Excision or clitoridectomy involves cutting off the clitoris and removing the inner and outer vaginal lips. In Sudan and Somalia the most widely-practiced form is infibulation, in which the clitoris and the inner and outer vaginal lips are removed and the vulva sewn up. This leaves a hole the size of a matchstick for the passage of urine and menstrual blood. During childbirth an infibulated woman's vulva is cut open, often causing haemorrhaging, prolonged delivery and increased risk of foetal brain damage and foetal loss. The woman's scar tissue must be opened for penetration on her wedding night, and sexual intercourse is often painful.
Husbands use fingers, a razor or a knife which can cause internal bleeding and infection.
In addition to these devastating physical effects, the woman's sex drive is greatly reduced after she loses her clitoris. Orgasm becomes difficult to experience. A study by Dr. A.A. Shandall in Sudan found that few infibulated women even knew that females could experience orgasm. Although the medical consequences of infibulation are widely accepted as harmful, more than 80 percent of Sudanese women are infibulated and the majority fear that they would be unmarriageable without it. Women in isolated villages feel they cannot afford the consequences of individual protest action.