Female genital mutilation affects millions of girls and women, yet it is often discussed through vague language, unreliable statistics, or stereotypes about particular communities. Clear information matters. Female genital mutilation, commonly abbreviated as FGM, is not a medically beneficial procedure or a harmless cultural variation. It is an injury to female genital organs performed for non-medical reasons, usually before a girl is old enough to give meaningful consent.
The practice can lead to immediate medical emergencies, lifelong physical complications, sexual difficulties, psychological distress, and problems during pregnancy and childbirth. At the same time, survivors are not a single, interchangeable group. Some experience severe complications, while others have few symptoms. Some prefer the term female genital cutting or FGM/C, while others identify strongly with the language of mutilation and human rights.
This guide explains the four recognized types of FGM, possible complications, current prevalence estimates, treatment options, prevention strategies, and the real-world experiences that can shape a survivor’s contact with health care.
What is female genital mutilation?
Female genital mutilation includes procedures that partially or completely remove external female genital tissue or otherwise injure the female genital organs for non-medical reasons. It has no health benefits. It differs from surgery performed to treat disease, repair an injury, address a congenital condition, or provide medically indicated obstetric care.
FGM is most often performed between infancy and age 15, although the age varies among communities. Some procedures occur shortly after birth, while others are associated with adolescence, marriage, pregnancy, or preparation for adulthood.
The words used to describe the practice can affect communication. “Female circumcision” is sometimes used within practicing communities, but health and human-rights organizations generally avoid that term because it can create a misleading comparison with male circumcision. In clinical settings, a patient may prefer FGM, FGM/C, cutting, or a term from her first language. Respectful care begins by asking rather than assuming.
FGM is not one standardized procedure
The term describes a broad range of injuries. The World Health Organization classifies them into four categories, but actual anatomy may not fit neatly into a textbook diagram. The person carrying out the cutting is generally not working from a medical classification system, and scar formation can further change what clinicians later observe.
The four types of female genital mutilation
Type I: Partial or total removal of the clitoral glans
Type I involves partial or total removal of the clitoral glans, the externally visible and highly sensitive part of the clitoris, and sometimes the clitoral hood or prepuce. Type Ia generally refers to removal of the clitoral hood alone, while Type Ib includes removal of the clitoral glans with the hood.
Even when the visible injury appears limited, Type I can cause bleeding, infection, nerve pain, scar sensitivity, sexual pain, and psychological trauma. Describing it as “minor” can minimize what happened and discourage a patient from discussing symptoms.
Type II: Excision involving the labia
Type II involves partial or total removal of the clitoral glans and labia minora, with or without removal of the labia majora. The amount of tissue removed varies considerably.
Possible consequences include extensive scarring, narrowing around the vaginal opening, chronic vulvar pain, cyst formation, discomfort during menstruation, pain during sex, and reduced tissue flexibility during childbirth. Damage may also extend beyond the tissue that was intentionally cut.
Type III: Infibulation
Type III, also called infibulation, involves narrowing the vaginal opening by cutting and repositioning the labia minora or labia majora to create a covering seal. The tissue may be held together while it heals, sometimes with sutures or other materials. A small opening is generally left for urine and menstrual blood. The clitoral glans may or may not also be removed.
This is the most anatomically extensive category and is especially associated with slow urination, urinary infections, menstrual obstruction, pain during penetration, difficulty with pelvic examinations, and childbirth complications. Some patients benefit from deinfibulation, a medical procedure that opens the scar seal.
Type IV: Other non-medical injury
Type IV includes other harmful procedures performed for non-medical reasons, such as pricking, piercing, incising, scraping, stretching, or cauterizing genital tissue. The category is broad, and the resulting injury can range from small scars to serious tissue damage.
Type IV should not be dismissed simply because no large amount of tissue was removed. Pain, infection, bleeding, fear, nerve damage, and emotional trauma can follow any intentional genital injury.
