Female Genital Mutilation: What Every American Dermatologist Needs to Know  Amish J. Dave, MD, Aisha Sethi, MD, Aldo Morrone, MD, PhD  Dermatologic Clinics  Volume 29, Issue 1, Pages 103-109 (January 2011) DOI: 10.1016/j.det.2010.09.002 Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 1 US states and metropolitan areas with the largest estimated numbers of women and girls with or at risk for female genital mutilation/female circumcision (FGM/FC), 1990. The Centers for Disease Control and Prevention (CDC) have developed a statistical model to estimate the number of girls and women with or at risk for FGM/FC living in the United States. Some 168,000 girls or women were estimated using 1990 census data to have received or to be at risk for these procedures. States with large African immigrant populations were found to have the greatest numbers of girls and women with or potentially at risk for FGM/FC. An estimated 45% of the women and 44% of the girls younger than age 18 estimated to have or be at risk for FGM/FC lived in 11 metropolitan areas. (Data from Jones WK, Smith J, Kieke B Jr, et al. Female genital mutilation: female circumcision; who is at risk in the US? Public Health Rep 1997;112:368.) Dermatologic Clinics 2011 29, 103-109DOI: (10.1016/j.det.2010.09.002) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 2 World Health Organization classification of female genital cutting. Type I, also known as clitoridectomy or sunna, involves removing part or all of the clitoris and/or the prepuce. Type II, also known as excision, involves removing part or all of the clitoris and labia minora, with or without excision of the labia majora. Type III, the most severe form, is also called infibulation or pharaonic. It entails removing part or all of the external genitalia and narrowing the vaginal orifice by reapproximating the labia minora and/or labia majora. (From Nour NM. Female genital cutting: clinical and cultural guidelines. Obstet Gynecol Surv 2004;59:272–9; with permission.) Dermatologic Clinics 2011 29, 103-109DOI: (10.1016/j.det.2010.09.002) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 3 Female genital cutting prevalence among women aged 15–49 years. (Adapted from Demographic and health surveys and multiple indicator cluster surveys. Female genital mutilation/cutting: a statistical exploration. New York: UNICEF; 2005:4.) Dermatologic Clinics 2011 29, 103-109DOI: (10.1016/j.det.2010.09.002) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 4 Deinfibulation to reveal clitoridectomy and excision of the labia as seen in type III female genital mutilation. (Courtesy of Dr Hassan Azadeh and David Ellis, The University of Gambia Medical School, 2010; with permission.) Dermatologic Clinics 2011 29, 103-109DOI: (10.1016/j.det.2010.09.002) Copyright © 2011 Elsevier Inc. Terms and Conditions