Many different terms have been used to describe FGC, including female genital mutilation, female genital cutting/mutilation, and female circumcision, with continued debate about the best term. Some object to “circumcision’ as suggesting an inaccurate parallel with male circumcision. The WHO adopted female genital mutilation as the term for this practice.¹ However, many researchers believe “mutilation” alienates the cultures practicing it, resulting in unproductive backlash. We use FGC as descriptive and as distinguished from male circumcision, while withholding judgment about the practice.

FGC is prevalent globally and not limited to any religious or ethnic group. Its highest prevalence occurs in western and eastern Africa where an estimated 90%–100% of females undergo some form of the practice in Egypt, Guinea, Mali, Somalia, and northern Sudan. Between 100 and 140 million girls and women have experienced FCG worldwide and three million girls may undergo the practice each year.¹ In an effort to preserve ethnic identity, immigrants from these countries have brought the practice to the West, including Europe and the US. Thus, first world physicians can no longer regard FGC as exotic and must confront requests for participation, especially where large concentrations of immigrants regard FGC as expected and routine.

FGC is deeply entrenched in cultures that practice it and persists despite large-scale international campaigns, including medical and health organizations condemning it. The WHO, the American Medical Association (AMA) and the International Federation of Gynecology and Obstetrics (FIGO) all oppose the practice and urge health professionals to abstain from participating. Ten international health and human rights organizations have created a consensus statement summarizing the international fight to end FGC.²

Commentators and analysts differ regarding the underlying influences promoting FGC. Many believe that patrilineal social, economic, and political values drive the practice of FGC. Some anthropologists think that women perpetuate the practice as a form of African cultural rebellion against encroaching Western societies. From the latter perspective, FGC has virtue, promoting female empowerment, strength, cleanliness, and purity. While some assert that FGC follows Islamic principles, the practice predates the beginning of Islam, is not practiced by the majority of Muslims, and is not universally endorsed by Islamic scholars and theologians. Some supporters believe FGC curbs sexual desire in women, preserving virginity prior to marriage.³ Others consider FGC to enhance the appearance of female genitalia. Many women consider FGC part of a coming-of-age ritual inducting young girls as members of a community. In any case, women who reject the practice endure stigmatization and ostracism. Females without FGC are often considered unsuitable for marriage within their community, creating practical dilemmas, as marriage grounds economic and social stability. All of these factors contribute to perpetuating FGC.³

Community elders and birth attendants traditionally performed FGC. Campaigns from the West highlighting severe medical consequences of FGC performed under unhygienic conditions have backfired. Rather than halting the procedure, the efforts have shifted the practice to the medical sector. Women from cultures practicing FGC now ask physicians from many specialties, including obstetrics/gynecology, surgery, and family practice, to perform the procedure using sterile technique with analgesic agents to minimize pain and adverse medical outcomes.

Patients or other medical professionals may request the help of anesthesiologists for female genital surgeries. This may put an anesthesiologist in a difficult position, as s/he must consider the patients’ wishes, the professional’s relationships with and obligations to other members of the medical team, and the ethical implications of participating in a procedure with a cultural, rather than medical, justification.