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Vedovo F, Pavan N, Bertolotto M, Giangreco M, Chiapparrone G, Ongaro L, Currò F, Liguori G, Barbone F, Trombetta C. Neoclitoral location may affect sexual function in transgender women: a preliminary pelvic MRI study. Int J Impot Res 2024; 36:526-530. [PMID: 37179422 DOI: 10.1038/s41443-023-00716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Assigned female at birth with anorgasmia possess a smaller clitoral glans and clitoral components farther from the vagina lumen than women with normal orgasmic function. There are no studies evaluating this correlation in operated transgender women. We evaluated whether differences in MRI measurements of neoclitoris volume and distance between the neoclitoris and the neovagina were correlated with differences in sexual function. We recruited for a prospective survey study 40 operated male to female patients (oMtF) who had undergone genital gender affirming surgery and postoperative pelvic MRI. Individual pelvic MRIs were reviewed by two blinded investigators, the three axes of the neoclitoris were measured and the volume was calculated using the ellipsoid formula. The distance between the neoclitoris and the neovagina was also measured. Sexual functioning was assessed using the Female Sexual Function Index (FSFI) and the operated Male to Female Sexual Function Index (oMtFSFI). Mean scores differences in FSFI, oMtFSFI were examined; associations with clitoral size, location, sexual functioning and demographical variables were investigated as well. The response rate was 55%, 11 MtFs operated with pubic neoclitoris technique (PNT) and 11 with neo-urethroclitoroplasty according to Petrović (NCP). The NCP group presented a neoclitoris mean volume of 1.04 (SD 0.39) cc vs 1.31 (SD 0.78) cc of the other group (p = 0.55). The mean distance between neoclitoris and neovagina was 4.20 (SD 0.57) cm in the PNT group and 2.55 (SD 0.45) in the NCP group (p < 0.001). Patients who had undergone NCP achieved a higher FSFI and oMtFSFI mean Total Score than those operated with the previous technique (FSFI 25.81 SD 3.02 vs 18.62 SD 9.92 p = 0.08; oMtFSFI 37.63 SD 8.28 vs 43.36 SD 13.02 p = 0.23). According to pelvic MRI measurements, this study suggests a correlation between neoclitoral location and oMtF sexual satisfaction.
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Affiliation(s)
- Francesca Vedovo
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy.
| | - Nicola Pavan
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Michele Bertolotto
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health-IRCCS "BurloGarofolo", Trieste, Italy
| | - Gaetano Chiapparrone
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Luca Ongaro
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Francesca Currò
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giovanni Liguori
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Fabio Barbone
- Institute for Maternal and Child Health-IRCCS "BurloGarofolo", Trieste, Italy
- University of Udine, Medical Area, Udine, Italy
| | - Carlo Trombetta
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
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von Fritschen U, Strunz C, Scherer R, Fricke A. Sensitivity after Clitoral Reconstruction in Patients with Female Genital Mutilation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5851. [PMID: 38881961 PMCID: PMC11177814 DOI: 10.1097/gox.0000000000005851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/08/2024] [Indexed: 06/18/2024]
Abstract
Background In the past decades, reconstructive choices after female genital mutilation extended beyond de-infibulation and scar release. The current trend to expand techniques addressing sexual and aesthetic aspects by reconstructing the clitoris and prepuce, and dissecting the clitoral nerves raises concern, as there is a paucity of evidence on the functional outcomes and suspected iatrogenic lacerations. Methods A total of 128 female genital mutilation patients were included in the study. To evaluate clitoral sensitivity after elevation, the Semmes-Weinstein-monofilament test was performed before and after genital reconstruction. Results Preoperatively, patients with a visually intact clitoris showed significantly better sensitivity compared with patients with a mutilated clitoris or infibulation (P < 0.0001). Surgery was performed in 84 patients. After clitoral reconstruction (CR), 70 of 73 patients were able to perceive 2.83 monofilaments (95.9%), whereas three perceived 3.61. Patients with a visually intact clitoris served as control, and 95.0% perceived 2.83 monofilaments. We showed a significant improvement of clitoral sensitivity (P = 0.0020) in the subgroup consisting of patients with a mutilated clitoris in whom the test was performed before and after reconstruction. Conclusions Clitoral sensitivity improves significantly after CR. Seventy of 73 patients attained the same sensitivity as unharmed women. No patient showed a decreased sensitivity compared with their preoperative findings. Therefore, our study supports the argument that CR offers sufficient improvement of objective clitoral sensitivity without additionally addressing clitoral nerves.
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Affiliation(s)
- Uwe von Fritschen
- From the Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Berlin, Germany
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - Cornelia Strunz
- Desert Flower Center, Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Berlin, Germany
| | - Roland Scherer
- Desert Flower Center, Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Berlin, Germany
| | - Alba Fricke
- From the Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Berlin, Germany
- Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg, Freiburg, Germany
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Longhurst GJ, Beni R, Jeong SR, Pianta M, Soper AL, Leitch P, De Witte G, Fisher L. Beyond the tip of the iceberg: A meta-analysis of the anatomy of the clitoris. Clin Anat 2024; 37:233-252. [PMID: 37775965 DOI: 10.1002/ca.24113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/04/2023] [Accepted: 08/20/2023] [Indexed: 10/01/2023]
Abstract
An understanding of ranges in clitoral anatomy is important for clinicians caring for patients including those who have had female genital mutilation, women seeking genital cosmetic surgery, or trans women seeking reconstructive surgery. The aim of this meta-analysis is to investigate the ranges in clitoral measurements within the literature. A meta-analysis was performed on Ovid Medline and Embase databases following the PRISMA protocol. Measurements of clitoral structures from magnetic imaging resonance, ultrasound, cadaveric, and living women were extracted and analyzed. Twenty-one studies met the inclusion criteria. The range in addition to the average length and width of the glans (6.40 mm; 5.14 mm), body (25.46 mm; 9.00 mm), crura (52.41 mm; 8.71 mm), bulb (52.00 mm; 10.33 mm), and prepuce (23.19 mm) was calculated. Furthermore, the range and average distance from the clitoris to the external urethral meatus (22.27 mm), vagina (43.14 mm), and anus (76.30 mm) was documented. All erectile and non-erectile structures of the clitoris present with substantial range. It is imperative to expand the literature on clitoral measurements and disseminate the new results to healthcare professionals and the public to reduce the sense of inadequacy and the chances of iatrogenic damage during surgery.
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Affiliation(s)
| | - Rebecca Beni
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Su Ryeon Jeong
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Marina Pianta
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Annie Louisa Soper
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Patricia Leitch
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Gabrielle De Witte
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Lauren Fisher
- Department of Anatomical Sciences, St George's University of London, London, UK
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Connor JJ, Abdi C, Chen M, Salad M, Pergament S, Afey F, Hussein I, Robinson BBE. Our Body Our Health (Jirkeena, Caafimaadkeena): Somali Women's Narratives on Sexual Health. JOURNAL OF SEX RESEARCH 2023:1-15. [PMID: 38047877 PMCID: PMC11147957 DOI: 10.1080/00224499.2023.2288077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Women across the globe have been subject to female genital cutting (FGC), with the highest rates in Somalia. FGC can result in sexual concerns, especially sexual pain and lower pleasure. Due to ongoing civil war and climate disasters, there is a large number of Somali immigrants and refugees living in countries where healthcare providers may be unfamiliar with the impact of FGC. In this qualitative study, sixty Somali women between the ages 20 and 45 and living in the U.S. shared their perspectives on how FGC has affected their sexual lives, including how they have coped with any complications attributed to FGC. Participants were recruited through convenience sampling and interviewed by a bilingual community researcher in either Somali or English. Data were analyzed through a participatory analysis process by academic and community researchers. Themes included sexual desire, arousal, and pleasure; sexual satisfaction; sexual pain at first intercourse; coping with sexual pain at first intercourse; long-term sexual pain, coping with long-term sexual pain. Results are discussed with a focus on agency of the participants, role of partners, and implications for healthcare professionals.
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Affiliation(s)
- Jennifer Jo Connor
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Cawo Abdi
- Department of Sociology, University of Minnesota
| | - Muzi Chen
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Munira Salad
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Shannon Pergament
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Foos Afey
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Intisar Hussein
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Beatrice Bean E Robinson
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
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Chaisson N, Johnson-Agbakwu CE, Finch A, Salad M, Connor JJ, Chen M, Robinson BBE. Beautiful vulvas: expanding illustrative visual imagery of female genital cutting types. J Sex Med 2023; 20:1301-1311. [PMID: 37721173 PMCID: PMC10627781 DOI: 10.1093/jsxmed/qdad102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/18/2023] [Accepted: 06/04/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Visual imagery has been used to educate healthcare providers, patients, and the lay public on female genital cutting (FGC) typology and reconstructive procedures. However, culturally inclusive, diverse, and anatomically accurate representation of vulvas informed by women possessing lived experience of FGC is lacking. AIM We sought to apply World Health Organization (WHO) FGC typology to the development of type-specific visual imagery designed by a graphic artist and culturally informed by women with lived experience of FGC alongside a panel of health experts in FGC-related care. METHODS Over a 3-year process, a visual artist created watercolor renderings of vulvas with and without FGC across varying WHO types and subtypes using an iterative community-based approach. Somali women possessing lived experience of FGC were engaged alongside a team of clinician experts in FGC-related care. Women and clinicians provided descriptive input on skin color variation, texture, and skin tone, as well as the visual depiction of actions necessary in conducting a genital examination. OUTCOMES A series of vulvar anatomic illustrations depicting WHO FGC typology. RESULTS FGC types and subtypes are illustrated alongside culturally informed descriptors and clinical pearls to strengthen provider competency in the identification and documentation of FGC WHO typology, as well as facilitate patient education, counseling, shared decision making, and care. CLINICAL IMPLICATIONS Ensuring equitable representation of race, gender, age, body type, and ability in medical illustrations may enhance patient education, counseling, and shared decision making in medical and/or surgical care. FGC provides a lens through which the incorporation of patient-informed and culturally relevant imagery and descriptors may enhance provider competency in the care of FGC-affected women and adolescents. STRENGTHS AND LIMITATIONS The strengths of this study include the development of visual imagery through an iterative community-based process that engaged women with lived experience of FGC alongside clinicians with expertise in FGC-related care, as well as the representation of historically underrepresented bodies in the anatomical literature. Study limitations include the lack of generalizability to all possible forms or practices of FGC given the focus on one geographically distinct migrant community, as well as the reliance on self-report given the inability to clinically verify FGC status due to the community-based methodology employed. CONCLUSION Patient-informed and culturally representative visual imagery of vulvas is essential to the provision of patient-centered sexual health care and education. Illustrations developed through this community-engaged work may inform future development of visual educational content that advances equity in diverse representation of medical illustrations.
