Female genital mutilation: consequences for reproductive and sexual health.

An estimated 80 million women worldwide have been subjected to female genital mutilation and 2 million new procedures are performed each year. The procedure, generally performed at home by medically untrained persons, has severe long-term physical and psychological consequences. At Northwick Park Hospital in the UK, genitally mutilated immigrants from countries such as Somalia and Sudan have presented health care personnel with immense challenges. Routine gynecologic and obstetric procedures cannot be performed when access to the vagina is inadequate, and there is often a need for psychosexual counseling. To address the unique needs of these women, the Hospital established an African Well Woman Clinic that was attended by 50 women (including 14 primigravidae and 23 multigravidae) in its first six months of operation. Women are offered de-infibulation, ideally before becoming pregnant, and infibulated women are not resutured after delivery. Tact and cultural sensitivity on the part of all medical personnel are essential to reduce feelings of shame. Although most attendees at the Northwick Park Hospital program state they do not intend to infibulate their female children, they are at risk of pressure from family when they visit their homeland. Ongoing counseling, education, and support are necessary to break the cycle of female genital mutilation.