WHO estimates that 100–140 million women worldwide have undergone FGC [6]. The most recent prevalence data indicates that approximately 91.5 million females above 9 years of age in Africa are currently living with the consequences of FGC [7]. with an estimated 3 million at risk of undergoing FGC every year [8]. Types I, II, and III have been documented in 28 countries in Sub-Saharan Africa, and in some countries throughout Southeast Asia and the Middle East. Some forms of FGC have also been reported in other countries, including Central and South America [4]. Eighty-five percent of all forms of FGC are type I/II, whereas 15% are type III. However, recent immigration and refugee resettlement from countries where type III FGC predominates (e.g., Somalia) have resulted in a rapid surge of females with this type throughout North America and Europe.

Medical Outcomes

Women who have undergone FGC can suffer short- and long-term complications. The range of short-term complications is rarely seen in Western countries, and may include shock, hemorrhage, infection, tetanus, urinary retention and/or oliguria, injury to adjacent structures, sepsis, and death [10–13]. The long-term complications mainly pertain to type III FGC and include epidermal inclusions cysts, keloids, dysmenorrhea, dyspareunia, apare-unia (i.e., no coitus due to the inability to achieve penetration), hematometra, hematocolpos, chronic vaginal and urinary tract infections, urinary retention and voiding difficulty, urinary calculi, incontinence, fistula neuromas, an d infertility [11,14–19]. In an attempt to avoid obstetrical complications, antenatal or intrapartum defibulation may become necessary. The WHO has found that women with FGC are significantly more likely than those without to experience adverse obstetric outcomes, with the risks increasing with more extensive FGC [20].

Psychosexual Outcomes

There are cultural taboos against discussing sexual displeasure and the “pain” of circumcision; these taboos persist even among immigrant communities living in the West [21]. Admitting to interest in sex or discussing sexual pleasure and/or the genitalia may, in some settings, be regarded as inappropriate with strangers. There may also be gendered notions of proper conversation, and modesty standards in responding to private questions [22]. As such, the focus of research on FGC has paid only peripheral attention to psychosexual sequelae. It has been assumed that women with FGC experience dyspareunia, marital disharmony, andpoor sexual outcomes. However, recent evidence does not support the hypothesis that FGC destroys sexual function or precludes enjoyment of sexual relations in all women [22].

There are mixed findings with regards to sexual pain associated with FGC. For example, dyspareunia was reported among 31.5% of women sampled in Egypt, the majority ofwhom were circumcised, and23% of these women perceived personal distress related to sexual dysfunction [23]. In contrast, El-Defrawi et al. [24] noted that circumcised women in Egypt complained more significantly of dysmenorrhea, vaginal dryness during intercourse, lack of sexual desire, and difficulty reaching orgasm as compared to noncircumcised women, yet they did not report more dyspareunia.

When dyspareunia is present, it is most commonly reported with first intercourse, during the initial period after marriage, and with re-infibulation [25]. Male partners may also experience complications due to FGC, including difficulty with penile-vaginal entry, penile infections, and psychological sequelae [26]. However, despite these problems, sexual excitement and pleasure may be present for some women with FGC. Recent data suggests that FGC does not affect sexual function uniformly, even in societies where infibulation is performed [27].