If the opening is more generous, sexual intercourse can take place after gradual dilation, which may take days, weeks, or months. If the opening is too small for dilation, recutting has to take place before intercourse. Recutting also occurs with each childbirth to allow exit of the fetal head without tearing the tough tissue. After birth the raw edges are sutured again, often to the same size as existed before marriage to recreate the illusion of virginal tightness.
In countries like Sudan, Somalia, and Djibouti, 80 to 90 percent of all FGM is infibulation. It is also practiced on a smaller scale in parts of Mali, Ethiopia, Eritrea, Gambia, and Egypt, and may be occurring in other communities where information is incomplete. A new practice known as intermediate circumcision has come to use in recent years. The term describes a variety of operations more severe than clitoridectomy and only slightly less damaging than infibulation. Intermediate circumcision was developed in countries where infibulation has been outlawed, like Sudan, or where the impact of infibulation on women's health has been criticized. Nevertheless, this category of operation is quite similar to infibulation and the effects and complications are more or less the same; for this reason, these procedures are not classified into a separate category.
It is important to remember that FGM is neither a disease nor a reproductive risk. It is a socially driven surgical procedure that causes grave damage to women. Both clitoridectomy and infibulation can have serious physical complications, although those resulting from infibulation generally occur more frequently and are more severe and long lasting. With clitoridectomy, hemorrhage may occur, and protracted bleeding commonly leads to anemia. If bleeding is very severe and uncontrolled, it can result in death. Infection is very common, caused by unsanitary cutting instruments or occurring within a few days the area becomes soaked in urine and contaminated by feces.