female genital mutilation ( fgm ) , previously inappropiately called female circumcision is the partial or total removal of the female external genitalia or other deliberate injury to the female genital organs , either for cultural or non - therapeutic reasons . the world health organization ( who ) estimates that between 100 and 140 million girls and women worldwide are presently living with fgm , and every year about three million girls are at risk . the practice is most prevalent in african countries such as nigeria , ethiopia , sudan , egypt , and some areas of the middle east . the practice of fgm has been perpetuated in large part by cultural and religious beliefs . for example , fgm is believed to attenuate sexual desire and thus ensures chastity and fidelity in marriage . female genital mutilation has been classified into four types ( 14 ) by the who , depending on the degree of scarification and distortion of the female external genitalia . type 1 involves excision of the prepuce , with or without total or partial excision of the clitoris . type 2 involves excision of the clitoris , with partial or total excision of the labia minora . type 3 involves total or partial excision of the external genitalia , and stitching and narrowing of the vaginal opening ( infibulation ) . type 4 unclassified , includes several other procedures such as pricking , piercing , or incising the clitoris and / or the labia , and also cauterization of the clitoris , cutting the vagina , and any other procedure that can be included in the definition of fgm . fgm type 1 and 2 are the most prevalent  80% , while 15% of the fgm is type 3 . female genital mutilation may result in immediate complications such as severe pain and bleeding and long - term complications such as : psychological , psychosexual , trauma , infertility , susceptibility to bacterial vaginosis , and genital herpes and obstetric complications including perinatal death.[1310 ] all types of fgm have been shown to be associated with complications . in this report , we present the case of a 23-year - old nigerian girl , with obstructed micturition and genital tract obstruction , as a complication of type 3 fgm , with a brief literature review . a 23-year - old undergraduate presented to our urology service with a history of obstructed micturition dating to infancy . she specifically complained of impaired urinary stream and splashing of the urine on her upper thighs during micturition . more recently she noticed she had difficulty with coitus ; inability to admit the partners erect penis because of a partially obstructed introitus . she had a normal 28-day menstrual cycle . on examination she was in apparent good health . examination of the external genitalia revealed a partially amputated labia majora and minora , with the fused labia minora remnant that completely covered the vestibule , except for a small opening at the posterior fourchette that could barely admit the tip of the index finger . ( the external urethral meatus was completely covered and the introitus was partially covered ) [ figure 1 ] . . clinical photograph of a 23-year - old , nigerian girl , with type 3 fgm , showing post mutilation fusion of the labia minora ; the external urethral meatus is completely covered and the introitus is partially covered laboratory investigations consisting of urinalysis , complete blood count , and hiv screening were entirely normal . she had elective defibulation , which consisted of splitting the fused labia minora in the midline superiorly , till the remnant of the clitoris was exposed and freed from the tethering fibrous tissue . the cut edges of the labia minora were sutured together with running sutures of 2 - 0 chromic catgut and seperated by means of gauze dressings , during the healing period , to prevent cross adhesions . she was discharged home on the same postoperative day and reviewed in the outpatient clinic on the eighth postoperative day and two weeks later . at the six - month follow - up she was happily married and had no further complaints . she had elective defibulation , which consisted of splitting the fused labia minora in the midline superiorly , till the remnant of the clitoris was exposed and freed from the tethering fibrous tissue . the cut edges of the labia minora were sutured together with running sutures of 2 - 0 chromic catgut and seperated by means of gauze dressings , during the healing period , to prevent cross adhesions . she was discharged home on the same postoperative day and reviewed in the outpatient clinic on the eighth postoperative day and two weeks later . at the six - month follow - up she was happily married and had no further complaints . although recognized as a form of violation of the rights of young girls and discrimination against women , and despite several international and regional human rights treaties and consensus documents condeming the practice of fgm , the practice is still ongoing in several parts of rural africa , including nigeria . for example , fgm is erroneously believed to attenuate sexual desire , and thus . ensures chastity and fidelity in marriage . a survey from gambia shows that 72.9% of gambian women will like their daughters to undergo fgm . another reason is the lack of knowledge regarding the complications of fgm , especially among the healthcare professionals , like nurses and midwifes . immediate health complications include hemorrhage , shock , infectious and psychological consequencies , pelvic and femoral fracture , and severe pain.[36 ] an anesthetic death has been reported in a young girl undergoing fgm in egypt , warranting the banning of the procedure in that country . in the long term , chronic pain , infections , keloid formation , sexual dysfunction , primary infertility , birth complications , danger to the new born , and psychological consequences can occur.[39 ] urological complications have also been reported to occur following fgm . in a study by dirie and lindmark , urinary retention , urinary tract infection , and urinary problems were documented . in that study , urinary retention occurred in the first three days after fgm and was attributed to any of the following factors ; postoperative pain , irritation of the raw areas by urine , and obstruction of the external urethral meatus by skin flaps or blood clots . in some instances we highlight a late urological complication of fgm ; the obstruction of the urinary stream by the fused labia minora , following type 3 fgm . during micturition , the urinary stream first impinges on the fused labia minora and then exits through the narrowed opening in the vulva causing urinary splashing around the perineum and upper thighs . dirie and lindmark also documented recurrent urinary tract infections , and according to them , these occurred because the meatus was covered by the infundibulum , causing the vaginal discharge to accumulate and favor the growth of bacteria . our index patient did not have urinary tract infection at the time of presentation , as evidenced by the negative urine cultures . our index patient presented primarily because of difficulty in penetration , at the point of getting married . this was due to the post fgm fusion of the labia minora , leaving only a narrow opening in the vulva , which could not admit the erect penis of an adult [ figure 1 ] . abdelhady found that circumcised women had significantly higher rates of psychological problems than women who were not circumcised . others have also found a higher prevalence of posttraumatic stress disorder and sexual health problems among circumcised women . she appeared , however , to be mentally stable , although she did not have an expert psychological evaluation , because the facilities for this were not readily available . after defibulation , she was found to have a normal vagina , and has since been happily married . this has been attributed to several factors such as the use of nonsterile instruments , an increased number of blood transfusions , due to blood loss during surgery , increased anal intercourse due to difficult or painful vaginal intercourse , and tearing of the vagina during intercourse . however , some other studies have found no statistically significant associations . the so - called gabbar 's defibulation surgery can be done under regional or general anesthesia . it involves incising the fused labia minora to restore the introital opening , with excision of clitoral or epidermoid inclusion cysts , if present . more extensive plastic reconstruction of the external genitalia may be warranted in some instances , but was not necessary in our index patient . where the clitoris has been amputated , little can be done to restore it , but the remnant of it could be freed from its tethering by fibrous tissue , as was done in the index case . gordon , who has a lot of experience in these surgeries , reports that in 60% of the cases , all natural functions are restored . female genital mutilation is a dehumanizing and dangerous practice that needs to be stopped . however there is need for a massive educational campaign on the harmful effects of fgm at all levels , such as ; the community level , women 's groups , traditional birth attendants , and healthcare professionals . also adequate psychological , social , and medical support needs to be provided for those who are already victims of this condition .
female genital mutilation ( fgm ) is the partial or total removal of the female external genitalia or other deliberate injury to the female genital organs , either for cultural or non - therapeutic reasons . 
 this barbaric act is accompanied by a variety of complications ranging from hemorrhage , fracture , infective complications , gynetresia , with its attendant sexual and obstetric difficulties , and death . 
 a 23-year - old girl , with urinary and genital tract obstruction following female genital mutilation(infibulation ) is presented . 
 she was managed by elective defibulation , with a satisfactory outcome . 
 robust health education strategies are needed for the eradication of fgm .