Cut against their will: How FGM leaves lasting scars on girls, women

A Maasai man walks past a mural against FGM and child marriage at Narok County Referral Hospital on December 3, 2025. [Tony Karumba / AFP]

In December 1983, 10-year-old Fauzia* (not her real name) travelled with relatives to her family’s ancestral home. Born in Mombasa and raised in Nairobi, she had family roots in Isiolo. She did not know the visit would change her life.

An aunt held her down as she struggled through a procedure involving the cutting and stitching of her genital tissue. She bled heavily, prompting a relative to arrange for a military doctor to attend to her. The procedure was carried out secretly, she recalls, at a time when efforts to stop the practice were attracting attention.

For Fauzia*, the experience did not end when the cutting was over. She returned to childhood carrying an experience she could not fully comprehend, with physical difficulties that emerged over time and questions she would only begin to understand years later.

In 2004, seven-year-old Michelle* (not her real name), from a Samburu-Meru family, travelled with her nine-year-old sister to their maternal grandmother’s home during the Easter holiday. It appeared to be an ordinary family visit. Nothing suggested the girls were about to undergo a procedure whose consequences they would spend years trying to understand.

Their grandmother and another female relative took them into a bedroom, shut the doors and windows, and spoke in a language the girls did not understand. The sisters initially thought their grandmother was examining their private parts.

Michelle* was afraid to scream, worried that people outside might hear her. She struggled to make sense of what the adults were doing.

“I wouldn’t expect my own grandmother to hurt me,” she recalls.

For a child, the people expected to provide protection had become the source of pain. The sisters had not fully healed when school reopened, while the experience altered their relationship with their bodies and with people they had trusted.

Fauzia* and Michelle* grew up in different circumstances and decades. Their accounts are not representative of every girl in their communities, yet they reveal a troubling continuity: children can be cut before they understand the procedure, its purpose or its consequences. Adults make the decision, leaving the girls to grow up with the questions.

For many survivors, those questions emerge through pain, conversations with peers, menstruation, relationships or thoughts about pregnancy. By the time a girl understands what was done to her, the practice may already have shaped how she experiences her body, relationships and future.

Female genital mutilation/cutting (FGM/C) refers to procedures involving the partial or total removal of external female genitalia, or other injury to female genital organs, for non-medical reasons. The World Health Organisation (WHO) classifies the practice into four broad types.

Type I involves partial or total removal of the clitoral glans and/or clitoral hood. Type II involves removal of the clitoral glans and labia minora, sometimes alongside the labia majora. Type III, known as infibulation, involves narrowing the vaginal opening by cutting and repositioning the labia. Type IV covers other harmful non-medical procedures, including pricking, piercing, scraping and cauterisation.

The procedures differ, as do their potential consequences.

As a secondary-school student, Fauzia* began experiencing difficulties with urination.

“It could take me 30 to 40 minutes,” she recalls, “while my menstrual flow also seemed unusually slow.”

Other women in her household had undergone similar cutting, so she assumed such experiences were normal.

Her description of being cut and stitched is consistent with infibulation. The resulting scar tissue can narrow the genital opening, potentially obstructing the passage of urine or menstrual blood.

As an adult studying abroad, Fauzia* eventually sought medical help for tight scar tissue. An initial attempt to open the scar was unsuccessful. A gynaecologist in Spain subsequently examined her and performed reconstructive surgery. Fauzia* says the intervention improved her physical experience and helped her relate differently to her past.

Dr Ruth Wamae, a consultant obstetrician-gynaecologist and medical director at Emory Hospital, says FGM/C has no health benefits, and performing it in a clinical setting does not make it safe.

“The immediate effects include severe pain, bleeding, swelling, infection and difficulty urinating, and, in serious cases, shock,” Dr Wamae explains.

An FGM survivor at House of Hope, a shelter for girls rescued from FGM and child marriage, in Narok County on December 1, 2024. [Tony Karumba / AFP]

Blades, knives, razor blades and other unsuitable instruments can cause injury and severe bleeding. Reusing instruments contaminated with blood can also transmit blood-borne infections.

