A woman speaks as Masai women gather for a meeting about the practice of female genital mutilation June 12, 2014, in Enkorika, Kajiado, in Kenya.
SIMON MAINA/Getty Images

The number of female African immigrants living in the U.S. who have had their genitals cut or mutilated is nearing the half-million mark, the New York Times reports. American gynecologists and other health care providers are increasingly being exposed to a custom that many of them are simply not prepared to take on.

That 500,000 estimate has nearly tripled since the last government estimate in 1997 because of an increase in African immigrants coming to the U.S. The procedure, called genital cutting, female circumcision or female genital mutilation, is actually on the decline in parts of Africa, but some communities still perform it on women, “with more than 90 percent of women cut in Somalia and Guinea,” according to the Times.

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American physicans—many of whom have never seen female genitals altered in the various forms that the mutilation can take—are finding that they’re treating infections and complications that arise from the cutting, like cysts and fused closures. In addition, some African couples come in for prenatal care, and then the husband will ask the doctor to restore his wife’s circumcision after delivery.

Some health care officials are concerned that American physicians may “unintentionally traumatize the women they are trying to help,” the New York Times explains. Dr. Nawal Nour, director of the African Women’s Health Center in Boston, described how going to the doctor’s office for a routine checkup or procedure, like a Pap test, or giving birth is a “humiliating” experience for some of these African women. “The worst thing a health care provider can do is wince or cringe or ask an inappropriate question,” she said, according to the Times. “It deters a patient from returning.”

The procedure is banned in the U.S. It is also illegal to send women abroad to have the cutting performed.

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Read more at the New York Times.