Female genital mutilation (FGM) is the practice of cutting or removing all or part of the external female genitals. These include the clitoris and its hood (prepuce), the labia minora and the labia majora. In some cases, the labia majora are sewn together or otherwise attached to each other, essentially blocking the opening to the vagina.

FGM is traditionally practiced in much of Africa and some parts of the Middle East and Asia. In these areas, it is generally considered an honored rite of passage for females, although some girls and women in these regions have in recent years begun resisting it. Of the 28 African nations that practice FGM, 14 countries have laws prohibiting it. However, the laws may not be enforced and the practice is still widespread. Only a few nations (Burkina Faso, Egypt, Ghana, Senegal and Sierra Leone) have arrested or charged people for practicing FGM.

In most Western countries the practice is discouraged or illegal and considered medically unnecessary and harmful. Although FGM is illegal in these countries, Western nations have experienced an influx of women with FGM as immigration from Africa and Asia has increased. It is sometimes performed in immigrant cultures in the United States, Canada, Europe and other developed regions.

The type of female genital mutilation varies by area and culture. In some places, it may be only a small, symbolic cut or scarring. Some groups in Kenya have succeeded in replacing the procedure with a rite of passage for girls that does not involve any cutting.

The World Health Organization (WHO) has divided female genital mutilation into four categories:

• Type I includes the removal of the hood of the clitoris (clitoridotomy) and may include the partial or total excision of the clitoris (clitoridectomy).
  
  
• Type II includes clitoridectomy and the partial or total excision of the labia minora. This is the most widely practiced form of FGM.
  
  
• Type III is called infibulation. It includes all procedures in Type II (clitoridectomy, partial or total excision of the labia minora) and cutting of the labia majora. The two sides of these labia are joined together with stitches, paste or thorns. The labia eventually fuse and cover most of the vaginal opening, with just a small opening remaining for urine and menstrual blood to pass.
  
  
• Type IV involves other methods not classified in the types above, such as pricking, burning, scarring or stretching the external genitalia.

FGM usually takes place before puberty, between the ages of 4 and 12 years. However, it may take place in infancy or shortly before a woman is married. The practice may be performed for one girl, but commonly includes a group of girls of a similar age. It is usually performed by a midwife or by another woman, most commonly someone with no medical training. A girl will be held and the genital area is cut with a knife, scissors or even a piece of broken glass. For infibulation, the labia may be sewn or held together with thorns or some sort of paste, leaving just a small opening for the passage of urine and menstrual blood. Some girls may have their legs bound together to promote healing and fusing of the labia.

The procedure is quite painful for a girl and may involve excessive bleeding. Anesthesia is not often used and the conditions are usually not sterile. In some cases, the procedure is performed by a physician or other medical professional. The WHO and other medical organizations have condemned this practice, indicating that the procedure is unnecessary and harmful and should not be legitimized by the medical establishment.

When a woman is ready to be married, the genital area can be opened, either by cutting, gradual dilation with instruments or more commonly through sexual intercourse with her husband. The previously performed FGM causes pain during the initial intercourse (dyspareunia), which may continue throughout a woman’s life.

Cultures practice FGM for a variety of reasons. It is considered a rite of passage for girls and makes them accepted members of their community. This conveys higher status to the girl’s family and makes her eligible for a better marriage. Those who promote FGM believe that by reducing female sexual response, it will discourage sexual promiscuity and help maintain a girl’s virginity until marriage. Some societies consider the female genitals unattractive and potentially harmful if touched by a man’s genitals or by a baby during childbirth. Some people consider it a tenet of religion, particularly Islam. However, FGM is practiced in many faith communities in Africa (indigenous religions, Muslim, Jewish and Christian) and predates the arrival of Islam in these areas.

Women who have undergone FGM may consider it a normal part of life and may not think they have been mutilated. They may think it is necessary for a good marriage in their culture. Many continue to encourage the practice for their own daughters and granddaughters. Women in some of these cultures have little exposure to outside societal influences. When these women move to other locations, some may be shocked that other people and medical professionals consider them mutilated. However, other women may have had the procedure performed against their will and now can seek relief without being condemned by their culture.