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In 2015, the international community agreed to end Female Genital Mutilation/Cutting (FGM/C) by 2030. However, the target is unlikely to be met as changes in practice, including medicalized female genital mutilation/cutting (mFGM/C), challenge abandonment strategies. This paper critically reviews the current World Health Organization (WHO) definition of mFGM/C to demonstrate that mFGM/C, as currently defined, lacks detail and clarity, and may serve as an obstacle to the collection of credible, reliable, and comparable data relevant to targeted FGM/C prevention policies and programs. The paper argues that it is necessary to initiate a discussion on the revision of the current WHO definition of mFGM/C, where different components (who-how-where-what) should be taken into account. This is argued by discussing different scenarios that compare the current WHO definition of mFGM/C with the actual practice of FGM/C on the ground. The cases discussed within these scenarios are based on existing published research and the research experience of the authors. The scenarios focus on countries where mFGM/C is prevalent among girls under 18 years, using data from Demographic Health Surveys and/or Multiple Indicator Cluster Surveys, and thus the focus is on the Global South. The paper places its arguments in relation to wider debates concerning female genital cosmetic surgery, male genital circumcision and consent. It calls for more research on these topics to ensure that definitions of FGM/C and mFGM/C reflect the real-world contexts and ensure that the human rights of girls and women are protected.

An increasing number of women are undergoing female genital cosmetic surgery (FGCS). Labiaplasty, the most commonly performed FGCS, consists of a surgical procedure to decrease the inner labia size so that no or less tissue protrudes beyond the outer labia. Anatomically, it is similar to female genital mutilation/cutting (FGM/C) Type 2a. Thus, what are the differences and similarities between FGCS and FGM/C? Even though FGCS is not recommended by most scientific societies, it is considered legal, contrary to FGM/C. Most women seeking FGCS have physiologic (neither diseased nor anatomically atypical) genitalia and are reassured by counseling. We recommend counseling, history taking, screening for relevant conditions, and, if surgery is pursued, medical care by a specialist. We present the cases of three patients who reported feeling genitally mutilated after having willingly undergone FGCS. This feeling led these women to seek care at an outpatient clinic that receives migrants, refugees, second-generation, or naturalized patients originating mainly from African countries having experienced FGM/C. We discuss clinical implications, health insurance coverage, legal, ethical, and social implications. Multiple unresolved issues must be carefully addressed by scientific societies, legislators, and anti-FGM/C advocates to ensure equal treatment of all individuals in relation to genital cutting or surgery. Genital modifications experienced as harmful, or that are performed without informed consent, should be studied in relationship to one another and evaluated with consistent principles, regardless of the skin color of the individuals concerned, their cultural, ethnic, or religious background, or the name given to the genital modification they underwent.

Background The real prevalence and incidence of women living with or at risk of female genital mutilation/cutting (FGM/C) is unknown in Switzerland and many parts of Europe, as there are no representative surveys similar to DHS or MICS for European countries. Indirect estimates are commonly used to estimate the number of women with FGM/C in high-income countries, but may not reflect the actual FGM/C prevalence among migrants. Direct measures may provide more accurate estimates that could guide policy- and clinical decision-making. Swiss hospital data may provide a sample of patients that can be used to describe the prevalence of FGM/C in Swiss hospitals. Our study assesses the number of inpatient women and girls in Swiss university hospitals from countries with high FGM/C prevalence, and of inpatients with a coded diagnosis of FGM/C. Methods We conducted an exploratory descriptive study in Switzerland to assess the number of women and girls admitted to Swiss university hospitals between 2016 and 2018 from 30 FGM/C practicing countries, as well as inpatients with a coded diagnosis of FGM/C using anonymized data. We calculated indirect estimates for inpatient women and girls living with or at risk of FGM/C and compared them with the number of inpatients with a coded diagnosis of FGM/C. Results 8720 women and girls from FGM/C practicing countries were admitted. 207 patients had a coded diagnosis of FGM/C, including 7 with a nationality outside the 30 targeted countries, corresponding to an overall prevalence of 2.3% (95%CI, 2.0–2.6). The number of FGM/C cases by hospital was significantly different across years ( P  < 0.001), with a higher proportion of cases collected in Geneva, Switzerland. Conclusions The comparison between indirect estimates of inpatients with or at risk of FGM/C and the low number of FGM/C cases coded, suggests low recording and coding capacities of FGM/C. Tweetable abstract The capacity of coding primary and secondary diagnosis of FGM/C in Swiss university hospitals seems low. Protocol number: 2018–01851: SwissEthics Committee, Canton of Geneva, Switzerland.