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Affiliation(s)
- Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Crista E Johnson-Agbakwu
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School and UMass Memorial Health, Worcester, MA, United States
| | - Ashley Finch
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Munira Salad
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Jennifer Jo Connor
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Muzi Chen
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Beatrice Bean E Robinson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
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Johnson-Agbakwu CE, Chen M, Salad M, Chaisson N, Connor JJ, Robinson BBE. Female genital cutting (FGC) type: proposing a multifaceted, interactive method for FGC self-assessment. J Sex Med 2023; 20:1292-1300. [PMID: 37721131 PMCID: PMC10627780 DOI: 10.1093/jsxmed/qdad101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Self-reporting female genital cutting (FGC) status and types by patients and clinicians is often inconsistent and inaccurate, particularly in community settings where clinically verifiable genital exams are not feasible or culturally appropriate. AIM In this study we sought to discern whether integrating multiple dimensions of participant engagement through self-reflection, visual imagery, and iterative discourse informed the determination of FGC status by a panel of health and cultural experts using World Health Organization (WHO) typology. METHODS Using community-based participatory research, we recruited 50 Somali women from the Minneapolis-St. Paul, MN, metropolitan area through convenience and snowball sampling to participate in semi-structured interviews. Participants were asked to discuss their recollection of their original circumcision-including the procedure itself and their assessment of the type of circumcision they experienced. Anatomical drawings of uncircumcised and circumcised vulvas were shown to participants to assist them in identifying their FGC type. A panel of health and cultural experts reviewed and independently assessed participant FGC type. Interrater reliability and degree of concordance between participants and panel were determined. OUTCOMES Outcomes included the following: (1) development of WHO-informed, anatomically accurate visual depictions of vulvas representing FGC typology, (2) development of an iterative, self-reflective process by which participants self-described their own FGC status aided by visual depictions of vulvas, (3) application of WHO FGC typology by a panel of health and cultural experts, and (4) determination of the degree of concordance between participants and panel in the classification of FGC type. RESULTS High interrater reliability (kappa = 0.64) and concordance (80%) between panel and participants were achieved. CLINICAL TRANSLATION Incorporation of FGC visual imagery combined with women's empowered use of their own self-described FGC status would optimize clinical care, patient education, and informed decision making between patients and their providers when considering medical and/or surgical interventions, particularly among women possessing limited health and anatomic literacy. STRENGTHS AND LIMITATIONS Strengths of this study include the incorporation of anatomically accurate visual representations of FGC types; the iterative, educational process by which participants qualitatively self-described their FGC status; and the high interrater reliability and concordance achieved between panel and participants. Study limitations include the inability to conduct clinical genital exams (due to the community-based methodology used), recall bias, and small sample size (n = 50). CONCLUSION We propose a new patient-informed educational method for integrating anatomically accurate visual imagery and iterative self-reflective discourse to investigate sensitive topics and guide clinicians in providing patient-centered, culturally informed care for patients with FGC.
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Affiliation(s)
- Crista E Johnson-Agbakwu
- Office of Health Equity and Division of Preventive and Behavioral Medicine, Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Muzi Chen
- Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, United States
| | - Munira Salad
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Jennifer Jo Connor
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Beatrice Bean E Robinson
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
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Holuszko OM, Abdulcadir J, Abbott D, Clancy J. Health Care Providers' Readiness to Adopt an Interactive 3D Web App in Consultations About Female Genital Mutilation/Cutting: Qualitative Evaluation of a Prototype. JMIR Form Res 2023; 7:e44696. [PMID: 37768712 PMCID: PMC10570893 DOI: 10.2196/44696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Comprehensive and appropriate health care provision to women and girls with female genital mutilation or cutting (FGM/C) is lacking. Use of visuals in health care provider (HCP) consultations facilitates the communication of health information and its comprehension by patients. A web app featuring a 3D visualization of the genitourinary anatomy was developed to support HCPs in conferring clinical information about FGM/C to patients. OBJECTIVE The aim of this study was to explore HCP perspectives on the use of visuals in discussion about FGM/C with their patients as well as to obtain their feedback on whether an interactive 3D web app showing the genitourinary anatomy would be helpful in patient consultations about FGM/C, identifying key features that are relevant to their clinical practice. METHODS We evaluated the web app through a semistructured interview protocol with seven HCPs from various disciplines experienced in care for women and girls with FGM/C in migration-destination settings. Interviews were audio- and video-recorded for transcription, and were then analyzed thematically for contextualized data regarding HCPs' willingness to use a 3D web app visualizing anatomy in FGM/C consultations with patients. RESULTS All but one of the seven participants expressed keen interest in using this web app and its 3D visuals of anatomy in FGM/C consultations with patients. Participants shared the common contexts for the use of visuals in health care for FGM/C and the concepts they are used to support, such as to help describe a patient's genitals after FGM/C and reinforce an understanding of clitoral anatomy, to illustrate the process of defibulation, or to explain the physiological effects of FGM/C. Participants also highlighted the benefit of using visuals that patients can relate to, expressing approval for the ability to customize the vulva by FGM/C subtype, skin tone, and complexity of the visual shown in the web app. Despite critiques that the visualization may serve to perpetuate idealistic standards for how a vulva should look, participants largely agreed on the web app's perceived usefulness to clinical practice and beyond. CONCLUSIONS Evaluation of the web app developed in this study identified that digital tools with 3D models of the genitourinary anatomy that are accessible, informative, and customizable to any specific patient are likely to aid HCPs in communicating clinical information about FGM/C in consultations. Universal access to the web app may be particularly useful for HCPs with less experience in FGM/C. The app also prompts options for applications such as for personal use, in medical education, in patient medical records, or in legal settings. Further qualitative research with patients is required to confirm that adoption of the web app by HCPs in a consultation setting will indeed benefit patient care for women and girls with FGM/C.
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Affiliation(s)
- Olivia May Holuszko
- School of Simulation & Visualisation, Glasgow School of Art, Glasgow, United Kingdom
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jasmine Abdulcadir
- Department of Women, Child and Adolescent, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daisy Abbott
- School of Simulation & Visualisation, Glasgow School of Art, Glasgow, United Kingdom
| | - Jennifer Clancy
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Beausang J, Mama ST. A Summary of Female Genital Mutilation/Cutting for the Pediatric and Adolescent Care Provider. J Pediatr Adolesc Gynecol 2023; 36:97-102. [PMID: 36402442 DOI: 10.1016/j.jpag.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/25/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
The World Health Organization defines female genital mutilation/cutting as any medically unnecessary procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs. It is a violation of human rights and associated with serious complications and lifelong impact on health. This review article summarizes for the pediatric and adolescent care provider the incidence worldwide, the impact of cultural practices, appropriate screening and diagnosis, interventions, and treatment, along with legal and ethical issues.
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Affiliation(s)
- Jasjit Beausang
- Cooper Medical School of Rowan University Cooper University Health Care, Camden, New Jersey
| | - Saifuddin T Mama
- Cooper Medical School of Rowan University Cooper University Health Care, Camden, New Jersey.
