cumcised, family and friends create an environment in which the practice of circumcision becomes a requirement for social acceptance. In industrialized countries, genital mutilation occurs predominately among immigrants from countries where mutilation is practiced. FGM can be classified into four separate groups. Type I, termed clitorectomy, involves the excision of the skin surrounding the clitoris, with or without excision of part or all of the clitoris. When this procedure is performed in infants and young girls, a portion of or all of the clitoris and surrounding tissues may be removed. If only the clitoral prepuce is removed, the physical manifestation of Type I FGM may be subtle, necessitating a careful examination of the clitoris and adjacent structures for recognition. Type II is referred to as excision. It is the removal of the entire clitoris and part or all of the labia minora. Crude stitches of catgut or thorns may be used to control bleeding from the clitoral artery and raw tissue surfaces. Patients with Type II FGM do not have the typical contour of the anterior perinea structures resulting from the absence of the labia minora and clitoris. In addition, the vaginal opening is not covered. Type III, known as infibulation, is the most severe form in which the entire clitoris and some or all of the labia minora are excised, and incisions are made in the labia majora to create raw surfaces. The labial raw surfaces are then stitched together to cover the urethra and vaginal introitus, leaving a small posterior opening for the urinary and menstrual flows. The patient will have a firm band of tissue replacing the labia and obliteration of the urethra and vagina openings. It is estimated that 15% of all mutilations in Africa are Type III. Type IV includes the different practices of variable severity including pricking, piercing, or incision of the clitoris and or labia. Stretching of the clitoris and or labia, caute...
