Female genital mutilation: what it is and why it is dangerous

The term "female circumcision" is considered a euphemism and does not reflect the actual harm. The correct term in medicine and human rights is "female genital mutilation," which refers to any non-medical intervention that results in the partial or total removal of the external genitalia or other genital trauma. The practice has no medical benefit and is considered a violation of human rights, including the right to health, bodily autonomy, and freedom from violence and degrading treatment. [1]

Medical organizations emphasize the unacceptability of "medicalization," that is, the performance of such interventions by healthcare workers under the guise of "safety." Any form of medical involvement legitimizes harmful practices and contradicts the professional ethic of "do no harm." Professional societies call for a ban on postpartum "reinfibulation" and "reinfibulation," as well as for disciplinary action for such actions. [2]

Clinical public health objectives encompass three areas: prevention and change in community norms, humane and competent care for girls and women who have undergone intervention, and safe management of pregnancy and childbirth in the presence of anatomical changes. These areas are summarized in the updated 2025 World Health Organization guidelines. [3]

When discussing the topic, respectful, non-discriminatory communication is essential. It is recommended to use person-centered language, avoid stigmatization, offer psychological and sexual support, and, if necessary, discuss surgical options, carefully weighing the expected benefits and risks. [4]

The scale of the problem: where and how often

According to the United Nations Children's Fund (UNICEF) estimate for 2024, more than 230 million women and girls worldwide have undergone female genital mutilation, 30 million more than eight years ago. African countries account for more than 144 million cases, Asian countries account for more than 80 million, and the Middle East for more than 6 million. The practice also persists in diasporas around the world. [5]

The United Nations Population Fund warns that if current trends continue, 4.6 million girls will be at risk of intervention annually by 2030. The response requires accelerating programs, especially in the context of conflict, rising poverty, and climate crises, which undermine prevention efforts. [6]

Despite a gradual decline in the proportion affected in a number of countries, the pace of change is insufficient to meet the global target of ending the practice by 2030. Social norms associated with “purity,” marriage, and initiation rituals continue to support intervention, including at earlier ages, reducing the chances of prevention before the fact. [7]

For migrant-receiving countries, the problem is transnational in nature. Health programs must take into account cultural specificities and legal frameworks, ensuring early identification of risk and access to specialized care for affected women and girls. [8]

Table 1. Geography and scale

Region	Estimated number of people affected
African countries	>144 million
Asia	>80 million
Middle East	>6 million
Other regions and diasporas	1-2 million
Result	>230 million
Based on United Nations Children's Fund 2024 estimates. [9]

Classification according to the World Health Organization

The classification includes four types, determined by the extent and nature of the injury. Type I is partial or complete removal of the clitoral glans and/or prepuce. Subtype Ia is limited to removal of the prepuce. Subtype Ib involves removal of the clitoral glans with the prepuce. Type II involves partial or complete removal of the clitoral glans and labia minora, sometimes with involvement of the labia majora.[10]

Type III is called infibulation. This is a narrowing of the vaginal vestibule with the creation of a skin "lock" by cutting and suturing the labia minora or labia majora, often leaving a small opening for urine and menstrual blood. This variant is associated with the most significant obstetric and urological complications. [11]

Type IV encompasses all other non-medical injuries, including puncturing, cauterization, incisions, and stretching, that do not fall under the first three types. Mixed forms are encountered in clinical practice, requiring individual assessment when planning care. [12]

Knowing the type of injury is essential for choosing the appropriate treatment strategy, especially during pregnancy and childbirth, chronic pain, sexual dysfunction, and urological problems. Accurate classification improves the predictability of outcomes and facilitates multidisciplinary planning. [13]

Table 2. Classification of interventions

Type	Brief description	Key clinical implications
I	Removal of the glans clitoris and/or prepuce	Pain, bleeding, infection, sexual dysfunction
II	Removal of the clitoral glans and labia minora	Moderate to severe sexual and gynecological effects
III	Infibulation with the creation of a "lock"	Difficulty urinating and menstruating, obstetric complications
IV	Other injuries without tissue removal	Diverse local and systemic consequences
Summary of World Health Organization guidelines. [14]

Acute consequences: what happens immediately after the intervention

Immediate complications include severe pain, acute blood loss, traumatic shock, soft tissue infections, tetanus, urinary retention, and injuries to adjacent structures. The severity of complications depends on the extent of the injury, the conditions under which the procedure was performed, and the lack of aseptic technique. The risk of death with severe acute complications cannot be ruled out. [15]

Infectious complications are exacerbated by lack of sterility and access to substandard instruments. Cellulitis and abscesses develop, and septic conditions are possible. Early medical attention reduces the risk of systemic complications and preserves reproductive health. [16]

