J Med Ethics doi:10.1136/medethics-2014-102375
  • Feature article
  • Paper

Female genital alteration: a compromise solution

  1. Allan J Jacobs3
  1. 1Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
  2. 2Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA
  3. 3Director of Gynecologic Oncology at Coney Island Hospital, Professor of Obstetrics and Gynecology and Associate Faculty in Bioethics, Stony Brook University, Stony Brook, New York, USA
  1. Correspondence to Dr Kavita Shah Arora, Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 MetroHealth Drive, G230E, Cleveland, OH 44109, USA; Kavita.shah.arora{at}
  • Received 17 July 2014
  • Revised 24 February 2015
  • Accepted 21 July 2015
  • Published Online First 22 February 2016


Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration (FGA) in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced. In order to better protect female children from the serious and long-term harms of some types of non-therapeutic FGA, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. We offer a revised categorisation for non-therapeutic FGA that groups procedures by effect and not by process. Acceptance of de minimis procedures that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights. More morbid procedures should not be performed. However, accepting de minimis non-therapeutic f FGA procedures enhances the effort of compassionate practitioners searching for a compromise position that respects cultural differences but protects the health of their patients.

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