Immediate complications of FGM
FGM may be performed without anesthesia, sterile equipment, trained medical staff, or access to emergency treatment. However, performing it in a clinic does not make it safe or medically acceptable. Medicalization changes the setting, not the absence of benefit or the violation involved.
Severe pain and traumatic stress
External genital tissue contains many nerve endings. Cutting can cause intense pain, especially when anesthesia is unavailable or inadequate. Being restrained, separated from trusted caregivers, or deceived about what will happen may intensify the trauma.
Heavy bleeding and shock
Injury to blood vessels can cause dangerous blood loss. Severe bleeding may lead to shock, organ damage, or death when emergency care is unavailable.
Infection
Contaminated instruments, unclean surfaces, reused blades, and untreated wounds increase the risk of bacterial infection, tetanus, abscesses, and blood-borne infections. A wound may also seal over contaminated material, allowing an infection to develop beneath the scar.
Urinary retention and tissue injury
Swelling, pain, and obstruction may make urination difficult or impossible. Nearby structures, including the urethra, may be unintentionally injured. Damage can extend to the vagina, anus, or surrounding tissue.
Long-term complications of female genital mutilation
Not every survivor develops every complication. Outcomes are influenced by the type of FGM, the amount of tissue damage, infection, scar formation, access to treatment, childbirth history, and individual anatomy. A survivor’s health should therefore be assessed personally rather than predicted from a label.
Urinary and menstrual problems
Scar tissue may redirect or slow urine flow, causing straining, prolonged urination, recurrent urinary tract infections, or urine collecting behind a scar. With Type III FGM, menstrual blood may pass slowly through a small opening, contributing to prolonged periods, pain, recurrent infections, or difficulty using menstrual products.
Scars, cysts, and chronic pain
FGM can produce thick or raised scars, inclusion cysts, abscesses, and painful nerve growths called neuromas. Some survivors experience burning, pulling, numbness, itching, or sharp pain years after the original injury. Symptoms may worsen during menstruation, exercise, sexual activity, or pregnancy.
Sexual health complications
Possible sexual effects include pain during penetration, reduced lubrication, fear of anticipated pain, difficulty reaching orgasm, decreased desire, and relationship stress. Sexual response is complex, however. The internal clitoral structure extends beyond the visible glans, and some women with FGM continue to experience desire, pleasure, and orgasm.
Health professionals should avoid declaring that a patient’s sexual function has been “destroyed.” That assumption is medically simplistic and can become a second injury delivered in a white coat.
Mental health effects
FGM may be associated with post-traumatic stress symptoms, anxiety, depression, sleep problems, intrusive memories, shame, and fear of medical examinations. A person may also have conflicting emotions toward relatives who arranged the procedure, particularly when those relatives believed they were fulfilling a social responsibility.
Other survivors may not describe the event as traumatic until a later experiencesuch as childbirth, migration, a medical examination, or learning how FGM is viewed elsewherechanges their understanding of it.
Pregnancy and childbirth complications
Scar tissue does not stretch like uninjured tissue. FGM, particularly more extensive forms, may contribute to prolonged labor, difficult examinations, genital tearing, assisted delivery, cesarean birth, and heavy bleeding after delivery. Obstructed access can complicate catheter placement and emergency procedures.
Appropriate prenatal planning can reduce risk. Patients with Type III FGM may be offered deinfibulation before pregnancy, during pregnancy, or during labor, depending on their anatomy, symptoms, preferences, and clinical circumstances.
Fertility concerns
FGM does not automatically cause infertility, but severe infection, pelvic inflammatory disease, painful intercourse, or obstructed penetration may make conception more difficult. Fertility concerns deserve a complete evaluation rather than being attributed to FGM without evidence.
How prevalent is FGM worldwide?
More than 230 million girls and women alive today are estimated to have undergone FGM. Updated global estimates released in 2024 represented an increase of approximately 30 million compared with estimates published eight years earlier.
Africa accounts for the largest share, with more than 144 million affected girls and women. More than 80 million are estimated to live in Asia, over six million in the Middle East, and another one to two million in smaller practicing communities and migration-destination countries elsewhere.
