Effect of female genital mutilation/cutting on sexual functions

Effect of Female Genital Mutilation on Sexual Function in Ibadan, Nigeria

Objective: Female genital mutilation, which harms women physically and psychologically, also causes serious problems in sexual life that continue throughout life. This study aimed to determine the impact of female genital mutilation on sexual outcomes in Ibadan, Nigeria. Method: This is a cross-sectional descriptive study. A self-administered questionnaire was used to obtain data from 161 women who agreed to participate in the study. After the data were collected, the sample group was divided into two groups those with female genital mutilation (84) and those without (77), and they were compared in terms of sexual outcomes. Results: Type I (77.3%) and type II (22.7%) mutilations were found in women with female genital mutilation. It was determined that women with FGM experienced statistically significantly more pain and bleeding during vaginal penetration than uncircumcised women. At the same time, the orgasm rate was found to be statistically significantly lower in this group. Conclusions: Our study revealed that female genital mutilation and enlargement of the incision area negatively affect sexual health.

The comparison of sexual function in types I and II of female genital mutilation

BACKGROUND

Female genital mutilation has many sexual, physical, and psychological consequences. The present study aimed to examine the relationship between Female Genital Mutilation/Cutting (FGM/C), and Sexual Function among circumcised women in Sardasht City, Iran."

METHODS

In this present cross-sectional study, 197 women who were mutilated entered the study by simple random sampling from two healthcare centers in Sardasht, Iran. A gynecologist first performed a genital examination to identify the type of female genital mutilation of participants. Subsequently, Socio-demographic and FGM/C-related characteristics checklist and the female sexual function index questionnaire were completed by interview method. Data were analyzed using SPSS 23 software.

RESULTS

Type I and II of female genital mutilation were performed in 73.1 and 26.9% of the participants, respectively. The age range of performing female genital mutilation in type I and II of female genital mutilation was 4-10 years old in 67.4% and 71.1% respectively. Traditional practitioners/local women carried out the circumcision in all of the participants, and Sunnah/tradition was reported as the most common reason for doing this procedure. The average total score of FSFI index in type I and II of female genital mutilation was 23.5 ± 2.0 and 17.4 ± 2.39, respectively. In all domains of FSFI, women with type II of female genital mutilation obtained lower scores than women with type I.

CONCLUSION

Circumcised women have reduced scores in all domains of FSFI, and the severity of sexual dysfunction is related to the type of FGM/C. Considering the prevalence of female genital mutilation and its adverse effects, it is imperative to initiate cultural improvements through education and awareness. By educating and raising awareness among individuals about this issue, we can foster positive changes and address the problem effectively.

The Impact of Female Genital Mutilation on Sexual Function: A Study Conducted in Rural Sudan

BACKROUND

 There are few studies comparing sexual function in women with female genital mutilation (FGM) in the literature, and most of these were evaluated with the Female Sexual Function Index (FSFI) questionnaire. Only one used the Female Genital Self-Image Scale (FGSIS) questionnaire.

AIM

This study aims to evaluate the effects of FGM on sexual function in Sudanese women who did or did not undergo FGM, using the FSFI and FGSIS questionnaires.

METHODS

 This descriptive study was conducted on Sudanese women from July 2020 to March 2021. Patients who attended to our hospital's gynecology outpatient clinic for health screening were included in this study. A total of 211 patients 113 with FGM and 98 without FGM were included in the study. The group with FGM was categorized according to the classification of the World Health Organization. The validated Arabic FSFI and FGSIS questionnaires were administered to groups with and without female genital mutilation and cutting (FGM/C).

RESULTS

When the FGM types of the cases participating in the study were examined, patients with FGM were classified according to the FGM/C classification defined by the World Health Organization. They were classified as 20.4% (n=23) Type 1, 49.6% (n=56) Type 2, and 30.1% (n=34) Type 3. FSFI and FGSIS scores were significantly lower in the FGM/C group, especially in Type 3 with the highest tissue loss. The survey results statistically support the possibility of sexual dysfunction in FGM group.

CLINICAL IMPLICATIONS

Female genital circumcision negatively affects sexual function. Therefore, clinicians should consider and sexual dysfunction in women with FGM attending primary care. Strengths and limitations: The strengths of this study are its originality, as it is the first study in the literature to use validated FGSIS and FSFI questionnaires together to assess sexual function in groups with and without FGM and to evaluate correlation of questionnaire results. We undertook the study it using validated and reliable scales, trained clinical staff, local staff gynecologist, and multivariate analysis. Limitation of the study is the chosen age range. The reason for limiting the age to under 35 is that we wanted to evaluate the more sexually active age group in our study. We cannot comment on the correlation of FSFI and FGSIS in circumcised patients over 35 years of age.