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Tognazzo E, Berndt S, Abdulcadir J. Autologous Platelet-Rich Plasma in Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: A Pilot Case Study. Aesthet Surg J 2023; 43:340-350. [PMID: 36251970 DOI: 10.1093/asj/sjac265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Postoperative healing after clitoral reconstruction (CR) for female genital mutilation/cutting can be long and painful due to prolonged clitoral re-epithelialization time (up to 3 months). Autologous platelet-rich plasma (A-PRP) might reduce postoperative clitoral epithelialization time and pain. OBJECTIVES The authors assessed postoperative clitoral re-epithelialization time and pain after intraoperative clitoral administration of A-PRP. METHODS Five consecutive women underwent CR (Foldès technique) followed by the administration of A-PRP Regen Lab SA (Le Mont-sur-Lausanne, Switzerland) plasma and glue, injected inside and applied above the re-exposed clitoris, respectively. We recorded surgical complications, postoperative clitoral pain (visual analogue scale), painkiller intake, time to complete re-epithelialization, and the experienced subjective changes in sexual response and perception of their own body image referred by women. RESULTS Sexual distress/dysfunction as well as the desire to be physically and symbolically "repaired" were the reasons behind women's requests for surgery. None of the women suffered from chronic vulvar or non-vulvar pain. All women achieved complete clitoral epithelialization by day 80, 3 women between day 54 and 70, and only 1 woman was still taking 1 g of paracetamol twice a day at 2 months postoperative. She had stopped it before the 3-month control. There were no short- or long-term complications. All women described easier access and stimulation of their clitoris as well as improved sexual arousal, lubrication, and pleasure and claimed to be satisfied with their restored body image. CONCLUSIONS A-PRP could expedite postoperative clitoral epithelialization and reduce postoperative pain after CR after female genital mutilation/cutting. LEVEL OF EVIDENCE: 4
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Jordal M, Påfs J, Wahlberg A, Johansen REB. "Damaged genitals"-Cut women's perceptions of the effect of female genital cutting on sexual function. A qualitative study from Sweden. FRONTIERS IN SOCIOLOGY 2022; 7:943949. [PMID: 36033981 PMCID: PMC9413146 DOI: 10.3389/fsoc.2022.943949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Female genital cutting (FGC) is a traditional practice, commonly underpinned by cultural values regarding female sexuality, that involves the cutting of women's external genitalia, often entailing the removal of clitoral tissue and/or closing the vaginal orifice. As control of female sexual libido is a common rationale for FGC, international concern has been raised regarding its potential negative effect on female sexuality. Most studies attempting to measure the impact of FGC on women's sexual function are quantitative and employ predefined questionnaires such as the Female Sexual Function Index (FSFI). However, these have not been validated for cut women, or for all FGC-practicing countries or communities; nor do they capture cut women's perceptions and experiences of their sexuality. We propose that the subjective nature of sexuality calls for a qualitative approach in which cut women's own voices and reflections are investigated. In this paper, we seek to unravel how FGC-affected women themselves reflect upon and perceive the possible connection between FGC and their sexual function and intimate relationships. The study has a qualitative design and is based on 44 individual interviews with 25 women seeking clitoral reconstruction in Sweden. Its findings demonstrate that the women largely perceived the physical aspects of FGC, including the removal of clitoral tissue, to affect women's (including their own) sexual function negatively. They also recognized the psychological aspects of FGC as further challenging their sex lives and intimate relationships. The women desired acknowledgment of the physical consequences of FGC and of their sexual difficulties as "real" and not merely "psychological blocks".
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Affiliation(s)
- Malin Jordal
- Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Jessica Påfs
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Anna Wahlberg
- Department of Women's and Children's Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - R. Elise B. Johansen
- Norwegian Centre for Violence and Traumatic Stress Studies, Department of Children and Adolescents, Oslo, Norway
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Beni R, Fisher L, Longhurst GJ. The importance of diverse and accurate descriptions of genital anatomy in textbooks. ANATOMICAL SCIENCES EDUCATION 2022; 15:985-988. [PMID: 35593013 DOI: 10.1002/ase.2200] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Rebecca Beni
- Medicine M.B.B.S. Program, Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Lauren Fisher
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Georga J Longhurst
- Department of Anatomical Sciences, St George's University of London, London, UK
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Reconsidering the role of patriarchy in upholding female genital modifications: analysis of contemporary and pre-industrial societies. Int J Impot Res 2022; 35:202-211. [PMID: 35701657 PMCID: PMC10159853 DOI: 10.1038/s41443-022-00581-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/08/2022]
Abstract
According to the World Health Organization (WHO), customary female genital modification practices common in parts of Africa, South and Southeast Asia, and the Middle East are inherently patriarchal: they reflect deep-rooted inequality between the sexes characterized by male dominance and constitute an extreme form of discrimination against women. However, scholars have noted that while many societies have genital modification rites only for boys, with no equivalent rite for girls, the inverse does not hold. Rather, almost all societies that practice ritual female genital modification also practice ritual male genital modification, often for comparable reasons on children of similar ages, with the female rites led by women and the male rites led by men. In contrast, then, to the situation for boys in various cultures, girls are not singled out for genital modification on account of their sex or gender; nor do the social meanings of the female rites necessarily reflect a lower status. In some cases, the women's rite serves to promote female within-sex bonding and network building-as the men's rite typically does for males-thereby counterbalancing gendered asymmetries in political power and weakening male dominance in certain spheres. In such cases, and to that extent, the female rites can be described as counter-patriarchal. Selective efforts to discourage female genital modifications may thus inadvertently undermine women-centered communal networks while leaving male bonding rites intact. Scholars and activists should not rely on misleading generalizations from the WHO about the relationship between genital cutting and the social positioning of women as compared to men. To illustrate the complexity of this relationship, we compare patterns of practice across contemporary societies while also highlighting anthropological data regarding pre-industrial societies. Regarding the latter, we find no association between the presence of a female initiation rite and a key aspect of patriarchy as it is classically understood, namely, social endorsement of a gendered double-standard regarding premarital sexual activity. We situate this finding within the broader literature and discuss potential implications.
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13
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Bowen ST, Dutta A, Rytel K, Abramowitch SD, Rogers RG, Moalli PA. 3D quantitative analysis of normal clitoral anatomy in nulliparous women by MRI. Int Urogynecol J 2022; 33:1649-1657. [PMID: 35394140 DOI: 10.1007/s00192-022-05172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We present a 3D computational approach for automated clitoral measurements. We hypothesized that computationally derived measurements would be comparable and less variable than reported manual measures. METHODS In this retrospective study, MRIs of 22 nulliparous women age 20-49 years with normal vaginal and clitoral anatomy were collected. Manual segmentations were performed to reconstruct 3D models of the whole clitoris (glans, body, crura, and bulbs) and vagina. The length, width, and volume of the clitoral structures and the distance between the vagina and clitoral structures were calculated. Computed clitoral morphometrics (length, width) were compared to median [range] values from a previously published cadaver study (N = 22) using the median test and Moses extreme reaction test. Calculated distances were compared to mean (± SD) reported by a 2D MRI study (N = 20) using independent t-test and Levene's test. RESULTS Overall, computed clitoral morphometrics were similar to manual cadaver measurements, where the majority of length and width measures had ~1-2 mm difference and had less variability (smaller range). All calculated distances were significantly smaller and had smaller SDs than manual 2D MRI values, with two-fold differences in the means and SDs. Large variation was observed in clitoral volumetric measures in our cohort. CONCLUSIONS The proposed 3D computational method improves the standardization and consistency of clitoral measurements compared to traditional manual approaches. The use of this approach in radiographic studies will give better insight into how clitoral anatomy relates to sexual function and how both are impacted by gynecologic surgery, where outcomes can assist treatment planning.
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Affiliation(s)
- Shaniel T Bowen
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arijit Dutta
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Krystyna Rytel
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Rebecca G Rogers
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
| | - Pamela A Moalli
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. .,Division of Urogynecology & Pelvic Reconstructive Surgery, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA. .,Magee-Womens Research Institute, 204 Craft Avenue, Lab A320, Pittsburgh, PA, 15213, USA.
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14
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Tordrup D, Bishop C, Green N, Petzold M, Vallejo FR, Vogel JP, Pallitto C. Economic burden of female genital mutilation in 27 high-prevalence countries. BMJ Glob Health 2022; 7:e004512. [PMID: 35105556 PMCID: PMC8744099 DOI: 10.1136/bmjgh-2020-004512] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Female genital mutilation (FGM) is a traditional harmful practice affecting 200 million women and girls globally. Health complications of FGM occur immediately and over time, and are associated with healthcare costs that are poorly understood. Quantifying the global FGM-related burden is essential for supporting programmes and policies for prevention and mitigation. METHODS Health complications of FGM are derived from a meta-analysis and stratified by acute, uro-gynaecological, obstetric and psychological/sexual. Treatment costs are calculated from national cohort models of 27 high-burden countries over 30 years. Savings associated with full/partial abandonment are compared with a current incidence reference scenario, assuming no changes in FGM practices. RESULTS Our model projects an increasing burden of FGM due to population growth. As a reference scenario assuming no change in practices, prevalent cases in 27 countries will rise from 119.4 million (2018) to 205.8 million (2047). Full abandonment could reduce this to 80.0 million (2047), while partial abandonment is insufficient to reduce cases. Current incidence economic burden is US$1.4 billion/year, rising to US$2.1 billion/year in 2047. Full abandonment would reduce the future burden to US$0.8 billion/year by 2047. CONCLUSION FGM is a human rights violation, a public health issue and a substantial economic burden that can be avoided through effective prevention strategies. While decreasing trends are observed in some countries, these trends are variable and not consistently observed across settings. Additional resources are needed to prevent FGM to avoid human suffering and growing costs. The findings of this study warrant increased political commitment and investment in the abandonment of FGM.
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Affiliation(s)
- David Tordrup
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht, The Netherlands
- Triangulate Health Ltd, Doncaster, UK
| | | | | | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Christina Pallitto
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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15
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Manin E, Taraschi G, Berndt S, Martinez de Tejada B, Abdulcadir J. Autologous Platelet-Rich Plasma for Clitoral Reconstruction: A Case Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:673-678. [PMID: 34779981 PMCID: PMC8858308 DOI: 10.1007/s10508-021-02172-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
Clitoral reconstruction after female genital mutilation/cutting (FGM/C) is associated with significant post-operative pain and months-long recovery. Autologous platelet-rich plasma (A-PRP) reduces the time of healing and pain in orthopedic and burn patients and could also do so in clitoral reconstruction. In the present case, a 35-year-old Guinean woman who had undergone FGM/C Type IIb presented to our clinic for clitoral reconstruction. Her request was motivated by low sexual satisfaction and body image. We surgically reconstructed the clitoris using the Foldès method and applied plasma and glue of A-PRP. The patient was highly satisfied with the procedure. Two months post-operatively, her pain had ceased entirely and re-epithelialization was complete. We conclude that A-PRP may improve pain and healing after clitoral reconstruction. Extensive studies investigating long-term outcomes are needed.