The consequences may extend well beyond the day of cutting. Some survivors experience scarring, nerve damage, chronic genital pain, cysts, recurrent urinary tract infections, painful menstruation, difficulty urinating and pain during sex. Others experience psychological distress, including anxiety, fear, shame or difficulty processing what happened. Not every survivor develops the same complications.

“The consequences can also emerge during pregnancy and childbirth,” Dr Wamae says. “FGM/C is associated with an increased risk of prolonged or obstructed labour, severe tears, haemorrhage and poor outcomes for newborns. Where infibulation has narrowed the vaginal opening, clinical assessment and, in some cases, de-infibulation may be needed to support safe care.”

Obstetric fistula can develop when prolonged, obstructed labour damages tissue between the birth canal and the bladder or rectum, causing urine or faeces to leak. A direct association between FGM/C and fistula has not been established.

For women who have undergone infibulation, de-infibulation may be recommended where clinically appropriate. The procedure opens scar tissue to restore an adequate vaginal opening.

“Reconstructive surgery is different, and treatment depends on a woman’s anatomy, symptoms, preferences and clinical needs. Not every survivor requires surgery or will experience the same outcome,” Dr Wamae explains.

A 2025 WHO review of evidence from more than 75 studies across about 30 countries reinforced the breadth of the health burden, including menstrual and urinary difficulties, painful sex and childbirth complications. The organisation reported that women who have undergone FGM/C face more than twice the risk of prolonged or obstructed labour or haemorrhage compared with women who have not undergone it. These are increased risks, not inevitable outcomes for every survivor.

Research at Garissa Level 5 Hospital also highlighted gaps in care. A study conducted by Dr Wamae and colleagues in February and March 2015 and published in the East African Medical Journal in 2019 involved 311 postpartum mothers, 263 of whom had undergone FGM/C. That proportion reflects the hospital study participants, not national prevalence.

Of the 263 women, only 11 reported being asked about the type of cutting during antenatal care, while 15 said they had been examined for FGM/C status. Twenty-nine reported receiving information about bleeding, 24 about poor neonatal outcomes and 19 about de-infibulation.

The findings pointed to missed opportunities to identify women’s needs and prepare them for possible childbirth complications.

“Care should not be limited to pregnancy or the treatment of a visible physical complication for survivors,” Dr Wamae says. “It should also allow women to discuss pain, sexual health, fears and emotional distress without judgement.”

The invisible wounds

For Michelle*, understanding what had happened came later, through conversations with peers. At around 14, she began to question why adults had decided on her body without giving her a choice.

“I felt I was not allowed to decide,” she says.

The realisation brought anger and hurt. She had been too young to understand the procedure, yet old enough to remember being frightened and betrayed by people she trusted.

The experience has also influenced how she approaches dating. She worries about explaining what happened to someone outside her community who may not understand the practice or its effects.

“I worry about the unknown surrounding pregnancy and childbirth,” Michelle* says.

Her concern reflects anxiety about the future, rather than a prediction that she will necessarily experience medical complications.

George Ndungu, a clinical psychologist and founder of Bloom Psych Health, says FGM/C can affect physical, psychological and social wellbeing. Being forced to undergo cutting may be particularly distressing when relatives or other trusted adults are involved. Reminders of the event, including tools or places associated with it, can trigger distress.

“Some survivors may experience anxiety, depression, trauma-related symptoms or difficulties trusting others. Others may struggle with shame, body image or fear about relationships and future motherhood,” Ndungu says.

These effects are not universal, and survivors should not be reduced to a diagnosis. The possibility of psychological harm, however, must be taken seriously.

“Healing requires a trauma-informed approach that helps survivors understand that what happened was not their fault. Psychological support can help them process the experience, challenge harmful beliefs about themselves and rebuild a sense of safety,” Ndungu says.

Recovery looks different for different people. It does not require a survivor to forgive relatives, undergo surgery or speak publicly about what happened.

Michelle* says psychological support and the companionship of other survivors have helped her see herself differently.

“I have come to appreciate and love myself the way I am,” she says.

Her growing self-acceptance has shaped how she responds when younger girls face the possibility of being cut. She and her elder sister challenged their parents when they learnt their younger sister was at risk, threatening to report the practice and involving a Sunday school teacher. Their intervention helped prevent the younger girl from undergoing FGM/C.

Their actions did not erase their own experiences, but helped protect another child.