CONCLUSION

 Sexual function and sexual self-image of women with FGM/C were found to be significantly lower compared to women without FGM when compared with the validated FSFI and FGSIS questionnaires.

Effect of short-term dynamic psychotherapy on sexual function and marital satisfaction in women with depression: Clinical trial study

Background and Aims

This study aimed to look at the influence of short-term dynamic psychotherapy on sexual function and marital satisfaction in women with depression.

Methods

Through a clinical trial study using a pretest-posttest design and a control group, this study enlisted the participation of 60 women diagnosed with depression. The patients were interviewed before being randomly assigned to experimental or control groups. Data were obtained through the Beck Depression Inventory, the Enrique Marital Satisfaction Questionnaire, and the Female Sexual Function Questionnaire. The experimental group received intense short-term dynamic psychotherapy intervention, while the control group was on a 2-month waiting list. The SPSS 24 program utilized an analysis of variance to analyze the data.

Results

The pre- and posttest study results revealed a significant difference in marital satisfaction, sexual function, and depression between the experimental and control groups (p < 0.01).

Conclusion

During the posttest phase, a short-term intensive dynamic psychotherapy intervention helped the experimental group feel better about their marriage and improve their sexual function. It also helped them feel less depressed.

Views of female genital mutilation survivors, men and health-care professionals on timing of deinfibulation surgery and NHS service provision: qualitative FGM Sister Study

Background

Female genital mutilation is an important UK health-care challenge. There are no health benefits of female genital mutilation, and it is associated with lifelong physical, psychological and sexual impacts. The annual cost to the NHS to care for survivors is £100M. Deinfibulation may improve the health and well-being of some women, but there is no consensus on the optimal timing of surgery for type 3 survivors. UK care provision is reportedly suboptimal.

Objectives

We aimed to explore the views of survivors, men and health-care professionals on the timing of deinfibulation surgery and NHS service provision.

Methods

This was a qualitative study informed by the Sound of Silence framework. This framework is useful for researching sensitive issues and the health-care needs of marginalised populations. A total of 101 interviews with 44 survivors, 13 men and 44 health-care professionals were conducted, supplemented by two workshops with affected communities (participants, n = 10) and one workshop with stakeholders (participants, n = 30). Data were analysed using a hybrid framework method.

Results

There was no clear consensus between groups on the optimal timing of deinfibulation. However, within groups, survivors expressed a preference for deinfibulation pre pregnancy; health-care professionals preferred antenatal deinfibulation, with the caveat that it should be the survivor's choice. There was no consensus among men. There was agreement that deinfibulation should take place in a hospital setting and be undertaken by a suitable health-care professional. Decision-making around deinfibulation was complex. Deficiencies in professionals' awareness, knowledge and understanding resulted in impacts on the provision of appropriate care. Although there were examples of good practice and positive care interactions, in general, service provision was opaque and remains suboptimal, with deficiencies most notable in mental health. Deinfibulation reportedly helps to mitigate some of the impacts of female genital mutilation. Interactions between survivors and health-care professionals were disproportionately framed around the law. The way in which services are planned and provided often silences the perspectives and preferences of survivors and their families.

Limitations

Only a minority of the interviews were conducted in a language other than English, and the recruitment of survivors was predominantly through maternity settings, which meant that some voices may not have been heard. The sample of men was relatively small, limiting interpretation.

Conclusions

In general, service provision remains suboptimal and can silence the perspectives and preferences of survivors. Deinfibulation services need to be widely advertised and information should highlight that the procedure will be carried out in hospital by suitable health-care professionals and that a range of time points will be offered to facilitate choice. Future services should be developed with survivors to ensure that they are clinically and culturally appropriate. Guidelines should be updated to better reflect the needs of survivors and to ensure consistency in service provision.

Future work

Research is needed to (1) map female genital mutilation service provision; (2) develop and test effective education to address deficits in awareness and knowledge for affected communities and health-care professionals; and (3) develop, monitor and evaluate clinically and culturally competent female genital mutilation services.