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Affiliation(s)
- Emily Manin
- Weill Cornell Medical College, New York, NY, USA
| | - Gianmarco Taraschi
- Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, 30 Blvd de la Cluse 1211, 14, Geneva, Switzerland
| | - Sarah Berndt
- Regen Lab SA, En Budron b2, 1052, Le Mont-sur-Lausanne, Switzerland
| | - Begoña Martinez de Tejada
- Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, 30 Blvd de la Cluse 1211, 14, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jasmine Abdulcadir
- Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, 30 Blvd de la Cluse 1211, 14, Geneva, Switzerland.
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16
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Earp BD. Protecting Children from Medically Unnecessary Genital Cutting Without Stigmatizing Women's Bodies: Implications for Sexual Pleasure and Pain. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1875-1885. [PMID: 31965452 DOI: 10.1007/s10508-020-01633-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Brian D Earp
- Yale-Hastings Program in Ethics and Health Policy, Yale University, New Haven, CT, 06511, USA.
- The Hastings Center, Garrison, NY, USA.
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17
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Connor JJ, Brady SS, Chaisson N, Mohamed FS, Robinson BBE. Understanding Women's Responses to Sexual Pain After Female Genital Cutting: An Integrative Psychological Pain Response Model. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1859-1869. [PMID: 31011992 PMCID: PMC8240838 DOI: 10.1007/s10508-019-1422-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 05/05/2023]
Abstract
The World Health Organization estimates that over 200 million women and girls have experienced female genital cutting (FGC). Many women and girls who have undergone FGC have migrated to areas of the world where providers are unfamiliar with the health needs associated with FGC. Both providers in Western healthcare systems and female immigrant and refugee patients report communication difficulties leading to distrust of providers by women who have experienced FGC. Sexual pain is one common problem requiring discussion with healthcare providers and possible intervention. Yet, existing clinical and research literature provides little guidance for assessment and intervention when sexual pain is a result of FGC. Several conceptual frameworks have been developed to conceptualize and guide treatments for other types of pain, such as back pain and headaches. In this article, we integrate four prominent models-the fear avoidance model, eustress endurance model, distress endurance model, and pain resilience model-to conceptualize sexual pain in women who have experienced FGC. The resulting integrative psychological pain response model will aid in providing culturally responsive clinical management of sexual pain to women who have experienced FGC. This integrative model also provides a theoretical foundation for future research in this population.
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Affiliation(s)
- Jennifer Jo Connor
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Beatrice Bean E Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA
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18
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Abdulcadir J, Catania L. Conceptualizing Sexual Pain in Women with Female Genital Mutilation/Cutting. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1871-1874. [PMID: 32279168 DOI: 10.1007/s10508-020-01691-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jasmine Abdulcadir
- Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, 30 Bld de la Cluse, 1211, Geneva, Switzerland.
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19
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Johnson-Agbakwu CE, Manin E. Sculptors of African Women's Bodies: Forces Reshaping the Embodiment of Female Genital Cutting in the West. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1949-1957. [PMID: 32328914 PMCID: PMC8275492 DOI: 10.1007/s10508-020-01710-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Watts College of Public Service and Community Solutions, Arizona State University, MC 5120, 201 North Central Avenue, 33rd Floor, Phoenix, AZ, 85004, USA.
- Refugee Women's Health Clinic, Obstetrics and Gynecology, Valleywise Health, Phoenix, AZ, USA.
| | - Emily Manin
- Southwest Interdisciplinary Research Center, Watts College of Public Service and Community Solutions, Arizona State University, MC 5120, 201 North Central Avenue, 33rd Floor, Phoenix, AZ, 85004, USA
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20
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Blayney F, Camuzard O, Klein A, Perchenet AS, Bertrand B, Philandrianos C, Massin V, Abellan-Lopez M, Casanova D. Anatomical study of the clitoris and its implications on female genital mutilation and surgical repair. J Plast Reconstr Aesthet Surg 2021; 74:3394-3403. [PMID: 34253487 DOI: 10.1016/j.bjps.2021.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/29/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Worldwide, 200 million girls and women have been subjected to female genital mutilation. To restore the clitoral function and vulvar anatomy, clitoral repair has been performed since the 2000s. Nevertheless, there is a lack of precise and comprehensive data on the clitoral anatomy during surgical repair. This study aimed to precisely describe the terminal anatomies of the dorsal nerve and artery of the clitoris, and the clitoral neurovascular flap advancement for reconstruction in patients with female genital mutilation. METHODS This study was performed on seven fresh female cadavers. The site of origin, diameter, length, and trajectory of each nerve and artery were recorded. The clitoral neurovascular flap advancement was measured after a midline transection of the suspensory ligament was performed and after extensive liberation of the dorsal bundles at their emergence from the pubic rami. RESULTS At the distal point of the clitoral body, the width of the dorsal nerve and artery was 1.9 ± 0.3 mm and 0.9 ± 0.2 mm, respectively. The total length of the dorsal bundles was 6.6 cm (± 0.4). The midpart of the suspensory ligament was sectioned, which allowed a mean anteroposterior mobility of 2.7 cm (± 0.2). Extensive dissection of the neurovascular bundles up to their point of emergence from the suspensory ligament allowed a mean mobility of 3.4 ± 0.2 cm. CONCLUSION We described the anatomical characteristics of the dorsal nerve and artery of the clitoris and the mobility of the clitoral neurovascular flap for reconstruction post clitoridectomy. This was done to restore the anatomic position of the glans clitoris while preserving and potentially restoring clitoral function in patients with female genital mutilation.
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Affiliation(s)
- Fanny Blayney
- Conception Hospital/assistance publique hôpitaux de Marseille Plastic, esthetic and Reconstructive surgery department Pr. Casanova PhD, 147, Boulevard Baille, 13005, Marseille, France.
| | - Olivier Camuzard
- Pasteur universitary hospital, Plastic surgery department and Hand Reconstruction, 30 voie Romaine, 06001 Nice Cedex 1, France
| | - Arthur Klein
- Conception Hospital/assistance publique hôpitaux de Marseille Plastic, esthetic and Reconstructive surgery department Pr. Casanova PhD, 147, Boulevard Baille, 13005, Marseille, France
| | | | - Baptiste Bertrand
- Conception Hospital/assistance publique hôpitaux de Marseille Plastic, esthetic and Reconstructive surgery department Pr. Casanova PhD, 147, Boulevard Baille, 13005, Marseille, France
| | - Cécile Philandrianos
- Conception Hospital/assistance publique hôpitaux de Marseille Plastic, esthetic and Reconstructive surgery department Pr. Casanova PhD, 147, Boulevard Baille, 13005, Marseille, France
| | - Valentin Massin
- Conception Hospital/assistance publique hôpitaux de Marseille Plastic, esthetic and Reconstructive surgery department Pr. Casanova PhD, 147, Boulevard Baille, 13005, Marseille, France
| | - Maxime Abellan-Lopez
- Conception Hospital/assistance publique hôpitaux de Marseille Plastic, esthetic and Reconstructive surgery department Pr. Casanova PhD, 147, Boulevard Baille, 13005, Marseille, France
| | - Dominique Casanova
- Conception Hospital/assistance publique hôpitaux de Marseille Plastic, esthetic and Reconstructive surgery department Pr. Casanova PhD, 147, Boulevard Baille, 13005, Marseille, France
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21
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Michlig G, Warren N, Berhe M, Johnson-Agbakwu C. Female Genital Mutilation/Cutting among Somali Women in the U.S. State of Arizona: Evidence of Treatment Access, Health Service Use and Care Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3733. [PMID: 33918419 PMCID: PMC8038251 DOI: 10.3390/ijerph18073733] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is associated with adverse sexual, reproductive and psychological sequelae. The aim of this study was to quantitatively explore factors related to satisfaction with FGM/C-related care in the US focusing on access to care, health service utilization, and women's experiences. METHODS A community-based survey of 879 Ethnic Somali and Somali Bantu women using snowball sampling was conducted in Arizona. Bivariate, multivariable and ordered logistics analyses assessed the relationship between the aforementioned factors measured along six dimensions: non-discrimination, physical, economic, informational, health system accessibility and individual-level health service use factors. FINDINGS Most participants possessed FGM/C (77.4%), namely Type III (40.2%). FGM/C related health service use was low (14.3%). Perceived discrimination was associated with reduced satisfaction in care (OR = 0.22; CI 0.13-0.37). For FGM/C-specific variables, only recollection of adverse physical or psychological events at the time of circumcision predicted service use (OR = 3.09; CI 1.67-5.68). Somali Bantu (OR = 0.10; CI 0.02-0.44) and highly acculturated women (OR = 0.39; CI 0.17-0.86) had lower odds of service use. CONCLUSIONS Achieving respectful care and outreach to women affected by FGM/C has contextual complexity. However, the clinical implications and insights provided may have broader impacts on advancing health equity for FGM/C-affected women.