More than four million girls were estimated to be at risk during 2026. That figure describes risk, not a prediction that every one of those girls will undergo FGM.
Why can the total rise while prevalence rates fall?
In several countries, younger generations are less likely to undergo FGM than older generations. That is genuine progress. Yet population growth in countries where FGM remains common can increase the absolute number of affected girls, even while the percentage declines.
Progress is also uneven. Conflict, displacement, poverty, disrupted education, weak health systems, and reduced funding for community programs can make prevention more difficult. National averages may hide major differences between regions, ethnic groups, cities, rural communities, and generations.
FGM is not limited to one continent or religion
National survey data are concentrated in parts of Africa, the Middle East, and Asia, but FGM also occurs in communities elsewhere, including parts of Europe, North America, South America, and the Pacific. It is practiced among communities with different religious identities and is not unique to a single faith.
Female genital mutilation in the United States
A CDC estimate published in 2016 concluded that as many as 513,000 girls and women living in the United States may have experienced FGM or could be at risk. The estimate was based largely on 2012 population data and country-of-origin prevalence rates.
This number is frequently misunderstood. It is not a count of 513,000 procedures performed in the United States, nor is it a current measurement of domestic incidence. It combines people who may already have undergone FGM with those considered potentially at risk, using an indirect statistical method.
Accurate U.S. prevalence is difficult to determine because medical records may not document FGM consistently, patients may not disclose it, clinicians may lack training, and families may fear stigma or legal consequences. Migration patterns and attitudes can also change over time. Many families who come from countries where FGM is practiced oppose it.
U.S. law and child protection
Federal law prohibits performing FGM on a person younger than 18 and prohibits transporting a minor for the purpose of having it performed. Tradition, custom, or parental approval does not create a legal exception. Many states also have specific laws addressing FGM, while general child-abuse laws and mandatory-reporting duties may apply in other situations.
Safeguarding should focus on protecting the child without treating an entire ethnic or immigrant community as automatically suspect. Risk assessment must be based on evidence, family circumstances, expressed intentions, travel plans, and the child’s safetynot nationality alone.
Why does FGM continue?
FGM is maintained through social expectations rather than one universal motive. Families may believe it is necessary for marriage, social acceptance, cleanliness, modesty, adulthood, family honor, or control of sexuality. In tightly connected communities, refusing the practice can bring criticism, exclusion, or fear that a daughter will be rejected.
These pressures help explain why individual education alone is often insufficient. A parent may understand the health risks and still fear the social consequences of refusing. Successful prevention therefore involves respected community members, survivors, young people, health professionals, educators, religious leaders, and men as well as women.
Understanding social pressure does not excuse the harm. It helps prevention programs replace condemnation with practical support for families choosing abandonment.
Treatment and supportive care for FGM survivors
Trauma-informed medical care
A clinician should explain why each question or examination is recommended, obtain consent at every stage, offer an interpreter when needed, and allow the patient to pause or decline. An examination should never be performed merely to satisfy curiosity or confirm a cultural assumption.
Visible shock, pity, or intrusive questioning can make a patient feel displayed rather than treated. Calm language is not indifference; it is professionalism.
Deinfibulation
Deinfibulation surgically opens the scar tissue created by Type III FGM. It may improve urinary or menstrual flow, facilitate penetration and gynecologic examinations, reduce some forms of pain, and prepare for vaginal birth. It does not reverse every effect of FGM, and the decision should be individualized.
Multidisciplinary treatment
Depending on symptoms, care may involve an obstetrician-gynecologist, urogynecologist, urologist, pelvic-floor physical therapist, sexual-health specialist, pain clinician, mental-health professional, or surgeon experienced in FGM-related anatomy.
Treatment can include pain management, cyst or neuroma treatment, infection care, counseling, pelvic-floor therapy, sexual education, deinfibulation, and selected reconstructive procedures. Evidence for some reconstructive techniques is still developing, so benefits, limitations, and surgical risks should be discussed without promising a complete restoration of anatomy or sensation.