Trial registration

Current Controlled Trials ISRCTN14710507.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme and will be published in full in Health Technology Assessment; Vol. 27, No. 3. See the NIHR Journals Library website for further project information.

Mental and sexual health outcomes associated with FGM/C in Africa: a systematic narrative synthesis

There are gaps in evidence regarding mental and sexual outcomes and associated interventions for women with Female Genital Mutilation/Cutting (FGM/C) living in Africa. This study employed a narrative synthesis to collate evidence on mental and sexual health outcomes. A systematic search of bibliographic databases and websites was performed using appropriate keywords and studies published in English from January 1, 2010 to March 25, 2022. 25 studies were retrieved and reported mental and sexual health complications associated with FGM/C. Most studies, n = 13 studies reported on sexual health outcomes including sexual pain, orgasm and sexual desire problems at sexual arousal and difficulties in lubrication. Mental health outcomes were reported in four studies including depression which was most prominent followed by somatisation and anxiety, Post Traumatic Stress Disorder (PTSD) and sleep disorder. Studies did not highlight combined mental and sexual health interventions. The findings of this narrative synthesis reveal the need to prioritise provision of mental and sexual health care services for women with FGM/C. The study recommends strengthening of health systems in Africa through awareness building, training and capacity building of primary health and specialist health workers in offering mental and sexual health care to women with FGM/C.

FUNDING

This work was self-funded.

Factors associated with general practitioners' routines and comfortability with assessing female genital cutting: a cross-sectional survey

BACKGROUND

Female genital cutting (FGC) may cause a series of health problems that require specialized healthcare. General practitioners (GPs) are gatekeepers to specialized healthcare services in Norway. To refer girls and women subjected to FGC to appropriate services, GPs need to assess whether the health problems reported by these patients are related to FGC. However, we do not know to what degree GPs assess FGC as a potential cause of the patients' health problems. We also know little about the GPs' patterns of training and knowledge of FGC and their effect on the GPs' assessment of FGC as a potential cause of health problems.

METHOD

We employed a cross-sectional online survey among GPs in Norway to examine: 1) patterns of received training on FGC, self-assessed knowledge, and experiences with patients with FGC-related problems and 2) the association between these three factors and the GPs' assessment of FGC as a potential cause of patients' health problems. A total of 222 GPs completed the survey. Data were analysed using binary logistic regression, where we also adjusted for sociodemographic characteristics.

RESULTS

Two-third of the participants had received training on FGC, but only over half received training on FGC-related health problems. Over 75% of the participants stated a need for more knowledge of FGC typology and Norwegian legislation. While the majority of the participants assessed their knowledge of FGC medical codes as inadequate, this was not the case for knowledge of the cultural aspects of FGC. Female GPs were more likely to have experience with patients with FGC-related health problems than male GPs. Among GPs with experience, 46% linked health problems to FGC in patients unaware of the connection between FGC and such health problems. GPs were more likely to assess FGC as a potential cause of health problems when they had experience with patients having FGC-related problems and when they assessed their knowledge of FGC typology and FGC-related medical codes as adequate.

CONCLUSION

To improve their assessment of FGC as a potential cause of patients' health problems, GPs should receive comprehensive training on FGC, with particular emphasis on typology, health problems, and medical codes.

The impact of the COVID-19 pandemic-related quarantine on female sexual behavior: a cross-sectional study in China

To investigate the impact and factors of home quarantine life on women's sexual lives and behaviors in different areas of China and analyze the prevalence of female sexual dysfunction (FSD) during the COVID-19 pandemic. We surveyed adult women who had a regular sexual life (including regular masturbation) and had been isolated at home for at least one month during the COVID-19 outbreak using online questionnaires. This survey recovered 678 complete questionnaires after screening. According to the findings, the overall score of the Female Sexual Function Inventory (FSFI) during the pandemic was 21.98 ± 6.38, the frequency of FSD was 61.9%, and the frequencies of FSD in Shanghai, Nanjing, and Ningxia were 60.6%, 75.2%, and 52.2%, respectively. The frequency of FSFI scores and other specific items (Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain) varied significantly across the three regions (P < 0.05). The overall frequency of FSD in the masturbation population was 34.4%, which was lower than the frequency of FSD in women having paired sexual intercourse (60.1%) (p < 0.05). Further analysis revealed that the occurrence of FSD during the pandemic was related to different age stages, menopause, mode of delivery, level of anxiety and depression, and sexual lifestyles. The COVID-19 pandemic has had a great impact on people's spiritual and sexual lives, which are caused by multiple different variables related to both the individual and the environment. We should emphasize the importance of sexual health in epidemics, and having a harmonious and stable sex life will help us survive the boring life of isolation.

