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Female genital cutting is practiced in many countries around the world.
Female genital cutting
Female genital cutting (FGC), sometimes called female circumcision or female genital mutilation, means piercing, cutting, removing, or sewing closed all or part of a girl's or woman's external genitals for no medical reason. In the United States, available estimates suggest that more than 507,000 girls and women have experienced FGC or are at risk of FGC.1 Worldwide, as many as 140 million girls and women alive today have been cut.2 Three million more girls and women are thought to be at risk of FGC each year.2 FGC is often a part of the culture in countries where it is practiced. But FGC has no health benefits and can cause long-term health problems. FGC is against the law in the United States and many other countries.
The World Health Organization (WHO) and the United Nations (UN) define FGC as "any partial or total removal of the external female genitalia or any other injury of the female genital organs for nonmedical reasons." The United States also uses this definition in its efforts to end the practice.
FGC is sometimes called "female genital mutilation." People who practice FGC may call it "female circumcision." FGC is not the same as male circumcision.
The World Health Organization (WHO) describes four major types of FGC. Types 1 and 2 are the most common, but all types may be harmful.
The four types of FGC are:3
- Type 1: Partial or total removal of the clitoris. This is also called "clitoridectomy(klit-er-i-DEK-tuh-mee)".
- Type 2: Partial or total removal of the clitoris and the labia (the inner and outer "lips" that surround the vagina)
- Type 3: Sewing the labia together to make the vaginal opening smaller. This is called infibulation(in-fib-yuh-LEY-shuhn). The clitoris may be left in place.
- Type 4: All other harm to the female genitalia for nonmedical purposes, including pricking, piercing, cutting, scraping, and cauterization (burning)
FGC is done mostly in parts of northern and central Africa, in the southern Sahara, and in parts of the Middle East and Asia. See the map of countries where FGC is practiced most often (PDF, 22.7 MB).
Some immigrants in the United States and Western Europe from these countries also practice FGC, or may send their daughters back to their family homeland for FGC. Other immigrant families stop practicing FGC once they are in a new country.
Different communities and cultures have different reasons for practicing FGC; the reasons are often complex and can change over time.4 Social acceptability is the most common reason. Families often feel pressure to have their daughter cut so she is accepted by their community. Other reasons may include:
- To help ensure a woman remains a virgin until marriage
- Hygiene. Some communities believe that the external female genitals that are cut (the clitoris or the labia or both) are unclean.
- Rite of passage. In some countries, FGC is a part of the ritual that a girl goes through to be considered a woman.
- Condition of marriage. In some countries, a girl or woman is cut in order to be suitable for marriage.
- Belief that FGC increases sexual pleasure for the man
- Religious duty, although no religion's holy texts require FGC.
Girls and women who live in the countries where FGC is practiced most often (PDF, 22.7 MB) have the highest risk. In some countries, only a small number of girls and women are cut. In other countries, nearly all girls and women are cut.2
The specific community or part of the country a girl or woman lives in can increase or decrease her risk of certain types of FGC. For example, different ethnic groups may perform different types of FGC. Also, how much wealth, education, and the type of education a girl's parents receive may influence their choice to have a daughter cut. Lastly, whether a community is urban or rural can affect the practice of FGC.
The age when girls are cut varies from country to country and even within communities.
- Girls are most at risk between birth and 15 years. In about half of the countries in which FGC is practiced, girls are cut before 5 years old. In other countries, most girls are cut between 5 and 14.4
- Sometimes, FGC is done to adult women. Women may be cut just before marriage. Some communities wait until the first pregnancy.5
An estimated 100 to 140 million women alive today have undergone FGC. Three million girls and women may be at risk of FGC each year.2 The percentage of women who have been cut is very different from country to country. In Indonesia, 86% to 100% of girls and women have been cut.6 In Guinea and Somalia, more than 95% of girls and women have been cut. In Djibouti, Egypt, Eritrea, and Sierra Leone, it is near 90%. However, in Cameroon and Uganda, less than 2% of girls and women have been cut.
