What's the difference between male and female circumcision?

Dear Reader, 

Although female and male circumcision share similar names, the two greatly differ in terms of risks, health outcomes, and cultural norms surrounding them. One of the most compelling reasons for the distinction is that some of the more severe forms of female circumcision (also known as female genital mutilation or FGM) have very serious short-term and long-term health consequences; consequences that rarely, if ever, arise for male circumcision. In order to understand the distinction, it helps to understand the specific practices and backgrounds behind each.

To begin, it's good to discuss the details of these practices: Male circumcision is the surgical removal of the foreskin that covers the glans or head of the penis. Generally, this procedure is performed in the hospital shortly after birth, but it can also take place as part of a religious or cultural ceremony after an infant leaves the hospital. In addition, some adults are circumcised for medical, hygienic, or aesthetic reasons. While male circumcision has been uncommon in Asia, South America, Central America, and most of Europe, it’s practiced nearly universally in Middle Eastern countries and still is common in Canada and in the United States. In the United States, it’s estimated that 55 to 65 percent of babies with a penis are circumcised annually. Medical complications are generally rare, especially in medical settings, but there still are risks involved. These can involve minor bleeding or local infection, but these are very easily treated by a health care provider when caught promptly. As for the benefits of circumcision, there are some advantages in addition to aligning with cultural norms in certain communities. Some studies have shown that circumcision may protect against HIV and other STIs in heterosexual men, as it's easier to keep a circumcised penis clean. For example, there is also some supporting evidence that uncircumcised men may experience penile problems (irritation, inflammation, and infection) more frequently, although this is mostly negligible in those that keep their penis clean.

Where male circumcision has been normalized in medical settings, female circumcision often takes place in informal, community settings and has received a significant amount of international pushback. Female circumcision is a ritual cutting or alteration of the clitoral glans (external portion of the clitoris), labia minora, or labia majora. It’s most often performed between the ages of four and ten years for cultural or religious reasons. Usually, community members, who are otherwise medically untrained individuals, are designated to conduct the procedure. Often, FGM takes place without anesthesia outside of medical settings and without sterilized medical instruments. Although FGM continues primarily in African nations and small communities in the Middle East and Asia, it’s prohibited by law in many countries around the world. Due to its divisiveness in a broader global setting, the World Health Organization has condemned the practice and identified four types of FGM. Type I and II refer to the partial or total removal of the clitoral glans. Type I can also involve removal of the clitoral hood (the skin surrounding the clitoral glans), and Type II can involve the removal of part or all of the labia minora and majora; these two are the most common forms of FGM. Type III can include aspects of Type I or II but is characterized by the stitching or narrowing of the vaginal opening, called infibulation. Female circumcision that falls into Type IV includes all other forms of genital alteration that can include pricking, piercing, stretching or burning of the clitoris, scraping of tissue surrounding the vaginal opening, or cutting of the vagina. 

The consequences for all types of FGM can be severe. People may experience severe pain, shock, hemorrhage (significant bleeding), urinary track complications or infections, fever, wound infection, or septicemia (bacterial infection of the blood stream) as short-term consequences. In the long-term, there may be urethra damage, incontinence, pain during sex, or sexual dysfunction. Infibulation (Type III) has the most severe long-term consequences, particularly if an infibulated person attempts vaginal childbirth. It’s estimated that around 200 million people around the world have been subjected to FGM, with more than three million estimated to be at risk annually. Despite the plethora of complications that can arise from the practice, careful consideration is warranted regarding its cultural significance. It’s believed in some communities to be a critical part of girlhood to ensure modesty and reduced sexual activity. Therefore, it’s often a requirement for marriage prospects. In this sense, many communities globally consider FGM to be essential to their identity.  

Although both female and male circumcision are accepted to varying degrees in different communities, the procedures still present a range of potential physical complications and psychological risks. Many women's advocacy and human rights campaigns are currently focused on making female circumcision practices locally discouraged and outlawed by countries where practiced. Even in the United States, where male circumcision has been conducted on a large scale without question for many decades, new attention is being drawn to what psychological effects early childhood injury may cause young children with a penis. To learn more, you can refer to the statements from the American Academy of Pediatrics on Male Circumcision and Female Genital Mutilation. In addition to anatomical differences, the expected health risks and social-cultural context for each make male and female circumcision two distinct modern health topics.