Knowledge Mapping of Articles on Application of the Quran and Hadiths in Health Care: VOSviewer Visualization Techniques

This study sought to conduct a knowledge mapping of articles to shed light on the application of the Quran and Hadiths in health care. The study is applied in terms of purpose and scientometrics in terms of type, which has been carried out using retrospective bibliometric analysis methods and visualization through knowledge mapping. In order to do so, the PubMed database with related keywords was thoroughly searched. Then, 302 relevant articles were reviewed in terms of the author, the year of publication, the journal, and the subject. In addition, VOSviewer software was employed to analyze and visualize keywords and maps of the articles. The findings showed that 302 articles were published between 1972 and 2021 in 190 journals, among which the Journal of Religion and Health was ranked first with 43 articles. Word co-occurrence map of scientific products of the Quran and Hadith in health care were categorized into six clusters, namely: "complementary and alternative medicine," "ethics," "the effectiveness of spirituality on the treatment and control of mental illness," "women's rights and status," "family planning, infertility treatment and abortion," and "the views of the Quran and Hadiths on sexual issues." Adopting a holistic approach toward the application of various aspects of the Quran and Hadiths on health care, the present study can be considered as a pioneering research whose results can account for determining relevant applied research projects.

Oral, genital and anal human papillomavirus infections among female sex workers in Ibadan, Nigeria

BACKGROUND

There are limited data on the epidemiology of HPV in different anatomical sites of female sex workers (FSW). We investigated the prevalence and concordance of cervical, vulval, oral and anal HPV among FSW in Ibadan, Nigeria.

METHODS

FSWs aged 18-45 years were enrolled in a cross-sectional survey. After interview and clinical examination, samples were collected from mouth, cervix, vulva and anus. HPV genotyping was done with Anyplex II 28HPV assay. Multivariable analyses were performed to explore associated risk factors and concordance of HPV infections across sites.

RESULTS

In total, 315 FSWs participated in the study with a mean age of 30-6.5 years. The prevalence of any HPV infection was 88% in the vulva, 84% in the cervix, 75% in the anus and 24% in the oral cavity. HPV 35 was the most prevalent and concordant high-risk type in the four sites. The risk factors for HPV infection by anatomic site varied.

CONCLUSION

This large study showed a high prevalence and concordance of HPV infections of cervical, vulval, oral and anal HPV among FSWs in Nigeria. The potential to acquire and transmit HPV is high in this population, and we highlighted the urgency to protect young women through HPV vaccination.

Economic burden of female genital mutilation in 27 high-prevalence countries

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.

The comparison of sexual function in women with or without experience of female genital circumcision: A case-control study in a Kurdish region of Iran

Studies on the sexual consequences of female genital circumcision are controversial. In this article, we intend to compare the sexual function in women with or without experience of circumcision in the Kurdish region of Mahabad in Iran. In this case-control study 550 women completed the demographic and Female Sexual Function Index (FSFI) questionnaires. Female genital circumcision was associated with reduction of lubrication and sexual satisfaction as well as increasing dyspareunia compared to the uncircumcised women. However, there was no significant difference between two groups regarding to arousal, desire and orgasm of women.

Barriers and facilitators to the access to specialized female genital cutting healthcare services: Experiences of Somali and Sudanese women in Norway

BACKGROUND

Girls and women subjected to female genital cutting (FGC) risk experiencing obstetrical, gynecological, sexual, and psychological health problems. Therefore, Norway has established low-threshold specialized healthcare services where girls and women with FGC-related health problems can directly seek medical attention. Nevertheless, we lack data about access to these services, especially for non-maternity-related purposes. In this article, we explore experiences of seeking medical attention for health problems that are potentially FGC-related, aiming to identify factors that hinder or facilitate access to FGC-specialized services.

METHODS

We conducted a qualitative study in three Norwegian cities employing semi-structured repeat interviews with 26 girls and women subjected to FGC, participant observation, and three validation focus group discussions with 17 additional participants. We thematically analyzed the data and approached access as a dynamic process of interactions between individuals and the healthcare system that lasts from an initial perception of need until reception of healthcare appropriate to that need.

