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Female Genital Mutilation (FGM)

The World Health Organization has classified female genital mutilation in 4 major sub-types.  Today saw Type IIa, removal of the labia minora which has had a profound psychological effect on this lady’s ability to enjoy sex.  Yes, she is married, yes she has had 3 children and her husband was present in the office with her.  Her Female Sexual Funcion Index (FSFI) score was about 5.2 on a scale of  (2 to 36)

The complete typology with sub-divisions is described below:

  • Type I — Partial or total removal of the clitoris and/or the prepuce (clitoridectomy). When it is important to distinguish between the major variations of Type I mutilation, the following subdivisions are proposed:
    • Type Ia, removal of the clitoral hood or prepuce only; Type Ib, removal of the clitoris with the prepuce.
  • Type II — Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed:
    • Type IIa, removal of the labia minora only; Type IIb, partial or total removal of the clitoris and the labia minora; Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora.
  • Type III — Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation). When it is important to distinguish between variations in infibulations, the following subdivisions are proposed:
    • Type IIIa, removal and apposition of the labia minora; Type IIIb, removal and apposition of the labia majora.
  • Type IV — All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

What an abhorrent practice.

Harold M. Reed, M.D.

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