It is reported that over 230 million girls and women across 31 countries have undergone some form of FGM/C. Most cases are in Africa, followed by Asia and then the Middle East. The highest reported rates in Africa occur in Somalia, Guinea, and Djibouti, where it affects nearly all women. In high-income countries, it is primarily practiced in migrant and refugee populations. FGM/C is illegal in the United States, so families may send children abroad to have FGM/C performed, known as "vacation cutting." FGM/C is commonly performed on girls between infancy and age 15 years, but it may be carried out in older adolescents and even adults.
Although it is considered a severe violation of human rights and a form of gender inequality by the World Health Organization (WHO) and other international organizations, the practice of FGM/C is driven by multiple, often overlapping, factors. FGM/C is often seen culturally and socially as a rite of passage into womanhood and an essential step for marriage and motherhood. It is motivated by beliefs that it ensures social acceptance, avoids community rejection, and secures economic security. Perceived religious reasons also play a role, although this practice is not mandated by any religious texts. A systematic review on factors associated with FGM/C, mostly from the African region, reported that family history of the practice, rural living, and specific religious beliefs were commonly associated with increased likelihood of FGM/C, while higher parental education was linked to lower rates.
FGM/C is often performed by individuals in the community with no or informal medical training who use knives, scissors, scalpels, or razor blades, usually without any anesthesia or antiseptics.
Per the WHO, FGM/C is classified into 4 types, depending on the extent and nature of the genital tissue affected:
- Type I (clitoridectomy): Partial or total removal of the clitoral glans and/or the prepuce / clitoral hood.
- Type Ia: Removal of the prepuce / clitoral hood only.
- Type Ib: Removal of the clitoral glans with the prepuce / clitoral hood.
- Type II (excision): Partial or total removal of the clitoral glans and the labia minora, occasionally with removal of the labia majora.
- Type IIa: Removal of the labia minora only.
- Type IIb: Partial or total removal of the clitoral glans and the labia minora (prepuce / clitoral hood may be affected).
- Type IIc: Partial or total removal of the clitoral glans, the labia minora, and the labia majora (prepuce / clitoral hood may be affected).
- Type III (infibulation): Narrowing the vaginal opening by creating a seal, often formed by cutting and repositioning the labia minora or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce / clitoral hood and glans.
- Type IIIa: Removal and repositioning of the labia minora.
- Type IIIb: Removal and repositioning of the labia majora.
- Type IV: All other harmful nonmedical procedures to external female genitalia (eg, pricking, piercing, incising, scraping, and cauterizing).
Chronic complications can occur at any point in life. A WHO systematic review reported an increased risk of pain, sexual dysfunction, and mental health issues, as well as numerous urologic, gynecologic, obstetric, and dermatologic complications.
There has been an increase in medicalized FGM/C, where health care providers carry out the procedure, typically using surgical tools, antiseptics, and/or anesthetics, in a medical facility or at home. However, there is little to no evidence that medicalization prevents long-term complications or decreases rates of the practice. The WHO strongly discourages health care providers from performing FGM/C.
