Female genital mutilation: between violence, culture, and surgical reconstruction

A silent cry that crosses continents and cultures: female genital mutilation (FGM) continues to affect millions of girls and women, marking their bodies and lives. It is one of the most severe violations of human rights, with deep physical and psychological consequences. Dr. Massimiliano Brambilla, Plastic Surgeon at the Gynecoplasty Service, Obstetrics and Gynecology Unit of San Giuseppe Hospital in Milan, and head of the Female and Male Genital Surgery Chapter of SICPRE, provides a detailed analysis of the phenomenon, its consequences, and the possible surgical solutions to restore dignity and health to the victims.

FGM is a serious human rights violation and a global health issue. Dr. Brambilla, a plastic surgery specialist with extensive experience in treating FGM, offers an in-depth look at the practice, its effects, and potential surgical remedies.

What is female genital mutilation?

«Genital mutilation is a procedure performed on a woman’s genitals, involving the removal of part of the vulva, depending on the type of mutilation», explains Brambilla. These practices range from the removal of the clitoris to the excision of the labia minora, and even to the near-complete closure of the vulva.

«After the cutting, in some cases the genital walls are sutured together, in others everything is done to ensure the wound heals in a closed state», he adds.

FGM poses immediate risks and long-term damage, as the doctor outlines: «In the short term, there are numerous risks linked to a procedure that is illegal in 99% of the countries worldwide». Infections, haemorrhage, and impaired urinary function are among the first complications.

«In the medium term, problems involve interpersonal relationships, as sexual intercourse, especially the first experience, is almost always traumatic». 

Pregnancy and childbirth can also be extremely problematic: «Some victims manage to give birth relatively normally, while others require assistance because they can’t do it on their own. And some can’t even be helped and suffer tearing», he explains.

Surgical Solutions and Reconstruction

In severe cases, surgical intervention is essential. «There are certainly women who need reconstruction either before pregnancy or immediately during childbirth». The most common procedure is deinfibulation, often accompanied by tissue regeneration techniques: «Along with the incision, we harvest adipose tissue from other parts of the body and inject it into the scars to make them softer and more elastic».

More complex procedures can be performed to restore both anatomy and function, such as labia minora reconstruction or clitoral stump re-eversion. «There are two types of procedures: the first is eversion, and the second, even more sophisticated, involves finding the nerve endings and extending them», says Brambilla.

Between Cultural Imposition and Cultural Identity

As appalling as it may be, FGM is embedded in deep-rooted social and cultural contexts.
«If you approach the subject with curiosity rather than prejudice, you’ll find these practices are part of cultural and social identity», Brambilla notes. In some communities, group belonging is essential for social survival: «When you step outside your cultural identity, you’re no longer considered part of the group». The debate over terminology reflects this complexity: «The term that’s increasingly being used now is cutting, no longer mutilation», Brambilla points out.

FGM remains a complex issue with profound health, cultural, and economic implications. Medical and social engagement is crucial to combat the practice, support victims, and develop effective reconstructive interventions.SICPRE (Italian Society of Reconstructive-Regenerative and Aesthetic Plastic Surgery) has been at the forefront of raising awareness for several years.
Brambilla recalls: «For the past five years, we’ve been organizing a traveling event across Italy, the Itinerant Summit Against Female Genital Mutilation. This year it was held in partnership with ActionAid, which has two major projects, one in Milan and one in Rome. We support them and move forward together. The goal is to identify organisations that truly deal with this issue and turn them into highly specialised centres, much like Breast Units in breast cancer care».