Girls and adolescents often experience acute psychotraumatic reactions that can develop into stress disorders. This subsequently increases the risk of depressive and anxiety disorders, sexual pain, and avoidance of intimacy. Early psychological support reduces long-term harm. [17]

The World Health Organization recommends immediate medical assessment and treatment of complications, including bleeding control, tetanus prophylaxis, antibiotics as indicated, and adequate pain relief. Healthcare providers should be familiar with primary care and routing algorithms. [18]

Table 3. The most common acute complications and basic tactics

Complication	What may be required
Bleeding and shock	Stop bleeding, infusion therapy, transfusion as indicated
Soft tissue infection	Antibiotics, surgical treatment for abscesses
Urinary retention	Catheterization, assessment of anatomical obstructions
Acute pain	Multimodal pain relief, psychological support
Tetanus	Vaccination and immunoglobulin as indicated
Summarized from the clinical guidelines of the World Health Organization. [19]

Long-term health effects

Chronic urogenital problems include recurrent urinary tract infections, urinary discomfort, dysmenorrhea, chronic pelvic pain, cysts, and scarring. With infibulation, persistent obstruction of menstrual flow leads to ascending infections and a deterioration in quality of life. [20]

Sexual consequences include arousal and orgasm disturbances, dyspareunia, and decreased sexual satisfaction. Data from systematic reviews and studies indicate a consistent association between interventions and deterioration in sexual function, although the severity of impairment varies depending on the type and extent of injury. [21]

Psychological consequences include anxiety and depressive disorders, post-traumatic symptoms, decreased self-esteem and body image. Comprehensive care combines psychotherapy, trauma therapy, and, if necessary, pharmacotherapy, according to standards for treating mental disorders. [22]

Somatic complications may include dermoid and epidermoid cysts in the scar area, neuromas, chronic vulvar pruritus, and dermatoses. Diagnosis and treatment are based on the anatomy and associated cultural factors that influence health care seeking behavior. [23]

Table 4. Long-term consequences and approximate areas of assistance

Consequences Group	Examples	Approaches to assistance
Urogenital	Urinary tract infections, difficulty urinating	Treatment of infections, correction of anatomical obstacles
Sexy	Pain during intercourse, difficulty achieving arousal and orgasm	Sexual counseling, pain management, discussion of surgical options
Psychological	Anxiety, depression, post-traumatic stress disorder	Psychotherapy, drug therapy as indicated
Dermatological and cicatricial	Cysts, neuromas, itching	Surgical and/or conservative correction according to indications
Summary of reviews and recommendations. [24]

Pregnancy and childbirth: what's changing in tactics

Infibulation increases the risk of ruptures, obstructed labor, operative delivery, postpartum hemorrhage, and neonatal complications. Prevention includes planning scar smoothing before or during labor, depending on the woman's preference, availability of qualified care, and the team's skills. [25]

The World Health Organization recommends defibulation for the prevention and treatment of obstetric and urological complications in women with infibulation. Reviews show comparable obstetric outcomes when the procedure is performed both during pregnancy and during labor. Timing is based on preference, delivery site logistics, and staff expertise. [26]

Pregnancy management requires a multidisciplinary plan, including education, pain management, infection prevention, and a clear flow through the maternity ward. Delivery should take into account the need for timely defibulation and prevention of perineal tears. [27]

Re-suturing after childbirth is unacceptable for ethical and medical reasons. It is necessary to document the volume and duration of defibulation, provide recommendations for care and sexual health, and offer psychological and sexual support in the postpartum period. [28]

Table 5. Obstetric risks and tactics for infibulation

Risk	What to plan
Delayed head advancement, soft tissue injuries	Early assessment of the need for defibulation
Postpartum hemorrhage	Prevention and readiness for active management of the third period
Neonatal complications	Availability of an experienced team and equipment
Perineal tears	Preventive measures and gentle obstetric techniques
Summarized from World Health Organization guidelines and clinical recommendations. [29]

Clinical care: from defibulation to psychosexual support

Defibulation—cutting the scar tissue during infibulation—is recommended for the prevention of obstetric and urological complications and can be performed during pregnancy or labor, based on an informed choice. Anesthesia, asepsis, subsequent formation of a natural vestibule, and detailed care instructions are essential. [30]

Sexual counseling and pain management are essential elements of care. International guidelines recommend offering evidence-based psychotherapeutic approaches and informing patients about surgical correction options for scars and cysts. Decisions are made collaboratively, taking into account expectations and the potential for sexual function rehabilitation without making unreasonable promises. [31]