Fauzia’s* journey offers a different perspective on navigating adulthood after FGM/C. She sought medical care for the physical consequences and describes her partner as supportive. Such support can matter when survivors are navigating treatment, intimacy and fears about the future, although it cannot replace appropriate healthcare.

Why the practice persists

FGM/C is practised for different reasons across communities. In some settings, it is linked to ideas about purity, modesty, womanhood and marriageability. Families may believe cutting will make a girl more acceptable as a wife or protect the family’s honour. Elsewhere, it is regarded as a marker of cultural identity or a necessary passage into adulthood.

Fear of social exclusion can be powerful. Parents who privately question the practice may still feel pressure to conform if they believe an uncut daughter will face ridicule, rejection or reduced marriage prospects. Misconceptions about religion are also used to justify cutting, even though FGM/C is not a universal religious requirement and many religious leaders oppose it.

Tony Mwebia, executive director of Men End FGM Foundation, says the practice must be understood as a human rights issue as well as a health concern.

“Families may regard cutting as part of cultural identity, a sign of purity or a condition for marriageability. Even people who privately question it may fear criticism or social exclusion if they refuse to follow tradition,” he says.

“FGM/C requires communities to change the social expectations that sustain it, rather than relying on awareness alone,” he adds. “Efforts must engage families, men, young people and religious leaders, and show that girls can be respected, marry and succeed without undergoing cutting.”

Medicalisation presents another challenge. Some families turn to health professionals because they believe the procedure will be safer. Having FGM/C performed in a clinical setting, however, does not remove the potential for physical or psychological harm. It can instead give a harmful, non-medical procedure a misleading appearance of legitimacy.

Progress, with gaps

Kenya has made progress in reducing FGM/C, although national figures conceal significant differences between communities and regions.

The Kenya Demographic and Health Survey reported that the proportion of women aged 15 to 49 who had undergone FGM/C fell from 38 per cent in 1998 to 21 per cent in 2014 and 15 per cent in 2022. The decline is significant, although the practice has not disappeared. The 2022 survey also found that some girls aged zero to 14 had already undergone FGM/C, highlighting the need for prevention before children reach the ages at which they may be targeted.

Prevalence remains much higher than the national average in counties including Wajir, Mandera, Marsabit, Garissa, Kisii and Samburu. The practice is not confined to rural areas either. The 2022 survey found prevalence among women aged 15 to 49 was about 10 per cent in urban areas, compared with 18 per cent in rural areas.

The age at which girls are cut also matters. Among women who had undergone FGM/C, 30 per cent reported being cut between the ages of five and nine, while 45 per cent were cut between 10 and 14. These figures describe the reported ages of women who had undergone the practice, not the proportion of all girls subjected to it.

Secrecy, family involvement and pressure to maintain social expectations can complicate prevention. Procedures may take place in private homes or during school holidays. Cross-border cutting has also been identified as a concern in East Africa, where movement between countries can complicate protection and law enforcement.

Kenya’s Prohibition of Female Genital Mutilation Act, 2011, criminalises FGM/C and related actions, including aiding, procuring or facilitating the practice. The Anti-FGM Board, established in 2013, coordinates efforts to end it.

Legislation alone cannot resolve the social pressures that make some families believe cutting is necessary. Enforcement must be accompanied by community engagement, education, accessible support for survivors and healthcare that responds to the needs of women who have undergone the procedure.

The challenge is to ensure that falling prevalence becomes lasting abandonment. That means protecting children before they are cut, holding perpetrators and health professionals accountable, supporting survivors without stigma and making quality medical and psychological care accessible. It also means confronting the social penalties imposed on families who refuse the practice, rather than leaving them to resist those pressures alone.

In 1983, Fauzia* was a 10-year-old who did not understand what was being done to her. In 2004, Michelle* was a seven-year-old who trusted her grandmother and could not understand why she was being hurt. Their experiences span decades, yet the central question remains: how many girls must grow up trying to make sense of a decision they were never old enough to make?

Ending FGM/C is not simply about reducing a statistic or enforcing a law. It is about ensuring that girls grow up with the right to understand decisions affecting their bodies and refuse procedures that can cause lasting harm. Those already living with the consequences must be met not with silence or shame, but with care, dignity and support.