Please note that when WHO refers to labia minora and majora such terms are now replaced by inner and outer labia.

1 FGM/C Type I

Fig. 5.1
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Diagram of FGM/C type Ia (cutting of the prepuce/clitoral hood) and type Ib (cutting of the prepuce/clitoral hood and the visible part of the clitoris). (Reprinted with permission from WHO [17])

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Fig. 5.2
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FGM/C type Ia (partial removal of the left side edge of the prepuce), 10-years old, from Ivory Coast (a, b). (Courtesy of Céline Deguette)

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Fig. 5.3
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FGM/C type Ia (partial removal of the prepuce) in three adult women (a1 and a2) 28-years old, from Senegal, (b) 36-years old, from Nigeria (ethnic group Icha), and (c) 44-years old, from Ivory Coast. (Courtesy of Jasmine Abdulcadir [8] (a) and Céline Deguette (b, c)). The woman in figure a underwent FGM/C at around the age of 10–12, the woman in figure b at 6, the woman in figure c at 8

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Fig. 5.4
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FGM/C type Ib or no FGM/C in a 2-year-old Ethiopian girl. She had just arrived in the US with her mother and they were being reunited with the father of the child. The mother denied a history of FGM/C. The experts disagreed in the diagnosis. For some, there was FGM/C type Ib. For some others, there was no cutting. Estrogen cream was applied without any changes in the appearance. (Courtesy of Janine Young)

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Fig. 5.5
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FGM/C type Ib (cutting of the prepuce and glans of the clitoris), 3-years old, from Mali. Please note that the FGM/C might also be classified as IIb as the scar reaches the right inner labium. (Courtesy of Céline Deguette)

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Fig. 5.6
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FGM/C type Ib, (a1 and a2) adult woman, from Nigeria. Courtesy of Jasmine Abdulcadir (8) (b) FGM Ib or IIb, 39 years old, from Nigeria, ethnic group: Legos. Total removal of the prepuce of the clitoris and cutting of the clitoris with removal of the posterior right side of the inner labium. The woman in figure b underwent FGM/C when less than 1-year-old. Courtesy of Céline Deguette

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2 FGM/C Type II

Fig. 5.7
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Diagram of FGM/C type IIa (cutting of labia minora only) (a); type IIb (cutting of the labia minora and the visible part of the clitoris more or less the clitoral hood) (b); and type IIc (cutting of the labia minora, majora, and the clitoris). (Reprinted with permission from WHO [17])

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Fig. 5.8
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FGM/C IIa (cutting of the left inner labium) of a prepubertal girl of 9-years old from Eritrea (a–c). She had undergone FGM/C as a newborn. (Courtesy of Jasmine Abdulcadir)

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Fig. 5.9
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FGM/C type IIa (cutting of the inner labia), 30-years old, from Senegal. (Courtesy of Jasmine Abdulcadir [8])

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Fig. 5.10
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FGM/C type IIb (a) 4-years old, from Mali, having undergone FGM/C after birth (Courtesy of Céline Deguette). (b) 3-years old, from Mali (Courtesy of Céline Deguette). (c) 4-years old, from Mali, having undergone FGM/C at age 2. A keloid is present above the cut clitoris. (Courtesy of Céline Deguette). (d) 5-years old, from Mali. (Courtesy of Céline Deguette); (e) prepubertal girl, from Mali (Courtesy of Moustapha Touré)

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Fig. 5.11
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FGM/C type IIb in adult women. (a) 30-years old, from Eritrea, cutting of the inner labia, the prepuce, and the glans of the clitoris. She had undergone FGM/C as a newborn (Courtesy of Jasmine Abdulcadir [8]). (b) 26-years old, from Senegal, ethnic group: Soninke. Cutting of the clitoris, clitoral hood, and inner labia. She had undergone FGM/C at her birth (Courtesy of Céline Deguette). (c) 25-years old, from Ivory Coast, ethnic group: Dioula. Partial removal of the prepuce of the clitoris and inner labia. She had undergone FGM/C at age 8 (Courtesy of Céline Deguette). (d) 30-years old, from Senegal, she describes pain during sexual intercourse (Courtesy of Céline Deguette). (e) 36 years old, from Ivory Coast, cutting of the prepuce of the clitoris and clitoris with the left inner labium. She underwent FGM/C when less than 4 years old. (Courtesy of Céline Deguette)