Purpose of reviewFemale genital mutilation/cutting (FGM/C or FGM) are procedures that involve partial or total removal of external female genitalia and other injuries to the female genital organs for non-medical reasons. Over 4 million girls are at risk of FGM annually. Since urogynecologic and obstetric complications of FGM have been extensively described and characterized, the aim of this review is to shift the focus on other aspects like perception of women, awareness of community, and knowledge of health workers. Our purpose is to highlight those aspects and understand how their grasp might help to eradicate this practice.Recent findingsSelf-perception of women with FGM changes when they emigrate to western countries; awareness of complications and awareness of their rights are factors that make women reject the practice. Women from rural areas, already circumcised, or without a secondary level education are more likely to have a circumcised daughter. Women with at least a secondary education are more likely to agree with the eradication of the practice. Lack of education and poor wealth index are factors associated with men’s support of FGM. Although aware of FGM, healthcare professionals need to be trained on this topic. General practitioners play a central role in addressing patients with FGM to the right path of diagnosis and treatment and psychologists in helping them with psychological sequelae.ConclusionThese findings point out the future area of intervention, stressing the need of higher standard of care and global effort to eradicate this practice.

Background We updated the indirect estimates for women and girls living with Female Genital Mutilation Cutting (FGM/C) in Switzerland, using data from the Swiss Federal Statistical Office of migrant women and girls born in one of the 30 high-prevalence FGM/C countries that are currently living in Switzerland. Methods We used Yoder and Van Baelen’s “Extrapolation of FGM/C Countries’ Prevalence Data” method, where we applied DHS and MICS prevalence figures from the 30 countries where FGM/C is practiced, and applied them to the immigrant women and girls living in Switzerland from the same 30 countries. Results In 2010, the estimated number of women and girls living with or at risk of FGM/C in Switzerland was 9059, whereas in 2018, we estimated that 21,706 women and girls were living with or at risk of FGM/C. Conclusion Over the past decade, there have been significant increases in the number of estimated women and girls living with or at risk of FGM/C in Switzerland due to the increase in the total number of women and girls originally coming form the countries where the practice of FGM/C is traditional.

Labial hypertrophy, which lacks an accepted definition, is generally understood to refer to morphological and aesthetic characteristics of the labia believed to deviate from a perceived norm. Such ostensive deviation has the potential to affect many domains of a person’s well-being, as does its surgical treatment, labiaplasty. Nearly 24,000 labiaplasty procedures were performed in the United States in 2022, representing a greater than three-fold increase since numbers were first reported in 2013. Nearly 20% of these procedures were performed on minors, and cases have been reported in children well before complete pubertal development or the age of personal consent. In this article, we explore the indications that are used to designate labiaplasty as “medically necessary” in minors, a status that, we argue, is required for such procedures to avoid fitting the definition of “medicalized FGM” (i.e., “female genital mutilation”) according to the World Health Organization. As a part of this, we consider the particular ways in which outcomes are measured in this population. We shed light on persistent methodological shortcomings in the research on labiaplasty, discuss ethical and legal implications, and make recommendations to improve the relevance, reliability, and generalizability of future investigations into this increasingly common, controversial surgical procedure.

A growing body of evidence indicates a significant decrease in support for female genital mutilation/cutting (FGM/C) within post-migration communities in Western countries. Addressing knowledge gaps and comprehending the factors associated with FGM/C discontinuation in these communities is crucial. The objective of this scoping review is to describe the effects of migration and cultural change on factors supporting FGM/C cessation in migrant communities. The review, from 2012 to 2023, included the following databases: Embase, PubMed, Google Scholar, Swisscovery, CINAHL, APA PsycInfo, and gray literature. Applying the PRISMA-ScR framework, we identified 2819 studies, with 17 meeting the inclusion criteria. The results revealed seven key factors shaping attitudes and behavior toward FGM/C abandonment: (1) legislation against FGM/C, (2) knowing that FGM/C is not a religious requirement, (3) enhancing education about the practice, (4) migration and cultural change, (5) awareness of the harmful effects of FGM/C, (6) a positive view of uncut girls, and (7) a sense of self-agency. These findings highlight factors on a social, community, interpersonal, and personal level that enhance the abandonment of the practice. Further research in the FGM/C field will gain more accuracy in understanding and accounting for these multilevel factors in post-migration settings, offering valuable insights for targeted interventions to promote the cessation of the practice.