In the United States, available estimates suggest that more than 507,000 girls and women have experienced FGC or are at risk of FGC.1
FGC can cause immediate and long-term medical problems. How bad these problems are depends on:7
- How clean (sterile) the place is where cutting happens. FGC is illegal in most countries and must be done in secret. In most of these countries, FGC is usually done on a floor, table, bed, or the ground. But, in some countries, such as Egypt, a loophole in the law allows doctors to do FGC in a sterile, medical site.4
- The experience of the person performing FGC and the tools used. The cutting is often done with glass, razor blades, or knives. The tools may not be sterilized between cuttings. In type 3 FGC, the sewing may be done with thorns and without sterile thread.
- The type of FGC. Type 3 causes more health problems than type 1 or type 2.
- The general health of the girl or woman
The type of FGC done may affect how much and how serious health problems are after FGC. Type 3 causes more health problems than type 1 or type 2.
Immediate medical problems can include:7
- Severe pain. Girls usually don't get any pain medicine before or after they are cut.
- Serious bleeding
- Infection of the wound. Girls can get fever, shock, and even die if the infection is not treated.
- Trauma. Girls are held down often against their will and may not understand why.
- Problems going to the bathroom, including burning and pain
- Tetanus and other infectious diseases, such as HIV, from unsterilized cutting tools
- Death. Researchers do not know how many girls die because of FGC. Few records are kept, and deaths that may have been caused by FGC are often not reported as related to FGC.8
FGC can cause long-term problems with a girl's or woman's physical, mental, and sexual health. The type of FGC done may affect how much and how serious the health problems are. Type 2 and type 3 cause more serious health problems than type 1.
Long-term health problems include:9
- Infections, such as genital abscesses (sores filled with pus that must be drained) and infectious diseases such as hepatitis B. In one large study, more infections and infectious diseases such as urinary tract infections, bacterial vaginosis, and HIV were found in women with type 3 FGC.10 This is probably because the damage caused by FGC can make vaginal tissue more likely to tear during sex. This increases the risk of HIV and other sexually transmitted infections (STIs).
- Problems having sex. Extra scar tissue from FGC (most common after type 2 or type 3) can cause pain, especially during sex. This can lead to a lack of interest in sex, vaginal dryness, and lower overall satisfaction.11 Scarring can also cause vaginal tissue to be less elastic than normal vaginal tissue. It might not stretch as easily for sex or childbirth.
- Depression and anxiety. Girls may not understand what is being done to them or why. The effects of this painful experience are similar to those of post-traumatic stress disorder. Girls or women who have already been cut and are living in the United States may be disgraced or humiliated when they receive medical care.12,13 They may also fear that health care providers in the United States do not know how to take care of them.14 This can make adjusting to a new country more challenging.
- Painful and prolonged menstrual periods. Type 3 FGC may cause some girls and women to have painful menstrual periods. Some women are left with only a small opening for urinating and menstrual bleeding. They may not be able to pass all of their menstrual blood. This can cause pain and periods that are longer than normal. Some women may also have infections over and over again.
- Urinary problems. Type 3 FGC may slow or strain the normal flow of urine, which can cause urinary tract infections. Urine can also get trapped behind the scar and crystallize, forming hard masses called bladder, or urinary, stones.
- Fistula, an opening between the urethra and vagina that lets urine run into the vagina. This can happen when the urethra is damaged during FGC. Fistula causes incontinence and other problems, including odors, and can cause girls and women to become social outcasts.
Girls and women who come to the United States and have already been cut may face additional health problems. Doctors and other health care providers may not know how to adequately treat the girls' and women's unique health needs. In some cases, health care providers lack training on counseling and caring for girls and women who have been cut.9
FGC does not usually cause problems for a woman during pregnancy, but women who have been cut face unique health risks during childbirth. These include:9
- Prolonged labor. Women with type 3 FGC are at greatest risk for a longer second stage of labor.
