Victims of female genital mutilation are rarely seen in the United States but are distressingly common in Africa (57,58). Surgical reconstruction will occasionally be useful and there are special considerations for the management of infertility and childbirth (59,60). The management of discomfort and pain will require thoughtful attention. The serious and occasionally lethal damage done to women subjected to female circumcision and infibulation has provoked transient attention in Europe and North America, and the damage has been studied and documented. An excellent review of the history of female circumcision is marred by deference to social custom with tacit partial approbation of this act (61). Equating female circumcision performed by untrained practitioners using primitive instruments without anesthesia to male circumcision performed by trained professionals with an established record of safety is a reckless implication in that review. Male circumcision as practiced in industrial societies does not leave a trail of blood and damage as is found too often with female circumcision, which is occasionally fostered by amateur midwives and others with a social or financial incentive. The generation of political and social pressure to control or eliminate the practice of female genital mutilation merits the support of all.
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