In the Somali community, women still swap stories about delivery room doctors turning pale and nurses fainting during pelvic exams. But after years of serving East African patients, physicians say they have come a long way in working with women who have experienced genital cutting. Still, advocates and doctors agree: There's room for improvement.

To make menstruation and sexual intercourse less uncomfortable for such patients, OB/GYNs offer surgeries to enlarge vaginal openings stitched almost closed during the ritual. Some, like Dr. Kamalini Das at Regions Hospital, also perform reconstructive surgery, even as they caution patients they cannot fully restore the look of uncut genitalia.

Caesarean sections were virtually unknown in Somalia, and some community members fear doctors here are too quick to order them for women who have experienced cutting, says Fartun Weli of the nonprofit Isuroon. But a recent analysis of hospital data by the Minnesota Department of Health suggests the rate of C-sections for women who have been cut is actually much lower than the rate for the state overall.

Dr. Nicole Chaisson at Smiley's Clinic in Minneapolis says because Somali patients tend to have larger families, doctors are reluctant to set them up for repeat C-sections: "We try to avoid C-sections at all costs with our Somali patients."

Physicians and advocates agree providers should be more proactive in discussing cutting-related issues with patients: Are they struggling with low libido? Do they have concerns about how doctors would handle their deliveries? Do they have mental healthcare needs?

"If doctors ask, women will talk," said Weli. "They are desperate to talk about this with anyone."

Mila Koumpilova