Infibulation is the most severe form of female genital mutilation (FGM), classified by the World Health Organization as Type III. It involves cutting and repositioning the inner or outer labia to create a seal that covers most of the vaginal opening, leaving only a small hole for urine and menstrual blood to pass through. The procedure may also include removal of the clitoris. Over 230 million girls and women worldwide have undergone some form of FGM, with infibulation concentrated primarily in the Horn of Africa.
What Infibulation Involves
During infibulation, part or all of the external genitalia is removed. The edges of the remaining tissue are then stitched together or held in place until they fuse, creating a smooth flap of skin over the vaginal opening. In some cases, chemical cauterization is used instead of stitching. The result is a narrow opening, sometimes only a few millimeters wide, where the vaginal entrance used to be.
The WHO divides infibulation into two subtypes. Type IIIa involves removal and repositioning of the inner labia (labia minora). Type IIIb involves the outer labia (labia majora). Both may or may not include removal of the clitoris and its hood. The procedure is sometimes called “pharaonic circumcision” in communities where it is practiced.
Infibulation is typically performed on girls between infancy and age 15. It is carried out without medical justification and is recognized internationally as a human rights violation.
Where It Is Practiced
Africa accounts for over 144 million of the estimated 230 million girls and women who have undergone FGM globally. The practice is near-universal in Somalia, Guinea, and Djibouti, where prevalence reaches 90 percent or higher. Infibulation specifically is most common in the Horn of Africa, including Somalia, Eritrea, and parts of Sudan and Ethiopia, though not all FGM in these regions is Type III.
Immediate Physical Consequences
Because infibulation is often performed outside of medical settings, using razors, scissors, or broken glass and without anesthesia, the immediate risks are severe. Heavy bleeding is one of the most dangerous, as the genital area has a dense blood supply. Infection is common, both from unsterilized instruments and from the binding of the wound during healing. Acute urinary retention can occur when swelling or the newly created seal blocks the urethra.
The pain itself is extreme. Girls may be physically restrained during the procedure, and the wound can take weeks to heal, during which the legs are sometimes bound together to encourage the tissue to fuse.
Long-Term Health Effects
The sealed vaginal opening creates a chronic obstruction that affects basic bodily functions for years or permanently. Menstrual blood cannot flow freely, leading to painful periods and, in some cases, a buildup of blood behind the sealed tissue. Urination often becomes slow and painful because the small remaining opening forces urine to pass in a thin stream or to pool behind the scar.
Recurrent urinary tract infections are well documented in women who have undergone FGM, and untreated infections can travel to the kidneys. Excessive scar tissue, including raised keloid scars, frequently forms at the site. Cysts and abscesses can develop along the scar line as trapped skin cells and fluids accumulate beneath the fused tissue.
Effects on Sexual Health
Infibulation directly removes or buries the clitoris, which is the primary source of sexual sensation. The sealed opening makes penetrative intercourse painful or, in many cases, physically impossible without first cutting the scar tissue open. Women who have undergone infibulation consistently report significant pain and discomfort during sex.
The impact extends beyond physical sensation. Studies of women who have experienced FGM find a significantly higher prevalence of post-traumatic stress disorder compared to women who have not. Depression, anxiety, chronic irritability, nightmares, and feelings of incompleteness are commonly reported. Some women experience memory difficulties specifically related to the event. Research on Senegalese women found that those who had undergone cutting had markedly higher rates of PTSD and other psychiatric conditions than those who had not, with associations between PTSD and memory dysfunction in the affected group.
Risks During Childbirth
Infibulation significantly complicates delivery. A systematic review and meta-analysis of obstetric outcomes found that women with FGM face a 69 percent higher risk of prolonged labor compared to women without FGM. The risk of perineal tearing increases by about 38 percent. Obstetric hemorrhage and the need for instrument-assisted delivery are also markedly higher.
The mechanism is straightforward: scar tissue around the vaginal opening does not stretch the way healthy tissue does during birth. This causes the second stage of labor to stall, which in turn raises the risk of tearing and bleeding. In many cases, the infibulation must be surgically opened before or during delivery to allow the baby to pass.
Deinfibulation: Surgical Reversal
Deinfibulation is a surgical procedure that reopens the sealed vaginal opening. A surgeon makes an incision along the scar tissue in the midline, separating the fused labia and restoring access to the urethra and vaginal canal. The cut edges are then sutured individually so they heal as separate structures rather than fusing again.
The procedure can relieve chronic urinary obstruction, reduce pain during menstruation and intercourse, and make childbirth safer. In some cases, if the clitoris was buried rather than fully removed, the remaining tissue can be freed from scar tissue, potentially restoring some sensation. Deinfibulation is performed under anesthesia and is typically a same-day procedure. It is most commonly sought by women experiencing pain, difficulty with intercourse, or in preparation for childbirth.
Legal and Human Rights Status
International law categorizes all forms of FGM, including infibulation, as a violation of human rights. The United Nations Declaration on the Elimination of Violence Against Women explicitly names female genital mutilation as a form of gender-based violence and states that no custom, tradition, or religious consideration can be invoked to justify it.
Multiple international treaties support this position, including the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), the Convention on the Rights of the Child, the Convention Against Torture, the Universal Declaration of Human Rights, and the UN Charter. CEDAW specifically calls on signatory nations to modify social and cultural practices based on ideas of gender inferiority.
FGM is criminalized in most countries where it is practiced, as well as in many destination countries for diaspora communities. Enforcement varies widely, and in some regions the practice continues despite legal prohibitions, sustained by social pressure and the belief that it is a necessary rite of passage.