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Fig. 5.12
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FGM/C type IIb or IIc or IIIa in a prepubertal girl. The experts disagreed in the classification of this FGM/C. For some, there is cutting of the clitoral hood, the clitoris, and the inner labia (FGM/C type IIb). For others, there is cutting of the outer labia too (FGM/C type IIc). Finally, as there is a partial adhesion of the inner labia covering the urethral meatus, some authors would classify this picture as FGM/C type IIIa with cutting of the clitoris. Source: Graham EA. Ritual Female Genital Cutting [RFGC] PowerPoint slides. 2014. Available at: https://ethnomed.org/resource/ritual-female-genital-cutting-rfgc-powerpoint-slides/ (CC BY-NC-ND 3.0 US) [58]

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Fig. 5.13
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FGM/C type IIc (a) 30-years old from Eritrea and (b) 40-years old from Burkina Faso. (Courtesy of Jasmine Abdulcadir [8])

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3 FGM/C Type III

Fig. 5.14
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FGM/C type III. Often referred to as infibulation. Narrowing of the vaginal opening with the creation of a covering seal. The seal is formed by cutting and appositioning the labia minora, or labia majora. The covering of the vaginal opening is done with or without removal of the clitoral prepuce/clitoral hood glans and, part of the body of the clitoris. When it is important to distinguish between variations of Type III FGM/C, the following subdivisions are used: Type IIIa. Removal and appositioning of the labia minora (a). Type IIIb. Removal and appositioning of the labia majora (b). (Reprinted with permission from WHO [17])

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Fig. 5.15
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FGM/C Type IIIa in prepubertal girls from Mali (a–e). (Courtesy of Moustapha Touré)

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Fig. 5.16
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FGM/C Type IIIa with cutting of the clitoris in a prepubertal girl (a) 11-years old, from Somalia (Courtesy of Martin Caillet). (b) Prepubertal girl, from Gambia. A urinary catheter is inserted (Courtesy of Adriana Kaplan Marcusan)

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Fig. 5.17
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FGM/C type IIIa, 12-years old from Ethiopia (a, b). (Courtesy of Amelia Valladolid)

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Fig. 5.18
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FGM/C Type IIIa in adult women from Mali (a–i). (Courtesy of Moustapha Touré)

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Fig. 5.19
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FGM/C type IIIa. (a) 28-years old, from Somalia with cutting and apposition of the inner labia, and cutting of the clitoral hood. She had undergone FGM/C at the age of 8. (b) 25-years old, from Somalia, narrowing of the vaginal orifice by the apposition of the inner labia after cutting of the inner labia, the clitoral hood, and the clitoris. She had undergone FGM/C at age 7 (Courtesy of Céline Deguette). (c) 33-years old, from Mali, narrowing of the vaginal orifice by the apposition of the inner labia after cutting of the inner labia, the clitoral hood, and the clitoris. She had undergone FGM/C at age 2 (Courtesy of Céline Deguette)

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Fig. 5.20
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FGM/C type IIIb in prepubertal girls from Mali (a–g). (Courtesy of Moustapha Touré)

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Fig. 5.21
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FGM/C type III b in adults (a) from Eritrea and (b) from Somalia. (Courtesy of Jasmine Abdulcadir [8])

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4 FGM/C Type IV

Fig. 5.22
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FGM/C type IV. Unclassified. All other harmful procedures to the female genitalia for nonmedical purposes, for example, pricking, piercing, incising, scraping, and cauterization and, stretching of the labia minora. (Reprinted with permission from WHO [17])

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Fig. 5.23
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FGM/C type IV (nicking), 6-months old, from Ivory Coast, born in France. Linear scar on the left outer labium. (Courtesy of Céline Deguette)

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Fig. 5.24
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FGM/C type IV in adult women. (a) Piercing in an adult woman from Switzerland (Courtesy of Jasmine Abdulcadir [8]). (b) and (c) 36 years old from Zambia. Stretching of the inner labia at 12 years old. Asymptomatic. Each time you report (Courtesy of Jasmine Abdulcadir). (d) and (e) khatna, nicking. 39 years old, born in France from a mother from a region in India on the border with Pakistan (Dawoodi Bohra community). She underwent FGM/C at age 6 during a trip to India. A linear scar is visible on the left side of the prepuce (white circle). Photo taken with a colposcope (Courtesy of Jasmine Abdulcadir). (f), (g) and (h) Linear scar of nicking of the prepuce of the clitoris in a 41-year-old woman from Kurdistan (black circle). She refers having undergone FGM/C at the age of 6, at home, in Kurdistan with spontaneous healing in 4–5 days after the cutting. Perineal scarring post two vaginal births and hemorrhoids. There is an asymmetry of the inner labia, probably unrelated to the history of FGM/C. For some examiners, there might be a doubt for a differential diagnosis of FGM/C type IIa (cutting of the right inner labium) and an obstetric perineal scar (Courtesy of Jasmine Abdulcadir)

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