Prevention: What is most likely to work?
Laws establish an essential boundary, but laws alone rarely change a social norm. Prevention is strongest when communities can abandon FGM collectively, allowing families to protect their daughters without sacrificing every important social relationship.
Effective efforts may include age-appropriate education, keeping girls in school, confidential health services, survivor-led advocacy, engagement with parents and elders, public declarations of abandonment, training for clinicians and teachers, and economic opportunities for women.
Medical professionals must also reject medicalization. There is no medically acceptable version of FGM, including a symbolic nick performed to satisfy family expectations.
Conclusion
Female genital mutilation includes four broad categories of non-medical genital injury, from cutting of the clitoral hood to infibulation and other forms of piercing, scraping, or cauterization. Every type can cause harm, although complications vary widely between individuals.
Globally, more than 230 million girls and women live with the consequences. The scale is enormous, but the statistics should never eclipse the people behind them. Survivors need skilled health care, privacy, informed choices, and freedom from stigma. Girls at risk need protection that is firm, culturally informed, and centered on their safety.
Ending FGM requires more than identifying a harmful act. It requires helping communities replace the social conditions that sustain it, while ensuring that survivors are treated as complete human beings rather than as diagnoses, evidence, or cautionary tales.
Extended experience section: What FGM-related care can feel like
The following scenarios are composites based on themes reported in survivor and health-care research. They do not describe identifiable individuals, and no single story represents every survivor.
An appointment shaped by consent
A woman schedules a routine cervical screening. She has postponed it twice because a previous clinician called several coworkers into the room after noticing unfamiliar scar tissue. Nobody asked whether additional observers were acceptable. The experience left her feeling less like a patient than a surprise item at a medical conference.
At the new appointment, the clinician asks which words she prefers, explains each part of the examination, and makes clear that it can stop at any time. The patient chooses a smaller speculum and asks to insert it herself. The procedure still feels uncomfortable, but she leaves with something she did not have before: confidence that she can return for preventive care without surrendering control.
Pregnancy brings old anatomy into a new chapter
A pregnant patient with Type III FGM has never considered deinfibulation because urination and menstruation, although slow, have always seemed normal to her. During prenatal care, a midwife explains how the scar may affect examinations and delivery. The conversation takes place early, not during an emergency in active labor.
The patient learns that deinfibulation may be performed during pregnancy or labor. She discusses pain control, healing, sexual concerns, cultural expectations, and whether she wants her partner involved. Her final decision is based on her health and preferences rather than pressure from relatives or clinicians. The key experience is not simply receiving surgery; it is being given understandable choices before the delivery room becomes urgent.
Chronic pain finally receives a name
Another survivor has lived for years with a small, intensely painful lump beneath a scar. She assumes pain is an unavoidable consequence of what happened and avoids tight clothing, cycling, and sexual activity. A specialist identifies a likely cyst or neuroma and explains that treatment may be possible.
The diagnosis changes how she sees her body. The pain is not a punishment, a private failure, or something she must silently tolerate. It is a medical symptom. Treatment may involve medication, pelvic-floor therapy, counseling, or surgery, depending on the cause. Even when symptoms cannot be eliminated completely, being believed can reduce the isolation surrounding them.
Prevention inside a family
A mother who underwent FGM as a child is preparing to visit relatives with her young daughter. She opposes cutting, but older family members describe it as a duty and accuse her of abandoning tradition. She worries that someone may arrange the procedure without her permission.
A community advocate helps her create a safety plan, understand the law, speak with her daughter in age-appropriate language, and identify relatives who will support her decision. A pediatrician documents the concern without interrogating the child or insulting the family’s background.
This experience shows why prevention cannot rely on a poster that simply says “FGM is bad.” Families may need confidential advice, legal information, health education, allies within their community, and practical help resisting pressure. Protection is most durable when a parent can say noand knows she will not be saying it alone.