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Affiliation(s)
- Georgia Michlig
- International Health Department, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Nicole Warren
- Johns Hopkins School of Nursing, Baltimore, MD 21205, USA;
| | - Merry Berhe
- University of Arizona College of Medicine—Phoenix, Phoenix, AZ 85004, USA; (M.B.); (C.J.-A.)
| | - Crista Johnson-Agbakwu
- University of Arizona College of Medicine—Phoenix, Phoenix, AZ 85004, USA; (M.B.); (C.J.-A.)
- Southwest Interdisciplinary Research Center, Arizona State University, Tempe, AZ 85281, USA
- Refugee Women’s Health Clinic, Obstetrics & Gynecology, Valleywise Health, Phoenix, AZ 85008, USA
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22
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Predicting Women's Sexual Function Based on Circadian Rhythms and Anxiety Sensitivity. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2021. [DOI: 10.52547/pcnm.11.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jordal M, Levin L, Påfs J, Griffin G, Wahlberg A. Swedish Gynecologists' Positioning in Relation to Clitoral Reconstruction After Female Genital Cutting. A Qualitative Interview Study. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 33:76-87. [PMID: 38596474 PMCID: PMC10807807 DOI: 10.1080/19317611.2020.1853301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 04/11/2024]
Abstract
Background: Clitoral reconstruction (CR) is surgical reparation of the clitoris cut as part of the practice of female genital cutting (FGC) available in a handful of countries, including Sweden. The surgery aims at restoring the clitoris esthetically and functionally, thus has implications for sexual health. Gynaecological examinations can be an opportunity for dialogue regarding women's sexual health. Gynecologist play a role in referring patients experiencing FGC-related problems, including sexual, to specialist services such as CR. Aim: The aim of this study was to explore how gynecologists position themselves in relation to CR. Method: Eight gynecologists were interviewed using semi-structured interviews. The interviews were tape-recorded, transcribed and analyzed using thematic analysis. Results: The gynecologists positioned themselves in three different ways in relation CR; outright negative, uncertain or positive toward the surgery. Those positioning themselves as negative thought CR was a harmful fraud and denied any possible benefits, at least sufficient for referral for CR. Those positioning themselves as uncertain did not deny possible benefits, but were skeptical toward CR improving cut women's sexual health and function. Those positioning themselves positive considered the potential physical, psychological/emotional, esthetic, or symbolic aspects of CR as important for general well-being and sexual health. Conclusion: There was a great variety in how the gynecologists positioned themselves toward CR, and many were skeptical toward the functional benefits in relation to sexual health. This is likely to diverge cut women's access to CR surgery.
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Affiliation(s)
- Malin Jordal
- Centre for Gender Research, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Linn Levin
- Centre for Gender Research, Uppsala University, Uppsala, Sweden
| | - Jessica Påfs
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | | | - Anna Wahlberg
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
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Ugarte-Gurrutxaga MI, Molina-Gallego B, Mordillo-Mateos L, Gómez-Cantarino S, Solano-Ruiz MC, Melgar de Corral G. Facilitating Factors of Professional Health Practice Regarding Female Genital Mutilation: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8244. [PMID: 33171622 PMCID: PMC7664698 DOI: 10.3390/ijerph17218244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
Introduction: According to figures released by UNICEF (United Nations Children's Fund), more than 200 million girls and women have suffered female genital mutilation (FGM) in 30 African and Middle East countries. An increasing number of African women who come from ethnic groups where FGM is practised are arriving in Western countries. Healthcare professionals play a fundamental role in its prevention. Goals: To learn about the factors that healthcare professionals consider as facilitators for prevention and action when faced with female genital mutilation. Methods: A cross-sectional descriptive study developed on the basis of the qualitative methodological perspective, where 43 healthcare professionals participated. A series of analysis dimensions were established, based on which, the interview and discussion group scripts were designed. Results: Addressing FGM requires a series of structural adaptations of the healthcare system that facilitate the recording and monitoring of cases, both for treatment and for prevention. In addition, it is necessary to establish coordination between the healthcare, social services and education sectors. Conclusions: The existence of a protocol of action and training in its use is one of the key tools to take into account.
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Affiliation(s)
- M Idoia Ugarte-Gurrutxaga
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | - Brígida Molina-Gallego
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina (Toledo), Spain
| | - Sagrario Gómez-Cantarino
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | | | - Gonzalo Melgar de Corral
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
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25
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Pérez-López FR, Ornat L, López-Baena MT, Pérez-Roncero GR, Tajada-Duaso MC, Chedrau P. Association of female genital mutilation and female sexual dysfunction: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 254:236-244. [PMID: 33011507 DOI: 10.1016/j.ejogrb.2020.09.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To meta-analyze possible associations between female genital mutilation (FGM) and female sexual dysfunction, dyspareunia and pelvic pain. METHOD A systematic literature search was performed in PubMed, EMBASE, Scopus, Web of Science, African Index Medicus and Cochrane Library. The PICO protocol included Population: Studies evaluating girls or women; Intervention/Exposure: participants with FGM; Comparison: participants without FGM; Outcomes: female sexual function, dyspareunia or pelvic pain using validated tests. Random effect models were used for meta-analyses, and standardized mean differences (SMDs) and their 95 % confidence intervals (CIs) for any of the measured continuous outcomes were calculated when possible. Risk of bias was assessed with the Newcastle-Ottawa Scale. RESULTS Fifteen studies (n = 6672 participants) reported on the outcomes of the 19-item Female Sexual Function Index (FSFI). The meta-analysis of the total FSFI score showed a SMD of -1.43 (95 % CI -2.17, -0.69) suggestive of female sexual dysfunction. In addition, scores for the six FSFI domains were significantly lower in women with FGM: SMDs for desire -0.62 (95 % CI -1.01, -0.22), arousal -0.88 (95 % CI -1.41, -0.35), lubrication -0.95 (95 % CI -1.45, -0.46), orgasm -1.07 (95 % CI -1.63, -0.50), satisfaction -0.96 (95 % CI -1.52, -0.41) and pain -0.48 (95 % CI -0.91, -0.05). Estimation of the prevalence of female sexual dysfunction with the FSFI was not possible since different cut-offs values were used in those studies that reported for this outcome. No other searched outcomes using other tools were reported. CONCLUSION FGM seriously alters female sexual function as assessed with the FSFI, globally and per domain.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain.
| | - Lía Ornat
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | | | | | - Mauricio C Tajada-Duaso
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Peter Chedrau
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
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Young J, Nour NM, Macauley RC, Narang SK, Johnson-Agbakwu C. Diagnosis, Management, and Treatment of Female Genital Mutilation or Cutting in Girls. Pediatrics 2020; 146:peds.2020-1012. [PMID: 32719089 DOI: 10.1542/peds.2020-1012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.
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Affiliation(s)
- Janine Young
- Department of General Pediatrics, Denver Health Refugee Clinic, and Human Rights Clinic, Denver Health and Hospitals and School of Medicine, University of Colorado Denver, Denver, Colorado;
| | - Nawal M Nour
- African Women's Health Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Robert C Macauley
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Sandeep K Narang
- Division of Child Abuse Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Crista Johnson-Agbakwu
- Refugee Women's Health Clinic, Department of Obstetrics and Gynecology, Valleywise Health Medical Center and Office of Refugee Health, Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, Arizona
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In Vivo Imaging-Based 3-Dimensional Pelvic Prototype Models to Improve Education Regarding Sexual Anatomy and Physiology. J Sex Med 2020; 17:1590-1602. [PMID: 32675048 DOI: 10.1016/j.jsxm.2020.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/05/2020] [Accepted: 05/22/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Myths, misconceptions, and taboos about sexual anatomy and physiology are common and can affect sexual health and maintain harmful practices and beliefs. AIM To construct a female and a preliminary male 3-dimensional (3D) pelvic model on the basis of in vivo imaging, which could be studied in sex education and clinical practice. METHODS We retrospectively studied the images of 200 female pelvic magnetic resonance examinations and reviewed the literature to choose the optimum magnetic resonance imaging (MRI) protocol for the study of the clitoris and surrounding organs. We also conducted a cross-sectional study of 30 women who were undergoing a pelvic MRI. 15 women had undergone female genital mutilation/cutting involving the clitoris and 15 had not. The best-quality MRI images of 3 uncut and 1 cut clitoris, together with the principal surrounding pelvic organs, were selected to generate 3D reconstructions using dedicated software. The same software was used to reconstruct the anatomy of the penis and the principal surrounding pelvic organs, based on contrast-enhanced computer tomography images. Images of both models were exported in .stl format and cleaned to obtain single manifold objects in free, open source software. Each organ model was sliced and 3D printed. A preliminary feedback was collected from 13 potential users working in urology, gynaecology, sexual medicine, physiotherapy, and education. OUTCOMES The main outcomes of this study are a kit of 3D pelvic models, 2-dimensional figures of female and male sexual anatomy, and files for 3D printing. RESULTS We present a kit containing 3D models and 2-dimensional figures of female and male sexual anatomy, based on in vivo imaging and, feedbacks and suggestions received from potential users. CLINICAL TRANSLATION Our kit can be used in anatomy and sex education among and by health professionals, teachers, sex educators, students, and the general population. STRENGTHS & LIMITATIONS The strengths are that the models were based on in vivo imaging, can be dismantled/reassembled, and show analogous anatomic structures of the clitoris and the penis. The female models represent diversity, including women with female genital mutilation/cutting. The limitations are that the male model is preliminary and can be improved if based on an MRI; that imaging-based anatomic representations can differ from anatomic dissections; and that the models represent the sexual organs at rest or during an unknown state of arousal only. CONCLUSION Our kit can be studied in anatomy, biology, and sex education, as well as in clinical practice. Abdulcadir J, Dewaele R, Firmenich N, et al. In Vivo Imaging-Based 3-Dimensional Pelvic Prototype Models to Improve Education Regarding Sexual Anatomy and Physiology. J Sex Med 2020;17:1590-1602.
