Female genital cutting: clinical and cultural guidelines

Clinical guidelines for managing women who have undergone female genital cutting are essential in providing appropriate and culturally competent care. The objectives of this study were to review the literature, describe the types of female genital cutting, evaluate its immediate and long-term complications, and provide clinical guidelines for managing women who have undergone this procedure. We conducted an extensive literature search on the MEDLINE database (1966-2003) for articles pertaining to female circumcision/genital mutilation/cutting. The search was extended further by citations in these journals not identified in MEDLINE. National and international nongovernmental organizations provided articles not available in American libraries. The author has developed guidelines based on personal experience and recommendations from the literature. The major inclusion criteria limited the search to: 1) English language, 2) medical journals, 3) WHO publications, 4) medical society publications, 5) case studies and statistical data on medical complications, 6) infertility and sexual issues, 7) U.S. legal practice, and 8) deinfibulation. The exclusion criteria pertained to articles: 1) reviewing the literature, 2) lacking epidemiologic data, 3) addressing political and ethical issues, and 4) discussing international concerns. Immediate complications include hemorrhage, infection, urinary dysfunction, shock, or death. Long-term complications include urinary complications, scarring, pain, infection, and infertility. Obstetric complications include lacerations, wound infections, postpartum hemorrhage, and sepsis. Fetal complications are rarely seen in Western countries. Women who have undergone female genital cutting can experience complications. Practitioners must recognize the type of circumcision, ensure cultural competency, and provide appropriate clinical care.