by Todd Neale

Clinicians should actively persuade families not to participate in the ritual cutting of female genitalia, the American Academy of Pediatrics urged.

However, the organization suggested that legislatures and doctors might ultimately consider legalizing ritual “nicks” to satisfy cultural or religious demands without more serious and problematic cutting.

The centuries-old practice, which is illegal in the U.S. and several other developed countries, carries with it a host of physical and psychological problems, according to a policy statement from the AAP’s bioethics committee.

But the custom of ritual cutting or alteration of the genitalia of female infants, children, and adolescents — performed with a variety of tools such as knives, razor blades, broken glass, or scissors — persists in some cultures, primarily in Africa and in some communities in the Middle East and Asia.

Researchers don’t know how prevalent female genital cutting is in Western societies, but U.S. clinicians may encounter immigrant families whose daughters have undergone the procedure or who request to have it done in a sterile environment by a healthcare professional.

“Although physicians should understand that most parents who request female genital cutting do so out of good motives, physicians must decline to perform procedures that cause unnecessary pain or that pose dangers to their patients’ well-being,” the statement read.

The AAP “urges its members to provide patients and their parents with compassionate education about the harms of female genital cutting while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.”

Female genital cutting has various degrees of severity, from the removal of skin surrounding the clitoris to removal of the clitoris to stitching together the labia to create a vaginal opening no wider than a pencil.

There are various cultural and religious reasons for the practice, such as the preservation of virginity, the easing of cultural integration, and the maintenance of cleanliness and health.

Some form of the female genital cutting has been performed in many major religions, including Christianity, Islam, and Judaism, according the AAP statement.

But in recent years the World Health Organization and several physicians organizations have condemned the practice because of its adverse health effects.

There are numerous complications associated with the practice. They include hemorrhage, shock, local infection, failure to heal, septicemia, tetanus, trauma to adjacent structures, and urinary retention in the short term. Potential long-term problems include development of painful subcutaneous dermoid cysts and keloid formation along excised tissue edges and difficulty with vaginal childbirth.

More serious complications include pelvic infection, dysmenorrhea, hematocolpos, painful intercourse, infertility, recurrent urinary tract infection, and urinary calculus formation.

There has been little research on the psychological, sexual, and social consequences of female genital cutting, but personal accounts have reflected anxiety, terror, and a subsequent lack of sexual pleasure during intercourse.

On the other hand, some young women have described the experience positively “as a communal ritual that inducted them into adult female society,” according to the AAP statement.

Several countries, including the U.S. and the U.K., have banned the practice. The U.S. also outlaws “ritual nicks” as a compromise to the more severe forms of female genital cutting.

However, according to the AAP statement, “the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting” and may serve to build trust with immigrant communities and prevent more severe forms of cutting.

“It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm,” the authors wrote.

Pediatricians should seek to educate patients and parents about the harms of female genital cutting in a culturally sensitive way, the statement read, and clinicians serving communities in which the practice is common should be aware of counseling centers.

Todd Neale is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more pediatrics news.