An estimated 230 million women worldwide have undergone female genital mutilation (FGM), which involves injury to the external genital organs for nonmedical reasons. According to the World Health Organization (WHO), these practices are performed as rites of passage into adulthood, expressions of cultural identity, or means of controlling female sexuality.

The most common form, classified by the WHO as type 1, involves excision of the external part of the clitoris. The next form, which is more invasive and less prevalent, is type 2, which involves the removal of the external clitoral tissue and labia minora, with or without removal of the labia majora. Type 3, known as infibulation, involves narrowing of the vaginal opening by cutting and suturing the labia minora and labia majora, leaving only a small opening for menstrual blood.

Specialists at the 100th National Congress of the Italian Society of Gynecology and Obstetrics, held in Bari, Italy, from December 14 to 17, 2025, dedicated a session to the diagnosis, treatment, and care of women in Italy who have undergone FGM. Estimates suggest that more than 88,000 women are affected in Italy, with approximately 16,000 girls considered at risk during visits to their countries of origin.

In Italy, the practice was prohibited under Law No. 7 of 2006, including when the act was performed abroad by an Italian citizen or resident against an Italian citizen or resident. Women from other countries who had undergone FGM or had a well-founded fear of undergoing the practice in their home country were entitled to refugee status in Italy and other EU countries under Directive 2011/95/EU, which was implemented in Italy by Legislative Decree No. 25 of 2008.

Active Screening

An update to the second part of the Guideline on “Physiological Pregnancy,” published by the National Center for Disease Prevention and Health Promotion of the Istituto Superiore di Sanità in Italy, recommends offering screening for FGM at the first health assessment to all women at risk. Clinicians were advised to ask directly whether the woman had undergone genital mutilation.

Women considered at risk included those born in countries where FGM was widespread, those whose mothers came from such countries, and those belonging to communities where FGM is traditionally practiced.

The aim of screening was to enable multidisciplinary counselling, dedicated programs, appropriate follow-up, and psychological support. The guidelines also recommend offering deinfibulation in cases of FGM type 3 and implementing preventive actions to reduce the risk for continuation of the practice within families.

Training in FGM is recommended as a mandatory component of undergraduate curricula and continuing professional development for all professionals working in perinatal care services in Italy.

“Pregnancy is an important opportunity to identify women who had undergone FGM,” said Lorenza Driul, MD, PhD, director of the Obstetrics and Gynecology Clinic of Udine Hospital and professor at the Department of Medical and Biological Sciences, University of Udine, Udine, Italy, speaking at the Bari congress.

“Active case finding is essential because many women do not report it unless they are explicitly asked. Some patients do not remember the procedure because it is performed at a very young age. Assessment needed to be conducted by experienced clinicians, as type 1 and some type 2 cases of FGM could be difficult to recognize.”

Care Access

In Italy, pregnancy is not the only time when women subjected to FGM meet healthcare services. “Colleagues in emergency departments referred women to us when they presented with an emergency condition,” said Luca Bello, MD, adjunct professor at the University of Turin, Turin, Italy, and head of the service for the prevention and treatment of FGM at the local health authority of the City of Turin, Italy, which has been active since 2021.

“Other points of contact included cervical cancer screening, requests for contraceptive counselling, and termination of pregnancy. Many women were accompanied by staff from third-sector workers who run shelters,” said Bello.

Medical staff from the Italian Red Cross working at the migrant hot spot in Lampedusa, Italy, recorded the presence of FGM in the medical records of each woman during the examination. “Between 60% and 70% of women attending assessments were affected,” reported Giuseppe Canzone, MD, director of the Department of Family Health, Azienda Sanitaria Provinciale 6, Palermo, Italy.

Clinical Pathways

The long-term consequences of FGM vary depending on the type of injury. Victims may experience dyspareunia, recurrent genitourinary infections, incontinence, fistulas, urinary dysfunction progressing to renal failure, scar tissue formation, keloids, and adhesions that narrow the vaginal introitus.

“The local health authority clinic in addition to treating these conditions and referring women patients who request for reconstructive surgery,” said Bello. “The service offers pre- and post-initiation counseling, education on personal hygiene, and support throughout childbirth.”

“During pregnancy and childbirth, type 1 and type 2 FGM does not necessarily increase the risk for complications,” said Driul. “In these cases, healthcare professionals need to provide reassurance and psychological support, as the process of childbirth could trigger traumatic memories of the violence she suffered.

In cases of infibulation, or type 3 FGM, the Royal College of Obstetricians and Gynaecologists in the UK recommends surgical intervention around the 20th week of pregnancy to restore functional anatomy and allow tissue healing before delivery.”

Women often request deinfibulation only at the onset of labor, reflecting the customary practice in their countries of origin. “In these situations, the role of the cultural mediator is essential, particularly in explaining that in Italy, reinfibulation after birth was prohibited, even when requested,” Driul added.

Reconstructive surgery aims to restore reproductive function and improve body image, sexual function, and quality of life. “In addition to deinfibulating and removing scar tissue, procedures could include reshaping of the labia minora and labia majora and intervention on residual clitoral tissue to partially restore sensitivity,” said Tommaso Simoncini, MD, professor and head of the Obstetrics and Gynecology Division at the Department of Clinical and Experimental Medicine of the University of Pisa in Pisa, Italy.

“The purpose of clitoral mutilation is precisely to deprive women of sexual pleasure. Couples from countries with high prevalence are developing greater awareness and are increasingly approaching us to undertake this type of care.” Simoncini said. “These procedures require specific expertise, which led the Pisa University Hospital in Italy to establish a dedicated Regional Referral Centre in 2024 and is committed to multidisciplinary training in this area.”

This story was translated from Univadis Italy, part of the Medscape Professional Network.