- Excessive bleeding after childbirth
- Higher risk for episiotomy(eh-pih-zee-AH-tuh-mee) during childbirth. A doctor makes a cut in the perineum(pair-uh-NEE-um), the flesh between the vagina and anus. There is also a higher risk that this flesh will tear on its own during birth. These risks are especially high for women who have had type 3 FGC.
- Higher risk for cesarean section (C-section). Doctors who are unfamiliar with scarring from FGC may suggest a C-section. However, a C-section may not be necessary. Women with type 3 FGC may have their vagina safely re-opened (defibulated) during pregnancy or in labor and delivery. But health care providers may not have the experience or training to provide adequate health care for women who have been cut.9,15
FGC is against the law in the United States. The United States and many other countries consider FGC a violation of women's rights and a form of child abuse. It is illegal in the United States to perform FGC on a girl younger than 18 or on a woman without her consent. It is against the law to send a girl younger than 18 outside the United States for an FGC procedure. Girls and women who have experienced FGC are not at fault and have not broken any U.S. laws.
The United States considers FGC to be a serious human rights abuse and a form of gender-based violence and child abuse.18 Many girls have FGC forced on them and have no choice about whether it happens. It is painful and offers no health benefits. And FGC often causes long-term physical and mental health problems. For these reasons, the U.S. government works with other governments and organizations to help end the practice.
Governments and groups in the United States and around the world are working together to end the practice of FGC. Some approaches include:
- Community involvement. Successful efforts to end or reduce the practice of FGC have the following in common:19
- Individuals from the community become trainers and educators. Many programs use respected local women to teach other girls and women in their communities about the harmful effects of FGC.
- Efforts focus on community needs and strengths, and recommendations from community members.
- The programs and the leaders of organizations respect the traditions and social structure of the community. Program participants earn community trust so that sensitive issues like FGC can be discussed honestly.
- Culturally sensitive programs include the use of theater, songs, and games to educate families about FGC.
- Passing laws against FGC. FGC is illegal in most countries around the world, including many of the countries in which FGC is regularly practiced.
Recent research shows that these efforts may be working. In some regions, education is changing attitudes and influencing a family's choice to have FGC performed. For example, in Egypt, 96% of women 45 to 49 years old were cut, but the percentage dropped to 81% among women 15 to 19 years old.2
Girls and women in the United States who have already been cut need access to clinically and culturally appropriate care from trained health care providers.
For more information about FGC, call the OWH Helpline at 800-994-9662 or contact the following organizations:
- GlobalHealth.gov, Office of Global Affairs, HHS
Phone Number: 202-690-6174
- U.S. Agency for International Development (USAID)
Phone Number: 202-712-4810
- African Women's Health Center
Phone Number: 617-732-4740
- American College of Nurse Midwives
- Position Statement: Female Circumcision (PDF, 80 KB)
- American College of Obstetricians and Gynecologists
- Amnesty International
Phone Number: 212-807-8400
- Center for Reproductive Rights
- International Counseling & Community Services (ICCS)
Phone Number: 206-816-3253
- Population Reference Bureau
Phone Number: 800-877-9881
- Refugee Women's Alliance
Phone Number: 206-721-0243
- Refugee Women's Health Clinic
Phone Number: 602-344-1445
- Sauti Yetu: Center for African Women and Families
Phone Number: 718-665-2486
- World Health Organization (WHO)
- Population Reference Bureau. (2015). Women and girls at risk of female genital mutilation/cutting in the United States.
- Population Reference Bureau. (2014). Female genital mutilation/cutting: data and trends (PDF, 870 KB).
- World Health Organization. (2008). Eliminating female genital mutilation. An interagency statement (PDF, 2.11 MB).
- United Nations Children's Fund (UNICEF). (2013). Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change (PDF, 22.7 MB).
- United Nations Population Fund. Frequently asked questions on female genital mutilation/cutting.
