Adopted by the 45th World Medical Assembly,
Budapest, Hungary, October 1993
and editorially revised at the 170th Council Session, Divonne-les-Bains,
France, May 2005
Female genital mutilation (FGM) is a common practice in over thirty
In many other countries the problem has arisen more recently
due to the presence of ethnic groups from countries in which FGM
is common practice, including immigrants and refugees who fled
from hunger and war.
Because of its impact on the physical and mental health of women
and children, FGM is a matter of concern to physicians. Physicians
worldwide are confronted with the effects of this traditional
practice. Sometimes they are asked to perform this mutilating
There are various forms of FGM. It can be a primary circumcision
for young girls, usually between 5 and 12 years of age, or a secondary
circumcision, e.g., after childbirth. The extent of a primary
circumcision may vary: from an incision in the foreskin of the
clitoris up to a pharaonic circumcision or infibulation removing
the clitoris and labia minora and stitching up the labia majora
so that only a minimal opening remains to allow for urine and
Regardless of the extent of the circumcision, FGM affects the
health of women and girls. Research evidence shows the grave permanent
damage to health. Acute complications of FGM are: hemorrhage,
infections, bleeding of adjacent organs, and excruciating pain.
Long-term complications include severe scarring, chronic infections,
urologic and obstetric complications, and psychological and social
problems. FGM has serious consequences for sexuality and how it
is experienced. There is a multiplicity of complications during
childbirth including expulsion disturbances, formation of fistulae,
ruptures and incontinence.
Even with the least drastic version of circumcision, complications
and functional consequences can occur, including the loss of all
capacity for orgasm.
There are various reasons to explain the existence and continuation
of the practice of FGM: custom, tradition (preserving virginity
of young girls and limiting the sexual expression of women) and
social reasons. These reasons do not justify the considerable
damages to health.
None of the major religions supports this practice. The current
medical opinion is that FGM is detrimental to the physical and
mental health of girls and women. FGM is seen by many as a form
of oppression of women.
By and large there is a strong tendency to condemn FGM more overtly:
- There are active campaigns against the practice in Africa.
Many African women leaders as well as African heads of state have
issued strong statements against the practice.
-International agencies such as the World Health Organization,
the United Nations Commission on Human Rights and UNICEF have
recommended that specific measures be aimed at the eradication
- Governments in several countries have developed legislation,
such as prohibiting FGM in their criminal codes.
- Taking into account the psychological needs and 'cultural
identity' of the people involved, physicians should inform women,
men and children about FGM and discourage them from performing
or promoting FGM. Physicians should integrate health promotion
and counselling against FGM into their work.
- As a consequence, physicians should have adequate information
and support for doing so. Educational programmes concerning
FGM should be expanded and/or developed.
- National Medical Associations should stimulate public and
professional awareness of the damaging effects of FGM.
- National Medical Associations should stimulate governmental
action in preventing the practice of FGM.
- National Medical Associations should cooperate in organising
an appropriate preventive and legal strategy when a child is
at risk of undergoing FGM.
The World Medical Association condemns the practice of genital
mutilation including the circumcision of women and girls and condemns
the participation of physicians in such practices.