Current Sexual Health Reports

, Volume 11, Issue 2, pp 108–114 | Cite as

Female Genital Cutting in Immigrant Children—Considerations in Treatment and Prevention in the United States

  • Janine YoungEmail author
Sociocultural Issues and Epidemiology (J Abdulcadir and C Johnson-Agbakwu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Sociocultural Issues and Epidemiology


Purpose of Review

Female genital cutting (FGC) is a pediatric practice; however, the vast majority of United States (US) and international review articles and research have focused on women. Given recent immigration to the US of immigrants from countries where FGC is practiced, there are children living in the US who have FGC or are at risk of having FGC performed. Children with FGC are underdiagnosed in the US. It is imperative for medical providers who care for children to learn of FGC including medical findings, treatment, cultural beliefs, as well as the legal and ethical issues that may arise. Required, standardized training needs to be developed for all pediatric providers so that they can appropriately take care of children with FGC.

Recent Findings

There are no standardized national training requirements for medical providers who may care for children affected by FGC. FGC is under-identified in children and in general, pediatric providers lack the skills needed to appropriately identify and treat children with FGC as well as training to appropriately discuss prevention of FGC with patients and families. Pediatric legal and ethical guidelines are also lacking.


National training requirements need to be developed for medical providers who take care of children with FGC or who are at risk of being cut. This includes the development of standard of care practice guidelines recommending that all girls have external genital examinations at all well child checks. Without such guidelines and clinical expectations, children with FGC, including those with significant morbidity from the practice, will not be identified or treated. Cultural, legal, and ethical recommendations and guidelines must also be developed to guide medical providers.