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Karlsen S, Carver N, Mogilnicka M, Pantazis C. 'Putting salt on the wound': a qualitative study of the impact of FGM-safeguarding in healthcare settings on people with a British Somali heritage living in Bristol, UK. BMJ Open 2020; 10:e035039. [PMID: 32554738 PMCID: PMC7304797 DOI: 10.1136/bmjopen-2019-035039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This research documents the experiences of people with Somali heritage with female genital mutilation (FGM)-safeguarding services in healthcare and whether such services are considered appropriate by the people who encounter them. DESIGN Six focus groups conducted with ethnic Somalis living in Bristol, during the summer of 2018, divided by gender and whether people had experienced FGM-safeguarding as adults or children.SettingParticipants experienced FGM-safeguarding in primary and secondary care. PARTICIPANTS 30 people (21 women and 9 men), identified through local organisations or snowball sampling. All participants were of Somali heritage and aged over 18. RESULTS Government priorities to support those who have experienced female genital cutting/mutilation (FGC/M) are being undermined by their own approaches to protect those considered at risk. Participants argued that approaches to FGM-safeguarding were based on outdated stereotypes and inaccurate evidence which encouraged health and other service providers to see every Somali parent as a potential perpetrator of FGC/M. Female participants described providers in a range of healthcare settings, including Accident and Emergency Departments (A&E), antenatal care and general practice, as 'fixated' with FGC/M, who ignored both their health needs and their experience as victims. Participants felt stigmatised and traumatised by their experience. This undermined their trust in health services, producing a reticence to seek care, treatment delays and reliance on alternative sources of care. Associated recommendations include developing more accurate evidence of risk, more appropriate education for healthcare providers and more collaborative approaches to FGM-safeguarding. CONCLUSION All the participants involved in this study are committed to the eradication of FGC/M. But the statutory approaches currently adopted to enable this are considered ill-conceived, unnecessarily heavy-handed and ultimately detrimental to this. Recognising these common aims can enable the development of services better able to protect and support those at risk of FGC/M in ways which are culturally competent and sensitive.
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Affiliation(s)
- Saffron Karlsen
- Centre for the Study of Ethnicity and Citizenship, University of Bristol, Bristol, United Kingdom
| | - Natasha Carver
- School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Magda Mogilnicka
- School of Sociology, Politics and International Studies, University of Bristol, Bristol, United Kingdom
| | - Christina Pantazis
- Centre for the Study of Poverty & Social Justice, University of Bristol, Bristol, United Kingdom
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Earp BD, Johnsdotter S. Current critiques of the WHO policy on female genital mutilation. Int J Impot Res 2020; 33:196-209. [PMID: 32457498 DOI: 10.1038/s41443-020-0302-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/12/2023]
Abstract
In recent years, the dominant Western discourse on "female genital mutilation" (FGM) has increasingly been challenged by scholars. Numerous researchers contest both the terminology used and the empirical claims made in what has come to be called "the standard tale" of FGM (also termed "female genital cutting" [FGC]). The World Health Organization (WHO), a major player in setting the global agenda on this issue, maintains that all medically unnecessary cutting of the external female genitalia, no matter how slight, should be banned as torture and a violation of the human right to bodily integrity. However, the WHO targets only non-Western forms of female-only genital cutting, raising concerns about gender bias and cultural imperialism. Here, we summarize ongoing critiques of the WHO's terminology, ethicolegal assumptions, and empirical claims, including the claim that non-Western FGC as such constitutes an extreme form of discrimination against women. To this end, we highlight recent comparative studies of medically unnecessary genital cutting of all types, including those affecting adult women and teenagers in Western societies, individuals with differences of sex development (DSD), transgender persons, and males. In so doing, we attempt to clarify the grounds for a growing critical consensus that current anti-FGM laws and policies may be ethically incoherent, empirically unsupportable, and legally unsustainable.
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Affiliation(s)
- Brian D Earp
- Associate Director, Yale-Hastings Program in Ethics and Health Policy, Yale University, New Haven, CT, 06511, USA. .,The Hastings Center, Garrison, New York, NY, 10524, USA.
| | - Sara Johnsdotter
- Professor of Medical Anthropology, Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, SE-205 06, Malmö, Sweden
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Ziyada MM, Lien IL, Johansen REB. Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway. PLoS One 2020; 15:e0233440. [PMID: 32421757 PMCID: PMC7233551 DOI: 10.1371/journal.pone.0233440] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. Methods We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. Findings We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants’ intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. Conclusion The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.
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Affiliation(s)
- Mai Mahgoub Ziyada
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Inger-Lise Lien
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - R. Elise B. Johansen
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Kimani S, Kabiru CW, Muteshi J, Guyo J. Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:3. [PMID: 31992317 PMCID: PMC6986153 DOI: 10.1186/s12914-020-0222-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/20/2020] [Indexed: 01/29/2023]
Abstract
Background Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya. Methods We drew on qualitative data collected from purposively selected women aged 15–49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. Results Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals’ and health facilities’ capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare. Conclusion Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care.
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Affiliation(s)
- Samuel Kimani
- Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF), University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya. .,School of Nursing Sciences, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.
| | | | - Jacinta Muteshi
- Population Council-Kenya, PO Box 17643-00500, Nairobi, Kenya
| | - Jaldesa Guyo
- Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF), University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.,School of Nursing Sciences, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya
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Abstract
Clitoral reconstructive surgery is not sufficient to restore women's sexual pleasure after excision. If the surgical technique aims at reconstructing the cut clitoris after type 2 female genital mutilation, the surgery alone cannot reconstruct other dimensions invoked by women in their requests for the procedure. In France, where clitoral reconstructive surgery since 2004 has been entirely covered by national insurance, a multidisciplinary approach precedes the surgery. Ethnographic fieldwork in one public hospital contributes a wider comprehension of the entire process of clitoral reconstruction, as well as the tools elaborated by the medical team. In particular, analysis of the assessments of the psychologist and sex therapist compiled in the medical folders shows how the multidisciplinary medical team developed specific tools. These tools are oriented at reconstructing the patient's sexual sensibility, at breaking through psychological blocks such as self-esteem and body image, and/or at addressing abusive intimate relationships.
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Affiliation(s)
- Michela Villani
- Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
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Medically Unnecessary Genital Cutting and the Rights of the Child: Moving Toward Consensus. AMERICAN JOURNAL OF BIOETHICS 2019; 19:17-28. [PMID: 31557092 DOI: 10.1080/15265161.2019.1643945] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Palm C, Essén B, Johnsdotter S. Sexual health counselling targeting girls and young women with female genital cutting in Sweden: mind-body dualism affecting social and health care professionals' perspectives. Sex Reprod Health Matters 2019; 27:1615364. [PMID: 31533573 PMCID: PMC7888010 DOI: 10.1080/26410397.2019.1615364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western, multicultural societies. This article is based on interviews and focus group discussions with professionals in social and healthcare services. The aim of this study was to examine how professionals reflect upon and talk about sexuality and the promotion of sexual wellbeing in young circumcised women and girls. Policy documents guide their obligations, yet they are also influenced by culture-specific notions about bodies and sexuality and what can be called “the FGM standard tale”. The study found that professionals showed great commitment to helping the girls and young women in the best possible way. Their basic starting point, however, was characterised by a reductionist focus on the genitalia’s role in sexuality, thus neglecting other important dimensions in lived sexuality. In some cases, such an attitude may negatively affect an individual’s body image and sexual self-esteem. Future policy making in the field of sexual health among girls and young women with FGC would benefit from taking a broader holistic approach to sexuality. Professionals need to find ways of working that promote sexual wellbeing in girls, and must avoid messages that evoke body shame or feelings of loss of sexual capacity among those affected by FGC.
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Affiliation(s)
- Camilla Palm
- PhD Candidate, Faculty of Health and Society , Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden; Department of Women's and Children's Health (IMCH), Uppsala University , Uppsala , Sweden
| | - Birgitta Essén
- Professor, Department of Women's and Children's Health (IMCH) , Uppsala University , Uppsala , Sweden
| | - Sara Johnsdotter
- Professor, Faculty of Health and Society , Centre for Sexology and Sexuality Studies, Malmö University , Malmö , Sweden
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35
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Atkinson HG, Geisler A. Developing Physician Educational Competencies for the Management of Female Genital Cutting: A Call to Action. J Womens Health (Larchmt) 2019; 28:997-1003. [DOI: 10.1089/jwh.2018.7163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Holly G. Atkinson
- Department of Medical Education, CUNY School of Medicine, New York, New York
| | - Amaris Geisler
- Department of Medical Education, CUNY School of Medicine, New York, New York
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36
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Buggio L, Facchin F, Chiappa L, Barbara G, Brambilla M, Vercellini P. Psychosexual Consequences of Female Genital Mutilation and the Impact of Reconstructive Surgery: A Narrative Review. Health Equity 2019; 3:36-46. [PMID: 30805570 PMCID: PMC6386073 DOI: 10.1089/heq.2018.0036] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: We aim to provide a comprehensive overview of the health consequences of female genital mutilation/cutting (FGM/C), with a particular focus on the psychosexual implications of this practice and the overall impact of reconstructive plastic surgery. Methods: A MEDLINE search through PubMed was performed to identify the best quality evidence published studies in English language on long-term health consequences of FGM/C. Results: Women with FGM/C are more likely to develop psychological disorders, such as post-traumatic stress disorder, anxiety, somatization, phobia, and low self-esteem, than those without FGM/C. Most studies showed impaired sexual function in women with FGM/C. In particular, women with FGM/C may be physiologically less capable of becoming sexually stimulated than uncut women. Reconstructive surgery could be beneficial, in terms of both enhanced sexual function and body image. However, prospective studies on the impact of reconstructive surgery are limited, and safety issues should be addressed. Conclusion: Although it is clear that FGM/C can cause devastating immediate and long-term health consequences for girls and women, high-quality data on these issues are limited. Psychosexual complications need to be further analyzed to provide evidence-based guidelines and to improve the health care of women and girls with FGM/C. The best treatment approach involves a multidisciplinary team to deal with the multifaceted FGM/C repercussions.
