold. It gives communities a seemingly unassailable justification: if God requires it, who are outsiders to object? And it leads critics to blame a religion rather than a social norm, which both misdiagnoses the problem and alienates communities that might otherwise be open to change. The most effective abandonment programs work with religious leaders to clarify that the practice is cultural, not divine, and that stopping it does not mean abandoning faith.

Who Enforces the Practice

A persistent misconception is that men are the primary drivers of FGM. In reality, the day-to-day enforcement is usually carried out by women, particularly grandmothers and elder female community members. Grandmothers wield extensive authority and decision-making power over whether girls are cut in sub-Saharan Africa, and sidelining them from eradication programs has been identified as a major obstacle to ending the practice.¹⁰

But the intergenerational dynamics are more complex than the image of rigid older women imposing tradition on younger ones. Research using focus groups in Senegal and The Gambia found that younger women often felt they lacked the authority to question FGM because doing so would represent an unacceptable challenge to the authority of older women. Younger women had the most to lose by violating the norms: social acceptability, community support, and self-esteem. Meanwhile, the older women themselves were more willing than expected to debate among themselves about whether and how traditions should be modified in light of changing social circumstances.¹¹ The takeaway: older women are not monolithically pro-FGM. They are, however, the gatekeepers, and any serious effort to end the practice needs to include them as participants rather than treating them as obstacles.

The Real Health Consequences

Every claimed health benefit of FGM is a myth. The procedure has no medical advantages. It does, however, cause a long list of documented harms.

The most common immediate complications are excessive bleeding, urine retention, and swelling of genital tissue.¹² A study in The Gambia found complications in about a third of the patients examined, and even Type I, the least anatomically extensive form, caused complications in one out of five girls and women.¹³

The long-term consequences are broader and often lifelong. They include chronic vaginal and pelvic infections, painful intercourse, scarring, recurrent urinary tract infections, menstrual disorders, infertility, and psychological damage including depression and anxiety.¹⁴ A large systematic review and meta-analysis found that women who had undergone FGM faced increased risks across nearly every category of health outcome compared to women who had not: obstetric complications like prolonged labor, tearing, and cesarean delivery; urological complications; sexual difficulties; and mental health conditions including depression, anxiety, and somatoform disorders.¹⁵

The numbers on obstetric harm are striking. A meta-analysis found that FGM was associated with roughly double the odds of prolonged labor, about two and a half times the odds of painful intercourse, and about two and a half times the odds of perineal tears during delivery.¹⁶ These are not rare edge cases. They are the predictable outcomes of removing healthy tissue and, in the case of infibulation, creating scar tissue that obstructs the birth canal.

Psychological Toll

The mental health consequences of FGM are sometimes overshadowed by the physical ones but are no less real. A review of psychological outcomes found that symptoms were reported in the vast majority of cases studied, with anxiety, depressed mood, aversion to sexual activity, and nightmares being the most common. Formal psychological diagnoses were made in about a third of cases, with post-traumatic stress disorder diagnosed in roughly 30%, major depressive disorder in 20%, and generalized anxiety disorder in a smaller proportion.¹⁷

FGM is typically performed on girls between infancy and age fifteen, often without anesthetic and sometimes by force. The experience of being held down by trusted adults while someone cuts your genitals can constitute a severe trauma, and it is not surprising that PTSD rates among survivors resemble those seen in other populations exposed to violent trauma. The psychological harm can compound over time as women face painful sex, difficult childbirth, and the realization that the procedure served no real purpose.

The Medicalization Problem

One of the more troubling recent trends is the medicalization of FGM: the performance of the procedure by trained healthcare workers in clinical settings. The logic behind it is harm reduction. Parents want the cutting done, the reasoning goes, so it is better to have a nurse or doctor do it with sterile instruments than to have a traditional practitioner do it with a razor blade.

A review of healthcare providers’ motivations found four main drivers: the belief that performing FGM would be less harmful than having it done by a traditional practitioner, the belief that the practice was culturally justified, the financial gains from performing the procedure, and community pressure or requests to perform it.¹⁸ In Malaysia, the practice is almost entirely medicalized, with religion and health cited as primary justifications by doctors. Clinic ownership dramatically increased the likelihood of a doctor performing FGM, suggesting that financial incentives play a significant role.⁹

The World Health Organization and major medical associations oppose medicalization because it legitimizes the practice, gives it a veneer of medical respectability, and makes it harder to eradicate. A sterile scalpel does not prevent the long-term complications of tissue removal, scarring, and nerve damage. And once healthcare workers are performing the procedure routinely, it becomes embedded in the medical system in ways that are harder to undo than traditional community practices.

