Female genital mutilation or cutting (FGM/C) means piercing, cutting, removing, or sewing closed all or part of a girl's or woman's external genitals for no medical reason. Researchers estimate more than 513,000 girls and women in the U.S. have experienced or are at risk of FGM/C. Worldwide, as many as 140 million girls and women alive today have been cut. FGM/C is often a part of the culture in countries where it is practiced. But FGM/C has no health benefits and can cause long-term health problems. FGM/C is against the law in the U.S. and many other countries.

What is FGM/C?

The World Health Organization (WHO) and the United Nations (UN) define FGM/C 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.

FGM/C is sometimes called "female circumcision." FGM/C is not the same as male circumcision.

A general term encompassing three types of excision of the external female genitalia - Sunna, clitoridectomy, and infibulation. It is associated with severe health risks and has been declared illegal in many places, but continues to be widely practiced in a number of countries, particularly in Africa.

The World Health Organization (WHO) describes four major types of FGM/C. Types 1 and 2 are the most common, but all types may be harmful.

The four types of FGM/C are:

• Type 1: Partial or total removal of the clitoris. This is also called clitoridectomy.
• 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. 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)

An estimated 100 to 140 million women alive today have undergone FGM/C. Three million girls and women may be at risk of FGM/C each year. 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. 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 513,000 girls and women have experienced FGM/C or are at risk of FGM/C.

Girls and women who live in the countries where FGM/C is practiced most often 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.

The specific community or part of the country a girl or woman lives in can increase or decrease her risk of certain types of FGM/C. For example, different ethnic groups may perform different types of FGM/C. 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 FGM/C.

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 FGM/C is practiced, girls are cut before 5 years old. In other countries, most girls are cut between 5 and 14.
• Sometimes, FGM/C is done to adult women. Women may be cut just before marriage. Some communities wait until the first pregnancy.

FGM/C is done mostly in parts of northern and central Africa, in the southern Sahara, and in parts of the Middle East and Asia.

Some immigrants in the United States and Western Europe from these countries also practice FGM/C, or may send their daughters back to their family homeland for FGM/C. Other immigrant families stop practicing FGM/C once they are in a new country.

Different communities and cultures have different reasons for practicing FGM/C; the reasons are often complex and can change over time. 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, FGM/C 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 FGM/C increases sexual pleasure for the man
• Religious duty, although no religion's holy texts require FGM/C

FGM/C can cause immediate and long-term medical problems. How bad these problems are depends on:

• How clean (sterile) the place is where cutting happens. FGM/C is illegal in most countries and must be done in secret. In most of these countries, FGM/C 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 FGM/C in a sterile, medical site.
• The experience of the person performing FGM/C 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 FGM/C, the sewing may be done with thorns and without sterile thread.
• The type of FGM/C. Type 3 causes more health problems than type 1 or type 2.
• The general health of the girl or woman

The type of FGM/C done may affect how much and how serious health problems are after FGM/C. Type 3 causes more health problems than type 1 or type 2.

Immediate medical problems can include:

• 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 FGM/C. Few records are kept, and deaths that may have been caused by FGM/C are often not reported as related to FGM/C.

FGM/C can cause long-term problems with a girl's or woman's physical, mental, and sexual health. The type of FGM/C 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:

• 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 FGM/C. This is probably because the damage caused by FGM/C 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 FGM/C (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. 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. They may also fear that health care providers in the United States do not know how to take care of them. This can make adjusting to a new country more challenging.
• Painful and prolonged menstrual periods. Type 3 FGM/C 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 FGM/C 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 FGM/C. 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.

FGM/C does not usually cause problems for a woman during pregnancy, but women who have been cut face unique health risks during childbirth. These include:

• Prolonged labor. Women with type 3 FGM/C are at greatest risk for a longer second stage of labor.
• Excessive bleeding after childbirth
• Higher risk for episiotomy during childbirth. A doctor makes a cut in the perineum, 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 FGM/C.
• Higher risk for cesarean section (C-section). Doctors who are unfamiliar with scarring from FGM/C may suggest a C-section. However, a C-section may not be necessary. Women with type 3 FGM/C 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.

Risks to the infant include low birth weight (smaller than 5½ pounds at birth), breathing problems at birth, and stillbirth or early death.

FGM/C is against the law in the United States. The United States and many other countries consider FGM/C a violation of women's rights and a form of child abuse. Federal law makes it a crime to perform FGM/C on a girl younger than 18 or to take or attempt to take a girl out of the United States for FGM/C. Girls and women who have experienced FGM/C are not at fault and have not broken any U.S. laws.

The United States considers FGM/C to be a serious human rights abuse and a form of gender-based violence and child abuse. Many girls have FGM/C forced on them and have no choice about whether it happens. It is painful and offers no health benefits. And FGM/C 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 FGM/C. Some approaches include:

• Community involvement. Successful efforts to end or reduce the practice of FGM/C have the following in common:
  • 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 FGM/C.
  • 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 FGM/C can be discussed honestly.
  • Culturally sensitive programs include the use of theater, songs, and games to educate families about FGM/C.
• Passing laws against FGM/C. FGM/C is illegal in most countries around the world, including many of the countries in which FGM/C 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 FGM/C 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.

If you think a girl is at risk of FGM/C, contact your state's child protective services agency.

You may also contact the Human Rights and Special Prosecutions Section of the Department of Justice at 1-800-813-5863 or hrsptips@usdoj.gov or the Human Rights Violator and War Crimes Unit of the Department of Homeland Security at 1-866-DHS-2-ICE (866-347-2423) or HRV.ICE@ice.dhs.gov.

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.