Background Chad is one of the African countries with high prevalence of female genital mutilation (FGM). The aim of this study was to examine the factors associated with FGM among women aged 15–49 and girls aged 0–14 in Chad. Methods Data for the study were obtained from the 2014–2015 Chad Demographic and Health Survey. FGM among women aged 15–49 and girls aged 0–14 were the outcome variables. The prevalence of FGM among women and girls were presented using percentages while a mixed-effects multilevel multivariable logistic regression analysis was carried out to assess the factors associated with FGM. The results were presented using adjusted odds ratio with associated 95% confidence intervals. Results The results indicate that more than half (50.2%) of the women and 12.9% of girls in Chad had been circumcised. Among women aged 15–49, level of education, employment status, ethnicity, religion, wealth quintile and community literacy level were significant predictors of FGM. Age, partner’s level of education, marital status, employment status, ethnicity, religion and mother’s FGM status were associated with FGM among girls aged 0–14. Conclusion This study has identified several individual and contextual factors as predictors of FGM among women and girls in Chad. The findings imply the need to adopt strategies aimed at addressing these factors in order to help eliminate the practice of FGM. Government and non-governmental organisations in Chad need to implement policies that enhance media advocacy and community dialogue to help deal with FGM in the country.

Background Female genital mutilation (FGM) is a deeply rooted practice in Senegal, generally affecting girls at a very young age. The prevalence of FGM has remained virtually unchanged for at least two decades. The aim of this study is to identify the factors associated with the evolution of this practice in Senegal. Methods This study is a secondary analysis of data extracted from the Senegalese Demographic and Health Surveys (DHS) from 2015 to 2023. The record individual file of women aged 15 to 49 was used for the analysis. For both women aged 15-49 and their daughters, the dependent variable was \"being circumcised\". This is a binary qualitative variable which was coded as\"Yes\" if the woman and/or her daughter had been circumcised. A descriptive analysis was performed. A multivariate analysis was performed to determine the Adjusted Odds Ratios (ORaj) and estimate the corresponding 95% confidence intervals (CI) for all variables. Adjustment was made on a yearly basis. Results The prevalence of female circumcision was 24.2% in 2015, 22.7% in 2016, 24.0% in 2017, 23.3% in 2018, 25.2% in 2019 and 20.1% in 2023. The majority of women who undergo FGM do so between the ages of 0 and 9. The most frequent form of mutilation is \"flesh removed from genital area\", the frequency of which rises from 58.3% in 2015 to 76.5% of cases of mutilation in 2023. Infibulation (genital area sewn closed), which was the least common form of mutilation at 7% in 2015, will increase to 25.6% in 2023. The factors associated with the development of FGM among Senegalese women were region of residence and socio-economic level. Conclusion Our study has shown that the fact that the mother has been circumcised is a risk factor for the daughter. However, the level of wealth and education of women and their husbands would appear to be protective factors against the development of FGM in girls. To bend the curve, political decision-makers need to take targeted action in hotspot regions, considering aspects linked to women's empowerment.

Purpose Sierra Leone, a post-conflict sub-Saharan African country, has very high rates of intimate partner violence (IPV). Female genital mutilation (FGM) and early marriage are also common. Both practices can lead to negative health outcomes, and may increase vulnerability to IPV. The current study aims to contextualize IPV risk factors in Sierra Leone, a low-income country in which empirical IPV research remains limited, by considering the intersection between age at FGM and age at marriage. Method Analyzing data from the 2019 Sierra Leone Demographic and Health Surveys ( N  = 3,324), we use logistic regression models to examine the association of age at FGM and age at marriage, controlling for IPV risk factors, with the odds of women experiencing physical IPV. We consider the interaction between age at FGM and age at marriage, and incorporate age-specific models in light of the civil war. Results FGM and age at marriage were not significantly associated with IPV, but those who were circumcised between 10 – 14 years of age – when the practice traditionally occurs – were associated with higher odds of IPV. Among women aged 29 and younger, women circumcised under the age of 10 and also married between the ages of 10–14 were most at risk. Conclusions The results offer insight into the sociocultural practices and its association with IPV among Sierra Leonean women, especially in light of civil war timing. Our findings highlight the importance of considering the age at which these practices occur, as this may further exacerbate women’s vulnerability to IPV victimization.