Although illegal in the U.S. and in many other countries, female genital mutilation (FGM) is still practiced today in some parts of the world. The term refers to purposeful unnecessary surgical procedures performed on female infants, girls and women, usually as a cultural ritual.

The practice is most commonly found in parts of Africa as well as in some areas in Asia and the Middle East. However, it is known that some immigrants to the United States and other countries may practice FGM. Most pediatricians do not believe that such procedures are an acceptable form of "cultural diversity," seeing them instead as child abuse, and nearly all Western pediatricians condemn such procedures.

FGM may be seen as a means to protect a female's virtue or to make her more marriageable. As many as 4 to 5 million such procedures occur each year, often with no anesthesia and by nonmedical personnel using razor blades, broken glass or other sharp objects.

According to a 1998 issue of Pediatrics, all forms of FGM are condemned by the American Academy of Pediatrics, which actively discourages physicians from participating in any way in such a procedure. The authors described several key forms of FGM: Type I FGM, or clitoridectomy; Type II, or excising of all of the clitoris as well as some or all of the labia minora (similar to infibulation); and Type III, which is the most radical and includes excision of the clitoris and all or part of the labia minora, followed by cuts that are made in the labia majora.

The authors wrote, "The labial raw surfaces are stitched together to cover the urethra and vaginal introitus, leaving a small posterior opening for urinary and menstrual flow. In Type III FGM, the patient will have a firm band of tissue replacing the labia and obliteration of the urethra and vaginal openings.

Another type of FGM includes a variety of practices, such as cutting or stretching the clitoris and labia, cauterizing the clitoris and introducing corrosive substances into the vagina.

The physical effects of various forms of FGM, particularly Type III, are very severe. Females who have just undergone such a procedure may experience severe bleeding, pain, infection, tetanus and other complications. Adult women may later experience painful intercourse, recurrent urinary tract infections, pelvic infections and other complications. An episiotomy is required for a vaginal childbirth.

The psychological effects have not been studied but individuals who have experienced FGM report feeling great terror and anxiety.

Reference: Frader, Joel E., et al. "Female Genital Mutilation." Pediatrics 102 (July 1998): 153-157.

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