Female genital cutting Children 


Compliance with Ethical Standards

Conflict of Interest

Janine Young declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Berg R, Underland V, Odgaard-Jensen J, Fretheim A, Vist G. Effects of female genital cutting on physical health outcomes: a systematic review and meta-analsysis. BMJ Open. 2014;4(11):e006316. Accessed 25 May 2018.CrossRefGoogle Scholar
  2. 2.
    United Nations Population Fund. Female genital mutilation. Accessed 24 May 2018.
  3. 3.
    WHO, Human Reproduction Programme. Sexual and reproductive health. Female genital cutting. Accessed 24 May 2018.
  4. 4.
    Hess RF, Weinland J, Saalinger NM. Knowledge of female genital cutting and experience with women who are circumcised: a survey of nurse-midwives in the United States. J Midwifery Womens Health. 2010;55(1):46–54.CrossRefGoogle Scholar
  5. 5.
    Lazar JN, Johnson-Agbakwu CE, Davis OI, Shipp MPL. Providers’ perceptions of challenges in obstetrical care for Somali women. Obstet Gynecol Int. 2013;2013:149640. Scholar
  6. 6.
    •• Atkinson H, Geisler A. Developing physician educational competencies for the management of female genital cutting: a call to action. J Women's Health. 2019. A review of competencies needed to be developed for training of medical providers to care for girls and women affected by FGC.
  7. 7.
    WHO Fact Sheet, Female Genital Mutilation, 2017. Accessed 24 May 2018
  8. 8.
    Kopelman LM. Female circumcision/genital mutilation and ethical relativism. Second Opin. 1994;20(2):55–71.Google Scholar
  9. 9.
    Nour N. Female genital mutilation/cutting: health providers should be advocates for change. Population Reference Bureau. 2015. Accessed 24 May 2018.
  10. 10.
    Goldberg H, Stupp P, Okoroh E, Besera G, Goodman D, Danel I. Female genital mutilation/cutting in the United States: updated estimates of women and girls at risk, 2012. Public Health Rep. 2016;131(2):340–7. Scholar
  11. 11.
    UNICEF. Female genital mutilation/cutting: a global concern. 2016. Accessed 24 May 2018.
  12. 12.
    United Nations Population Fund. Demographic perspectives on female genital mutilation. 2015. Available at: Accessed 22 April 2019
  13. 13.
    Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. UNICEF. 2013 Accessed 25 May 2018.
  14. 14.
    United Nations Population Fund: Analysis of legal frameworks on female genital mutilation in selected countries in West Africa. 2018. Available at: Accessed 1/10/19.
  15. 15.
    UNICEF. Indonesia. Statistical profile on female genital mutliation/cutting. 2016. Available at: Accessed 25 May 2018.
  16. 16.
    US Department of State. Mali: report on female genital mutilation (FGM) or female genital cutting (FGC). Office of the Senior Coordinator for International Women’s Issues. Available at: Accessed 1/10/19.
  17. 17.
    WHO. An update on WHO’s work on female genital mutilation (FGM), Progress Report. 2011. Accessed 24 May 2018.
  18. 18.
    Ross CT, Campino PJ, Winterhalder B. Frequency-dependent social transmission and the interethnic transfer of female genital modification in the African diaspora and indigenous populations of Colombia. Hum Nat. 2015;26(4):351–77. Scholar
  19. 19.
    Cappa C, Van Baelen L, Leye E. The practice of female genital mutilation across the world: data availability and approaches to measurement. Glob Public Health. 2019:1–14.
  20. 20.
    •• Abdulcadir J, Catania L, Hindin M, Say L, Petignat P, Abdulacdir O. Female genital mutilation. A visual reference and learning tool for health care professionals. Obstet Gynecol. 2016;128:958–63. Photos of FGC, by type and sub-type, to improve clinicians’ skills at appropriate identification of FGC. CrossRefGoogle Scholar
  21. 21.
    WHO. International classification of diseases. Accessed 24 May 2018.
  22. 22.
    UNICEF. Population Reference Bureau. Female genital mutilation/cutting: data and trends. 2010. Accessed 24 May 2018.
  23. 23.
    Zurynski Y, Sureshkumar P, Phu A, Elliott E. Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice. BMC Int Health Hum Rights. 2015;15(1):1.CrossRefGoogle Scholar
  24. 24.
    Tamaddon L, Johnsdotter S, Liljestrand J, Essen B. Swedish health care providers’ experience and knowledge of female genital cutting. Health Care Women Int. 2006;27(8):709–22.CrossRefGoogle Scholar
  25. 25.
    Kaplan-Marcusan A, Toran-Monserrat P, Moreno-Navarro J, Castany Fabregas MJ, Munoz-Ortiz L. Perception of primary health professionals about female genital mutilation: from healthcare to intercultural competence. BMC Health Serv Res. 2009;9:11.CrossRefGoogle Scholar
  26. 26.
    •• Creighton S, Dear J, de Campos C, Williams L, Hodes D. Multidisciplinary approach to the management of children with female genital mutilation (FGM) or suspected FGM: service description and case series. BMJ Open. 2016;6(2). Accessed 24 May 2018. First review of FGC in children, by type, and approach to management, including use of a multi-disciplinary team.
  27. 27.
    Policy statement—use of chaperones during the physical examination of the pediatric patient. American Academy of Pediatrics. 2011. Committee on Practice and Ambulatory Medicine. Accessed 12/27/17.
  28. 28.
    Graham E, Sugar N. Common gynecologic problems in pre-pubertal girls. Pediatr Rev. 2006;27(6).Google Scholar
  29. 29.
    Berg R, Underland V, Odgaard-Jensen J, Fretheim A, Vist G. Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open. 2014;4(11). Accessed 25 May 2014.
  30. 30.
    Nour NM. Female genital cutting: clinical and cultural guidelines. Obstet Gynecol Surv. 2004;59:272–9.CrossRefGoogle Scholar
  31. 31.
    Berg RC, Underland V. Immediate health consequences of female genital mutilation/cutting. 2014. Accessed 25 May 2018.
  32. 32.
    Almroth L, Bedri H, El Musharaf S, Satti A, Idris T, Hashim MS, et al. Urogenital complications among girls with genital mutilation: a hospital-based study in Kartoum. Afr J Reprod Health. 2005;9(2):118–24.CrossRefGoogle Scholar
  33. 33.
    Knipscheer J, Vloeberghs E, vander Kwaak A, van den Muijsenbergh. Mental health problems associated with female genital mutilation. BJPsych Bull. 2015;39(6):273–7. Scholar
  34. 34.
    Brewer DD, Potterat JJ, Roberts JM, Brody S. Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania. Ann Epidemiol. 2007;17(3):217–26 Accessed 25 May 2018.CrossRefGoogle Scholar
  35. 35.
    The AHA Foundation, Female Genital Mutilation Law by State. Available at: Accessed 7 March 2019.
  36. 36.
    Mishori R, Warren N, Reingold R. Female genital mutilation. Curbside Consultation. Am Fam Physician. 2018;97(1):49–52.Google Scholar
  37. 37.
  38. 38.
    United States Center for Immigration Services, Asylum. Accessed 2/4/18.
  39. 39.
    Matter of Kasinga, 21 I& N Dec. 357 (BIA 1996). Accessed 2/4/2017.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General PediatricsUniversity of Colorado School of MedicineAuroraUSA

Personalised recommendations