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Conclusions While the precise estimation of the frequency and risk of immediate, gynaecological, sexual and obstetric complications is not possible, the results weigh against the continuation of FGM/C and support the diagnosis and management of girls and women suffering the physical risks of FGM/C.
Trial registration number This study is registered with PROSPERO, number CRD42012003321.
systematic review circumcision female female genital cutting health consequences.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Strengths and limitations of this study.
Based on the studies in this systematic review, there is clear evidence that female genital mutilation/cutting (FGM/C) entails harms to women’s physical health throughout their life, from the moment of cutting as an infant or child, to sexuality and childbirth in adulthood.
The precise estimation of the frequency and risk of complications was not feasible because of the small sample sizes and varying methods of the studies.
However, the consistency of results with increased risk of several physical harms in women with genital modification is robust.
Therefore, efforts should be expended in safeguarding girls and women against the physical risks of FGM/C and caring for those who suffer from its consequences.
The centuries-old practice of female genital mutilation/cutting (FGM/C), also known as female circumcision, is a culturally sanctioned practice1 , 2 that consists of “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.”1 According to the WHO typology, there are three main types: type I (clitoridectomy), type II (excision), type III (infibulation or pharaonic circumcision), and type IV, which is used to describe all other harmful procedures to the female genitalia in the absence of medical necessity.1 Types I–III and unaltered external female genitalia are depicted in figure 1. The nomenclature for the practice varies across regions, ideological perspectives and research frames, and we use the expression preferred by UNICEF and UNFPA, two central policymakers in the global effort to end the practice, ‘female genital mutilation/cutting’ (FGM/C).2 Wade explains that Western efforts to end FGM/C since the early 1970s has relied primarily on two frames that have influenced the discourse of FGM/C and, in turn, the ideological contestation over the practice.3 In addition to the women’s right frame, a dominant frame has been that the practice involves physical and mental harm.
Illustration of unaltered external female genitalia and female genital mutilation/cutting (FGM/C) types I–III. From top left: unaltered external female genitalia, type I (clitoridectomy), type II (excision) and type III (infibulation).
Indeed, for close to a century, observational studies, supported by biological theories, have suggested a negative association between FGM/C and various health outcomes. Such studies have been summarised in a handful of reviews. Epidemiologist and medical anthropologist Obermeyer first reviewed and critiqued the available literature on FGM/C until 1996, and next summarised the subsequent literature from 1997 to 2002.4 , 5 Another early review examined primary data on health complications after FGM/C with particular emphasis on sequelae in childbirth.6 Recently, Iavazzo et al ‘s 7 review explored the clinical evidence for an association between FGM/C and infections. The first systematic review in this field—addressing the social, psychological and sexual consequences of FGM/C—critically reviewed and extracted data and analysed 17 comparative studies.8 , 9 While much of this research suggests a harmful effect of FGM/C on women’s health, the findings from observational studies and non-systematic reviews are equivocal. Additionally, some commentators have questioned the evidence for many of the claimed short-term and long-term medical consequences of FGM/C, such as quality of sex life, obstetric complications and infections.10.
We aimed to systematically review the evidence for the range of physical health risks associated with FGM/C by summarising the findings from three technical systematic review reports detailing the association.11–13.
We conducted a systematic review of the physical health risks and consequences of female genital modification in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA (Preferred Reporting Items for Systematic reviews and meta-Analyses) guidelines,14 , 15 using a predetermined protocol (PROSPERO, number CRD42012001915). The full details of the systematic review including the search strategies, risk of bias assessment and analysis are found in three technical reports.11–13.

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