Clitoral reconstruction should only be discussed after careful consideration. The availability of publications on potential improvements in individual parameters does not eliminate the limited quality of evidence and the risk of complications, including pain, infection, and decreased sensitivity. Randomized trials and uniform outcome assessment standards are needed. [32]

Psychological support should be available at all stages. Research indicates a link between interventions and distress, depression, and sexual dysfunction, so support includes trauma therapy, coping skills training, and, if necessary, medication therapy in accordance with general psychiatric standards. [33]

Table 6. Defibulation Scenarios: How to Choose Timing

Situation	When to consider defibulation
Planning a pregnancy	Before pregnancy, at the woman's request
Pregnancy without complications	In the second trimester, subject to consent and conditions
Childbirth	At the moment of need to facilitate birth and reduce trauma
Urological complications	As needed outside of pregnancy
Based on World Health Organization guidelines. [34]

Table 7. Assistance options and expected effects

Direction	What does it include?	Commentary on the evidence
Defibulation	Scar dissection, vestibule restoration	Recommended for obstetric and urological complications
Surgical correction of scars and cysts	Excision of cysts, plastic surgery	Conducted according to indications
Clitoral reconstruction	Release of the clitoral remnant, plastic surgery	Evidence is limited, risks are significant
Psychosexual support	Psychotherapy, sex therapy, pain management	Recommended for all those in need
Summary of reviews and guides. [35]

Law, Ethics and Responsibility of Health Systems

Female genital mutilation is recognized as a human rights violation and is prohibited in many countries. Healthcare workers are prohibited from performing the procedures and performing their "re-suturing." In countries with multi-ethnic populations, national clinical protocols for risk identification, routing, and care of victims are in place. [36]

A clear distinction is made between cultural sensitivity and legal inadmissibility. Medical involvement in performing interventions is considered a professional violation. The positions of international societies emphasize the need for training medical workers, the creation of specialized services, and interagency cooperation. [37]

European countries, including Spain, have national protocols for primary care, obstetric services, and social support. These documents emphasize respectful communication, risk assessment for minors, safe routing, and the protection of children in situations of risk. [38]

Systems should provide access to psychological support and specialized obstetrics and gynecology services, and train teams in defibulation techniques and labor management for women with anatomical abnormalities. This reduces the risk of complications and improves trust in the healthcare system. [39]

Table 8. Legal and organizational guidelines

Direction	Key landmark
Ethical position	Inadmissibility of medical involvement and "reinfibulation"
Team training	Mandatory training in recognition, defibulation and communication
National protocols	Standards for primary care, midwifery and child protection
Documentation and route	Recording of anatomical features, care plan, referral to specialists
Summarized from positions of professional societies and national protocols. [40]

Prevention

Comprehensive programs that integrate community norms, opinion leader education, the participation of men and boys, and economic support for alternative rituals show the best promise. Evidence points to the need for multi-year, culturally appropriate approaches that involve girls and women themselves. [41]

United Nations collaborative elimination programmes are showing success in a number of countries, but achieving the 2030 target requires faster progress and sustained funding. Monitoring should take into account regional differences and age-related shifts toward earlier implementation of interventions. [42]

Mass media and schools are effective when messages debunk myths about "hygiene" and "marital status" and highlight medical harm and legal consequences. Training primary care providers in culturally sensitive conversations is essential to avoid losing trust and reinforcing stigma. [43]

It is critical to engage religious and traditional leaders who can publicly renounce practices and thereby accelerate a shift in norms. Partnerships with women's organizations and survivors help build realistic alternatives and sustainable pathways to help. [44]

Table 9. Preventive interventions with proven potential

Component	Why is it important?
Working with community standards and public commitments to opt-out	Changes expectations and social pressures
Participation of men and boys	Reduces demand for "marriage through trauma"
School and media components	Debunking myths, increasing timely treatment
Training of health workers	Improves quality of care and trust
Economic support for alternative rituals	Reduces motivation to continue practice
Summarized from program reports and guidelines. [45]

Frequently asked questions

Why is "medicalization" dangerous if the intervention occurs anyway? Any involvement of healthcare workers legitimizes the practice, increases its prevalence, and violates professional ethics. Furthermore, the risks of pain, bleeding, infection, and long-term consequences remain significant even in "clinical" settings. [46]

Is there evidence that clitoral reconstruction restores sexual function? The data are limited and inconsistent, and serious complications are possible. The decision is made individually after full information and in conjunction with psychosexual therapy. [47]

When is it optimal to perform defibulation? Whether it's during pregnancy or labor, the choice depends on the woman's preference, the logistics of the birthing site, and the team's expertise. The goal is a safe delivery and reduced trauma. [48]

What is the key focus for health systems? Prevention through changing social norms while simultaneously providing accessible, respectful, and competent care to girls and women who have experienced intervention. [49]