The term female circumcision has a greater range of meanings and implications than does male circumcision. It refers to anything from the removal of the clitoral hood, the small flap of skin covering the clitoris, to the removal of the labia and clitoris, as well as to the stitching shut of the vulva. Opponents of the practice often refer to female circumcision as female genital mutilation (FGM). (Female circumcision does not usually refer to such practices as consensual piercing of the labia and clitoris or gender modifications) Ceremonially, female circumcision is performed only in populations in Middle and Northern sections of Africa, parts of the Middle East, and parts of Malaysia. Worldwide, more than 100 million women have been circumcised. (Hosken 1994). It is estimated that at least 95 percent of the women in Somalia, Djibouti, and Egypt are circumcised (Gruenbaum 2001). Circumcision is traditionally performed in more than thirty countries, at least twenty-eight of which are in Africa. At the same time, given contemporary emigration patterns, circumcised women are found among immigrant populations in countries of Europe and North America. When performed on adolescents, the operation accompanies traditional instruction about womanhood. Although there appears to be no textual support for female circumcision in Islamic holy writings, the geographic areas of practice are primarily Islamic.
Nonceremonial genital modification was briefly practiced in Western medicine as a medical treatment. Western physicians recommended the practice of removing the clitoris as a treatment for women with certain nervous and sexual problems in the nineteenth and early twentieth century (Hosken 1994). This was bolstered by a belief that masturbation could cause insanity. The practice did not continue, and genital modification was never adopted as a religious ceremony or as a routine operation for females in Western culture.
Ceremonial female circumcision is variously thought to remove the maleness from the female by removing a undeveloped penis, the clitoris, to assure chastity among wives and young women, to purify and cleanse, and to make a woman more beautiful and sexually attractive to men. In places where this is most widely practiced, women must be circumcised before they can be married.
There are at least three categories of female circumcision: Sunna, Excision, and Infibulation. Sunna circumcision refers to the practice of letting a small amount of blood from the clitoral hood or removing sections of the clitoral hood. This is not a widely practiced type of circumcision and is confined primarily to sections of Malaysia. Sunna circumcision is the closest analogue to male circumcision, although the delicate nature of the operation increases chances of surgical error.
Excision is the practice of removing, that is, excising, a portion of the genitalia. This ranges from the removal of the clitoris to the removal of the clitoris, labia major, and labia minor. The medicalized term of clitorectomy is used in the historic medical literature to refer to the removal of the clitoris alone.
Infibulation involves the excision of the clitoris, labia major, and labia minor, and the stitching shut of the vulva with only a small hole left for urination and menses. This is also referred to as pharonic circumcision because of a traditional attribution of this practice as being imposed on the female Jewish population by ancient Egyptian Pharaohs. Infibulation is the most radical procedure and carries the most significant medical implications. The procedure is most common in populations from Somalia, Ethiopia, Sudan, and Egypt. The procedure leaves a girl with a smooth, nondescript genital area that is considered by some to be aesthetically pleasing. However, it also leaves a girl with significant health problems, such as chronic urinary infections, menstrual difficulties, sexual dysfunction, and difficulties when giving birth.