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Affiliation(s)
- Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Facchin
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
| | - Laura Chiappa
- Health Director, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Unit, General Surgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi Milano, Italy
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Tarr-Attia CK, Boiwu GH, Martínez-Pérez G. 'Birds of the same feathers fly together': midwives' experiences with pregnant women and FGM/C complications - a grounded theory study in Liberia. Reprod Health 2019; 16:18. [PMID: 30764836 PMCID: PMC6376772 DOI: 10.1186/s12978-019-0681-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 02/06/2019] [Indexed: 12/03/2022] Open
Abstract
Background In Liberia, approximately 70% of the women of the North-Central and North-Western regions could have undergone female genital mutilation/cutting (FGM/C) in their childhood during a traditional ceremony marking their entrance into Sande, a secret female society. Little is known about FGM/C from Liberian women’s perspective. This study aimed to understand the health implications of FGM/C as perceived by qualified female midwives. Methods This qualitative study was conducted in 2017 in Monrovia, Liberia’s capital. Twenty midwives were approached. Of these, seventeen consented to participate in in-depth interviews. A thematic guide was used to gain insights about their knowledge on FGM/C and their experiences attending women victims of FGM/C. A feminist interpretation of constructivist grounded theory guided data generation and analysis. Results The midwives participants described how clitoridectomy was the most common FGM/C type done to the girls during the Sande initiation ceremonies. Sexual impairment and intrapartum vulvo-perineal laceration with subsequent hemorrhage were described as frequent FGM/C-attributable complications that some midwives could be unable to address due to lack of knowledge and skills. The majority of midwives would advocate for the abandonment of FGM/C, and for the preservation of the traditional instructions that the girls in FGM/C-practicing regions receive when joining Sande. The midwives described how migration to urban areas, and improved access to information and communication technologies might be fuelling abandonment of FGM/C. Conclusion Liberian midwives need tailored training to provide psychosexual counseling, and to attend the obstetric needs of pregnant women that have undergone FGM/C. In spite of FGM/C being seemingly in the decline, surveillance at clinic-level is warranted to prevent its medicalization. Any clinic- or community-based training, research, prevention and awareness intervention targeting FGM/C-practicing populations should be designed in collaboration with Sande members, and acknowledging that the Liberian population may place a high value in Sande’s traditional values.
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Affiliation(s)
- Christine K Tarr-Attia
- Saint Joseph's Catholic Hospital, Monrovia, Liberia.,African Women's Research Observatory (AfWORO), Barcelona, Spain
| | | | - Guillermo Martínez-Pérez
- African Women's Research Observatory (AfWORO), Barcelona, Spain. .,NGO Nutrition Without Borders The Gambia, Centre for Rehabilitation and Education in Nutrition, Basse Santa Su, URR, The Gambia. .,Faculty of Health Sciences, University of Saragossa, Saragossa, Spain.
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Payne CK, Abdulcadir J, Ouedraogo C, Madzou S, Kabore FA, De EJ. International continence society white paper regarding female genital mutilation/cutting. Neurourol Urodyn 2019; 38:857-867. [PMID: 30681188 DOI: 10.1002/nau.23923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 11/11/2022]
Abstract
Female genital mutilation/cutting (FGM/C)-also known as Female Genital Cutting or Mutilation-is defined as the partial or total removal of the female external genitalia for non-therapeutic reasons. This White Paper, prepared under the auspices of the International Continence Society (ICS), is intended by the ICS as a statement promoting the abandonment of this practice. The ICS also supports the respectful and evidence-based care or treatment of women and girls already affected by FGM/C, in keeping with the World Health Organization (WHO) Guidelines on the Management of Health Complications from Female Genital Mutilation. Our members specialize in pelvic floor disorders from perspectives within a range of specialties; we encounter and treat women living with FGM/C and its consequences-particularly incontinence, infections, voiding dysfunction, sexual dysfunction, chronic pelvic pain, and obstetric trauma. Understanding the ethical, sociocultural, medical and surgical factors surrounding FGM/C is central to caring for women and girls with a history of FGM/C. The ICS voices herein state strong opposition to FGM/C. We encourage members to apply their skills to improve prevention strategies and the management of those affected.
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Affiliation(s)
- Christopher K Payne
- Department of Urology, Stanford University Medical School, Stanford, California
| | - Jasmine Abdulcadir
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Faculty of Médicine, UNIGE, Geneva, Switzerland
| | - Charlemagne Ouedraogo
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | - Sebastien Madzou
- Department of Obstetrics and Gynecology, Pole Femme Mere Enfants, Angers, France
| | | | - Elise Jb De
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
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- Department of Urology, Universite de Ouagadougou, Centre Region, Burkina Faso
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Female Genital Mutilation Reconstruction for Plastic Surgeons-A Call to Arms. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1945. [PMID: 30881780 PMCID: PMC6414122 DOI: 10.1097/gox.0000000000001945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/27/2018] [Indexed: 11/26/2022]
Abstract
The practice of female genital mutilation (FGM) is performed for historically engrained cultural beliefs with no recognized health benefits. FGM continues to be practiced secondary to motivating factors based on cultural beliefs, the majority of which aim to maintain the “purity” of the female victim. The World Health Organization has classified FGM into 4 types ranging from partial clitoral resection to complete clitoral excision along with the majority of the vulva. The list of short and long-term complications is extensive and morbid, including injury to the patient’s sexuality and feminine identity. Reconstructive surgery can be an important addition to psychotherapy for these women with the goal of correcting the appearance of the vulva to achieve a more normal appearance, and to restore clitoral function. We suggest that this represents an opportunity for plastic surgeons to use our wealth of reconstructive knowledge to provide restoration of form and function to FGM victims.
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Earp BD, Sardi LM, Jellison WA. False beliefs predict increased circumcision satisfaction in a sample of US American men. CULTURE, HEALTH & SEXUALITY 2018; 20:945-959. [PMID: 29210334 DOI: 10.1080/13691058.2017.1400104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Critics of non-therapeutic male and female childhood genital cutting claim that such cutting is harmful. It is therefore puzzling that 'circumcised' women and men do not typically regard themselves as having been harmed by the cutting, notwithstanding the loss of sensitive, prima facie valuable tissue. For female genital cutting (FGC), a commonly proposed solution to this puzzle is that women who had part(s) of their vulvae removed before sexual debut 'do not know what they are missing' and may 'justify' their genitally-altered state by adopting false beliefs about the benefits of FGC, while simultaneously stigmatising unmodified genitalia as unattractive or unclean. Might a similar phenomenon apply to neonatally circumcised men? In this survey of 999 US American men, greater endorsement of false beliefs concerning circumcision and penile anatomy predicted greater satisfaction with being circumcised, while among genitally intact men, the opposite trend occurred: greater endorsement of false beliefs predicted less satisfaction with being genitally intact. These findings provide tentative support for the hypothesis that the lack-of-harm reported by many circumcised men, like the lack-of-harm reported by their female counterparts in societies that practice FGC, may be related to holding inaccurate beliefs concerning unaltered genitalia and the consequences of childhood genital modification.
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Affiliation(s)
- Brian D Earp
- a Departments of Philosophy and Psychology , Yale University , New Haven , CT , USA
| | - Lauren M Sardi
- b Department of Sociology, Criminal Justice, and Anthropology , Quinnipiac University , Hamden , CT , USA
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Sigurjonsson H, Jordal M. Addressing Female Genital Mutilation/Cutting (FGM/C) in the Era of Clitoral Reconstruction: Plastic Surgery. CURRENT SEXUAL HEALTH REPORTS 2018; 10:50-56. [PMID: 29755298 PMCID: PMC5937872 DOI: 10.1007/s11930-018-0147-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE OF THE REVIEW The aim of this review is to give an overview of the recent evidence on clitoral reconstruction and other relevant reconstructive plastic surgery measures after female genital mutilation/cutting (FGM/C). RECENT FINDINGS Recent publications present refinements and modifications of the surgical technique of clitoral reconstruction along with reconstruction of the labia majora and clitoral hood. Novel approaches with reposition of the clitoral nerve, anchoring of the labia majora, fat grafting, and full thickness mucosa grafts have been introduced. The current evidence on outcomes of clitoral reconstruction shows potential benefits. However, there is a risk of postoperative complications and a negative outcome. Experts in the field advocate for a multidisciplinary approach including psychosexual counseling and health education with or without subsequent clitoral reconstructive surgery. SUMMARY The evolution of reconstructive treatment for women with FGM/C is expanding, however at a slow rate. The scarcity of evidence on clitoral reconstruction halters availability of clinical guidelines and consensus regarding best practice. Clitoral reconstruction should be provided by multidisciplinary referral centers in a research setting with long-term follow-up on outcomes of postoperative morbidity and possible benefits.
