Female Genital Surgery, Types of

Female genital surgery (FGS) refers to practices that involve the cutting, scarification, cauterization, piercing, tightening, and/or removal of female genitalia. Such surgeries are typically divided into two categories: (1) traditional practices (often termed female circumcision, female genital cutting, or female genital mutilation) that are most common in developing countries; and (2) medical procedures done for cosmetic reasons, which are most common in industrialized nations.

Traditional female genital surgeries are carried out for religious, aesthetic, social, or other nonmedical reasons. They have come under intense international scrutiny, particularly from human rights advocates. Surgeries are generally conducted without consent, without anesthesia, and are often performed by a midwife or elder female community member. They may be performed on girls anytime from infancy throughout adolescence (and on adult women, in some countries). A knife, razor blade, piece of glass, or other sharp object is used to cut or remove genital flesh. It is estimated that 2 to 3 million girls and women undergo traditional FGS annually, and over 120 million worldwide have had such surgeries. Traditional FGS practices are most common in Africa, but have also been documented in Asia, the Middle East, Central America, and South America.

The World Health Organization (WHO) has divided traditional FGS into four main types. Type I, commonly referred to as clitoridectomy, is the most common. The prepuce or clitoral hood is removed. The clitoris may also be partially or totally removed. Common side effects include bleeding, pain and shock, cysts, infection, keloid scars, nerve damage and loss of sensation, and transmission of human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), hepatitis, or other bloodborne pathogens as the cutting instrument may be used on multiple girls and is generally not sterilized. Individuals who undergo clitoridectomy may also experience psychological trauma.

Type II, or excision, involves the partial or total removal of the clitoris and labia minora. The labia majora may also be removed, and the wound is not stitched close. Side effects are similar to those experienced with Type I surgeries; however, scarring and blood loss are often more extensive with Type II surgeries. Together, Type I and Type II surgeries account for 80 to 85 percent of all traditional FGS practices.

Type III, infibulation (or Pharaonic circumcision), aims to narrow the vaginal opening by creating a covering or seal of skin and scar tissue. First, the labia majora and labia minora are cut or scraped away. The clitoris may also be removed. Next, the raw edges are brought together and secured with thorns or sewn shut so the wound may heal. An opening is maintained to allow for urine and menstrual blood to pass. When the infibulated individual is married [Page 528]the opening must be sufficiently dilated in order to allow intercourse to take place; if the opening is very small, it is cut open. Short-term risks associated with infibulation include those discussed above, as well as hemorrhage and septicemia. Long-term risks include recurrent urinary tract infections, pelvic disorders, and a variety of obstetrical complications, such as perineal tears, fetal obstruction, fistulas, and hemorrhaging. Infibulation has also been linked to higher maternal and neonatal mortality rates. After giving birth, a woman may be reinfibulated. Infibulation accounts for 10 to 15 percent of all traditional FGS surgeries worldwide; it is the most common type of FGS performed in Djibouti, Somalia, and northern Sudan. Type IV, or “unclassified,” includes all forms of piercing, pricking, cauterization, scraping, cutting, or stretching of the external genitalia done for social or religious purposes and not included in Types I-III. Type IV carry risks similar to those associated with Type I surgeries.

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