Female genital alteration: A novel clinical categorization system

Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced.  In order to better protect female children from the serious and long-term harms of some types of non-therapeutic female genital alteration, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia.  While “female genital mutilation” is the term currently used most widely by international health and policy organizations, the current categorization inappropriately conflates all procedures that alter female external genitalia, while not accounting for their disparate risk profiles and entirely misses other commonly performed procedures.  We offer a revised categorization system for non-therapeutic female genital alteration that groups procedures by effect and not by process in order to allow for a more informed and clear discussion of these procedures. Since it is the health consequences of these procedures that are the most worrisome to international health groups, it is logical to group the procedures based on these effects, rather than groups of procedures with a wide range of resultant consequences within each group.  This new categorization system will aid in clarifying academic discussion and policy efforts aimed at minimizing the harmful effects of some types of female genital alteration.