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Affiliation(s)
- Hannes Sigurjonsson
- Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Malin Jordal
- Center for Gender Research, Uppsala University, Uppsala, Sweden
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Johnsdotter S. The Impact of Migration on Attitudes to Female Genital Cutting and Experiences of Sexual Dysfunction Among Migrant Women with FGC. CURRENT SEXUAL HEALTH REPORTS 2018. [PMID: 29541003 PMCID: PMC5840240 DOI: 10.1007/s11930-018-0139-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of Review The purpose of this review was to explore current research on the impact of migration on issues related to female genital cutting and sexuality. Recent Findings There is growing evidence that migration results in a broad opposition to female genital cutting among concerned migrant groups in western countries. In addition, after migration, affected women live in the midst of a dominant discourse categorizing them as "mutilated" and sexually disfigured. There is also, in contrast to what is shown by most research, a public discourse saying that female genital cutting (FGC) leads to lost capacity to enjoy sex. Concurrently, a vast body of research demonstrates a strong correlation between a negative body image or body shame and sexual dysfunction. Summary Care for women with FGC needs to be holistic and, while offering medical care when needed, the health care providers should avoid feeding into self-depreciatory body images and notions about lost ability to enjoy sexual life.
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Affiliation(s)
- Sara Johnsdotter
- Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
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Esho T, Kimani S, Nyamongo I, Kimani V, Muniu S, Kigondu C, Ndavi P, Guyo J. The 'heat' goes away: sexual disorders of married women with female genital mutilation/cutting in Kenya. Reprod Health 2017; 14:164. [PMID: 29197397 PMCID: PMC5712182 DOI: 10.1186/s12978-017-0433-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) has been implicated in sexual complications among women, although there is paucity of research evidence on sexual experiences among married women who have undergone this cultural practice. The aim of this study was to investigate the sexual experiences among married women in Mauche Ward, Nakuru County. METHODS Quantitative and qualitative data collection methods were used. Quantitative data were obtained from 318 married women selected through multistage sampling. The women were categorized into: cut before marriage, cut after marriage and the uncut. A questionnaire was used to collect demographic information while psychometric data were obtained using a female sexual functioning index (FSFI) tool. The resulting quantitative data were analyzed using SPSS® Version 22. Qualitative data were obtained from five FGDs and two case narratives. The data were organized into themes, analyzed and interpreted. Ethical approval for the study was granted by Kenyatta National Hospital-University of Nairobi Ethics and Research Committee. RESULTS The mean age of the respondents was 30.59 ± 7.36 years. The majority (74.2%) had primary education and 76.1% were farmers. Age (p = 0.008), number of children (p = 0.035) and education (p = 0.038) were found to be associated with sexual functioning. The cut women reported lower sexual functioning compared to the uncut. ANOVA results show the reported overall sexual functioning to be significantly (p = 0.019) different across the three groups. Women cut after marriage (mean = 22.81 ± 4.87) scored significantly lower (p = 0.056) than the uncut (mean = 25.35 ± 3.56). However, in comparison to the cut before marriage there was no significant difference (mean = 23.99 ± 6.63). Among the sexual functioning domains, lubrication (p = 0.008), orgasm (p = 0.019) and satisfaction (p = 0.042) were significantly different across the three groups. However, desire, arousal and pain were not statistically different. CONCLUSION Generally, cut women had negative sexual experiences and specifically adverse changes in desire, arousal and satisfaction were experienced among cut after marriage. FGM/C mitigating strategies need to routinely provide sexual complications management to safeguard women's sexual right to pleasure subsequently improving their general well-being.
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Affiliation(s)
- Tammary Esho
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya. .,Department of Community and Public Health, Technical University of Kenya, P.O Box 52426, Nairobi, Kenya.
| | - Samuel Kimani
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya.,School of Nursing Sciences, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya
| | - Isaac Nyamongo
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya.,Cooperative Development, Research & Innovation, The Cooperative University of Kenya, Po Box 24814-00502, Karen, Nairobi, Kenya
| | - Violet Kimani
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya.,School of Public Health, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya
| | - Samuel Muniu
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya
| | - Christine Kigondu
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya.,Thematic Unit of Clinical Chemistry, Department of Human Pathology, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya
| | - Patrick Ndavi
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya
| | - Jaldesa Guyo
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, University of Nairobi, Kenyatta National Hospital, P.O Box 19676-00202, Nairobi, Kenya
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Jordal M, Griffin G. Clitoral reconstruction: Understanding changing gendered health care needs in a globalized Europe. EUROPEAN JOURNAL OF WOMENS STUDIES 2017. [DOI: 10.1177/1350506817742679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The migratory flows of recent decades that have exercised Europe as a socio-political and economic entity have produced extensive responses and interventions from European gender scholars. One relatively recent phenomenon in this context is the question of reparative surgical interventions, specifically clitoral reconstruction, in cases where women who have migrated to Europe have experienced female genital cutting. Clitoral reconstruction, which this article begins to explore, is recent in part because the related surgery was only established in the 1990s and is to date only practised in a few European countries, and in part because the research with women who ask for and have undergone such surgery has also only recently begun. This article is therefore an initial attempt to map some of the related terrain and to suggest further work that needs to be done in this increasingly important area.
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Affiliation(s)
- Malin Jordal
- Centre for Gender Research, Uppsala University, Sweden
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Okomo U, Ogugbue M, Inyang E, Meremikwu MM. Sexual counselling for treating or preventing sexual dysfunction in women living with female genital mutilation: A systematic review. Int J Gynaecol Obstet 2017; 136 Suppl 1:38-42. [PMID: 28164297 DOI: 10.1002/ijgo.12049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Female sexual dysfunction is the persistent or recurring decrease in sexual desire or arousal, the difficulty or inability to achieve an orgasm, and/or the feeling of pain during sexual intercourse. Impaired sexual function can occur with all types of female genital mutilation (FGM) owing to the structural changes, pain, or traumatic memories associated with the procedure. OBJECTIVES To conduct a systematic review of randomized and nonrandomized studies into the effects of sexual counseling with or without genital lubricants on the sexual function of women living with FGM. SEARCH STRATEGY Cochrane Central Register of Controlled Trials, MEDLINE, African Index Medicus, SCOPUS, LILACS, CINAHL, ClinicalTrials.gov, Pan African Clinical Trials Registry, and other databases were searched to August 2015. The reference lists of retrieved studies were checked for reports of additional studies, and lead authors contacted for additional data. SELECTION CRITERIA Studies of girls and women living with any type of FGM who received counselling interventions for sexual dysfunction were included. DATA COLLECTION AND ANALYSIS No relevant studies that addressed the objective of the review were identified. CONCLUSIONS Despite a comprehensive search, the authors could not find evidence of the effects of sexual counseling on the sexual function of women living with FGM. Studies assessing this intervention are needed. PROSPERO REGISTRATION CRD42015024593.
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Affiliation(s)
- Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia, Fajara, The Gambia
| | - Miriam Ogugbue
- Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Elizabeth Inyang
- Institute of Tropical Diseases Research and Prevention, University of Calabar, Calabar, Nigeria
| | - Martin M Meremikwu
- Institute of Tropical Diseases Research and Prevention, University of Calabar, Calabar, Nigeria.,Department of Pediatrics, University of Calabar, Calabar, Nigeria
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Interventions to Address Sexual Function in Women Affected by Female Genital Cutting: a Scoping Review. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0099-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Female genital mutilation: the role of medical professional organizations. Int Urogynecol J 2016; 28:537-541. [PMID: 27858133 DOI: 10.1007/s00192-016-3202-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
Female genital mutilation (FGM) refers to alteration of the external genitalia of girls without medical benefit. It is estimated by United Nations agencies that 200 million living girls and women have been subjected to different forms of FGM worldwide. Despite the criminalization of the procedure in the vast majority of countries where it is practiced, the decline in the incidence of this ritual is far from satisfactory. Immediate and long-term ill effects are well documented. Most publications of relevance originate from countries outside the map of FGM. In addition, there are major gaps in research related to this issue, considering the magnitude of the problem. International medical organizations and societies should assume their responsibility by providing a platform to professionals engaged in the prevention and treatment of the consequences of FGM, especially those living in the communities where the practice is endemic.
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Abstract
Female genital mutilation (FGM) is a collective term for the deliberate alteration, removal and cutting of the female genitalia. It has no known health benefits and can have negative physical and psychological consequences. The number of women and girls in the UK that are affected by FGM is unknown. Recent NHS data suggested that FGM has been evident (declared or observed) in women who have accessed health care; however, there are gaps in knowledge and a limited evidence base on the health consequences of FGM. This article explores the urological complications experienced by women who have undergone this practice, and the effects this can have on their health and wellbeing.
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Affiliation(s)
- Elinor Clarke
- RM, Senior Lecturer (Midwifery), Coventry University
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50
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Berliner D, Lambek M, Shweder R, Irvine R, Piette A. Anthropology and the study of contradictions. HAU-JOURNAL OF ETHNOGRAPHIC THEORY 2016. [DOI: 10.14318/hau6.1.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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