Why Bans Alone Do Not Work

Dozens of countries have enacted laws criminalizing FGM, and these laws are an important signal that the state considers the practice a human rights violation. But on their own, bans have a mixed track record. After government bans, some healthcare workers in Nigeria adopted covert new techniques to continue the practice, such as applying menthol and petroleum jelly to an infant girl’s clitoris over months to reduce its size, a method designed to circumvent the letter of the law while achieving the same goal. Others simply continued performing FGM in secret, with families only coming to attention when they brought their daughters in for treatment of complications or routine immunization.¹⁹

Criminalization can also push the practice underground and make it more dangerous, as families avoid healthcare facilities out of fear of prosecution. The evidence suggests that laws work best not in isolation but alongside community-level interventions, public education, and engagement with religious and traditional authorities. Legislation accompanied by political will and additional community programs shows more promise than laws that exist only on paper.²⁰

The diaspora dimension adds another layer of complexity. As migration increases, FGM persists within immigrant communities in Western countries, and some families travel back to their countries of origin to have daughters cut during school holidays, a phenomenon known as “vacation cutting.”²¹ While prevalence has declined in parts of East Africa, progress has stalled in areas of West Africa and Sudan.²

What Actually Works to End FGM

The most promising abandonment strategies focus on changing the social norm rather than punishing individuals. Public declarations of abandonment by community leaders, religious figures, or other influential people serve as a collective signal that the norm has shifted. When supported by follow-up and ongoing support, these declarations have been highly effective at preventing new cases.²⁰

The Tostan program in Senegal is one well-documented example. Beginning in the late 1990s, the program used community empowerment and education to mobilize villages toward public declarations against FGM and child marriage. An evaluation found that many communities did end the practices following a declaration, though the lack of sustained follow-up and support remained a significant obstacle. The program achieved meaningful shifts in knowledge and attitudes, moving communities toward abandonment even where it was not fully achieved.²²

The evidence points toward a combination approach: repeated, community-wide awareness campaigns that stress the health harms; engagement with religious leaders who can decouple the practice from religious obligation; inclusion of grandmothers and elder women as change agents rather than targets; training for healthcare providers to refuse requests and counsel families; and legislation that provides a legal backstop. No single intervention works in isolation, because no single factor sustains the practice in isolation.

Reconstructive Surgery for Survivors

For women who have already undergone FGM, reconstructive surgery is an emerging option, though access remains limited. Surgical approaches aim to restore normal anatomy, female sexual identity, and physical pleasure, and to reduce chronic pelvic pain and pain during intercourse.²³ For women who have undergone infibulation, deinfibulation (surgically opening the sealed vaginal opening) can relieve urinary obstruction, reduce recurrent infections, and make intercourse and childbirth possible without further trauma.

Reconstructive surgery is best delivered as part of a multidisciplinary approach that includes psychological support, sexual health counseling, and pelvic-floor physiotherapy. The physical repair is only part of what survivors need. Many women carry decades of trauma, shame, and loss of sexual function, and addressing those dimensions requires more than a scalpel. Specialist clinics in Europe and parts of Africa are beginning to offer this integrated care, but demand far outstrips availability, and many survivors do not know that surgical options exist.

The Four Types and Why It Matters

FGM is not a single procedure. The World Health Organization classifies it into four types, ranging from removal of the clitoral hood (Type I) to the complete removal of external genitalia and suturing of the vaginal opening (Type III, infibulation). Type IV covers all other forms of harm to the genitalia, including pricking, piercing, scraping, and burning.⁴ The health consequences vary with the severity of the type performed, but even the mildest forms carry risk of complications. As noted, roughly one in five girls who undergo Type I experience complications.¹³

The existence of multiple types sometimes leads to a misleading argument: that “mild” forms (a symbolic prick or nick) should be tolerated as a compromise to prevent more severe cutting. This argument surfaces periodically in medical ethics debates, but it runs aground on the principle that there is no safe or ethical amount of unnecessary genital cutting performed on a child who cannot consent. The harm-reduction framing also ignores the reality that once a community accepts any form of cutting as legitimate, there is little to prevent escalation over time.