- Population Council. (2003). Female Circumcision in Indonesia (PDF, 383 KB).
- Abdulcadir, J., Margairaz, C., Boulvain, M., & Irion, O. (2011). Care of women with female genital mutilation/cutting. Swiss Medical Weekly. DOI: 10.4414/smw.2011.13137.
- Innocenti Digest UNICEF. (2005). Changing a harmful social convention: female genital mutilation/cutting (PDF, 635 KB).
- Reisel, D., & Creighton, S. M. (2015). Long-term health consequences of female genital mutilation (FGM) (PDF, 371 KB). Maturitas, 80, 48–51.
- Iavazzo, C., Sardi, T. A., & Gkegkes, I. D. (2013). Female genital mutilation and infections: a systematic review of the clinical evidence. Archives of Gynecology and Obstetrics, 287, 1137–1149.
- Andersson, S. H. A., Rymer, J., Joyce, D. W., Momoh, C., & Gayle, C. M. (2012). Sexual quality of life in women who have undergone female genital mutilation: a case-control study (PDF, 12 KB). BJOG: An International Journal of Obstetrics and Gynaecology, 119(13), 1606–1611. DOI: 10.1111/1471-0528.12004.
- Brown, E., Carroll, J., Fogarty, C., & Holt, C. (2010). "They get a C-section…they gonna die": Somali women's fears of obstetrical interventions in the United States. Journal of Transcultural Nursing, 21(3), 220–227. DOI: 10.1177/1043659609358780.
- Beine, K., Fullerton, J., Palinka, L., & Anders, B. (1995). Prenatal care conceptions in San Diego. Journal of Nurse Midwifery, 40(4), 376–381.
- Pavlish, C.L., Noor, S., & Brandt, J. (2010). Somali immigrant women and the American health care system: Discordant beliefs, divergent expectations, and silent worries. Social Science & Medicine, 71, 353–361.
- Nour, N. (2015). Female Genital Mutilation/Cutting: Health Providers Should Be Advocates For Change (PDF, 606 KB). Population Reference Bureau.
- Berg, R.C., & Underland, V. (2013). The obstetrics consequences of female genital/cutting: a systematic review and meta-analysis. Obstetrics & Gynecology International, 2013.
- World Health Organization. (2006). Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. The Lancet, 367, 1835–1841.
- U.S. Department of Justice. (2015). U.S. Government Fact Sheet on Female Genital Mutilation or Cutting (FGM/C) (PDF, 17.5 KB).
- Population Reference Bureau. (2006). Abandoning female genital mutilation/cutting: an in-depth look at promising practices (PDF, 1.57 MB).
All material contained on this page is free of copyright restrictions and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated.
This fact sheet was reviewed by:
Cailin Crockett, M.Phil., Special Assistant for Gender Policy & Elder Rights, Office of the Deputy Assistant Secretary for Aging, Administration for Community Living/Administration on Aging, U.S. Department of Health and Human Services
Wanda K. Jones, Dr.P.H., Principal Deputy Assistant Secretary for Health, U.S. Department of Health and Human Services
Crista Johnson-Agbakwu, M.D., MSc, FACOG, IF, Founder & Director, Refugee Women's Health Clinic, Obstetrics & Gynecology, Maricopa Integrated Health System; Research Assistant Professor, Obstetrics & Gynecology, University of Arizona College of Medicine — Phoenix; Assistant Research Professor, School of Social Work, Southwest Interdisciplinary Research Center (SIRC), College of Public Programs, Arizona State University
Bettina Shell-Duncan, Professor, Department of Anthropology and Adjunct Professor of Global Health, University of Washington
Nicole Warren, Ph.D., M.P.H., C.N.M., Assistant Professor, Johns Hopkins School of Nursing, and Certified Nurse Midwife, Johns Hopkins Hospital
Content last updated: September 4, 2015.
Content last reviewed: March 24, 2015.