FINDINGS

We identified several barriers to healthcare, including 1) uncertainty about FGC as a cause of experienced health problems, 2) unfamiliarity with FGC-specialized services, 3) lack of assessment by general practitioners of FGC as a potential cause of health problems, and 4) negative interactions with healthcare providers. In contrast, factors facilitating healthcare included: 1) receiving information on FGC-related health problems and FGC-specialized services from a non-profit immigrant organization, 2) referral to gynecologists with good knowledge of FGC, and 3) positive interactions with healthcare providers.

CONCLUSION

Assessing whether FGC is the cause for experienced health problems requires diagnostic competency and should not be left entirely to the patients. We recommend that Norwegian policymakers acknowledge the central role of GPs in the clinical management of patients with FGC-related health problems and provide them with comprehensive training on FGC.

How to ensure policies and interventions rely on strong supporting facts to improve women's health: The case of female genital cutting, using Rosling's Factfulness approach

Rosling et al’s book Factfulness aims to inspire people to use strong supporting facts in their decision‐making, with 10 rules of thumb to fight dramatic instincts. In this paper, the Factfulness framework is applied to female genital cutting (FGC), in order to identify possible biases and promote evidence‐based thinking in studies on FGC, clinical guidelines on management of FGC, and interventions aimed at abolishing FGC. The Factfulness framework helps to acknowledge that FGC is not a uniform practice and helps address that variability. This framework also highlights the importance of multidisciplinarity to understand causalities of the FGC issue, which the authors argue is essential. This paper highlights the fact that FGC is a dynamic practice, with changes in the practice that are ongoing, and that those changes are different in different contexts. The “zero tolerance” discourses on FGC fail to acknowledge this. Factfulness encourages us to be more critical of methodologies used in the area of FGC, for example when estimating girls at risk of FGC in migration contexts. Factfulness provides the tools to calculate risks rather than judgments based on fear. This may help limit stigmatization of women with FGC and to allocate resources to health problems of migrant women based on real risks. The framework also calls for more research and production of less biased facts in the field of FGC, in order to improve interventions aimed at abolishing FGC, and clinical guidelines for the treatment of FGC. Factfulness is a useful and structured foundation for reflection over constructs, biases and disputes surrounding FGC, and can help improve the quality of future evidence‐based interventions and education that address the actual needs of women with FGC and girls at risk of FGC.

Trends and Determinants of Female Genital Mutilation in Ethiopia: Multilevel Analysis of 2000, 2005 and 2016 Ethiopian Demographic and Health Surveys

Background

Female genital mutilation (FGM) is a harmful practice that causes health-related problems in the life of the affected women and girls. Though FGM is declared as a human right violation, studies revealed it is being practiced throughout Ethiopia. Therefore, this study was conducted to assess the prevalence, trends, and predictors of FGM among reproductive-aged (1549 years) women in Ethiopia.

Methods

Trends of FGM among reproductive-age women were estimated using the three Ethiopian Demographic and Health Survey (EDHS): 2000 (n=15,367), 2005 (n=14,070) and 2016 (n=7248) data. Multilevel logistic regression analysis was conducted to identify both individual- and community-level factors of FGM using the latest (2016) EDHS. To adjust potential confounders, the analysis was conducted considering sample weighting, clustering, and stratifications using STATA-14 software.

Results

The prevalence of FGM among women of reproductive age in Ethiopia decreased from 79.91% in 2000 to 70.37% in 2016. Similarly, FGM among daughters of circumcised mothers decreased from 56.16% in 2000 to 16.76% in 2016. Being Muslim (adjusted odds ratio [AOR] 5.48; 95% confidence interval [CI]: 4.23, 7.09), attending higher education (AOR 0.40; 95% CI: 0.29, 0.54), 45–49 years old (AOR 5.06; 95% CI: 3.38, 7.57), marriage at ≥ 18 years (AOR 0.80; 95% CI: 0.66, 0.96), not working (AOR 1.20; 95% CI: 1.02, 1.41), married (AOR 1.41; 95% CI: 1.12, 1.77) and residing in peripheral region (AOR 3.0.4; 95% CI: 1.96, 4.70) were determinants of FGM.

Conclusion

Though the reduction of FGM among women of reproductive age in Ethiopia was minimal, it was encouraging among daughters of circumcised women over the last 16 years. Education, religion, age, age at marriage, occupation, marital status, and geographical regions were determinants of FGM. Combined and integrated interventions based on the identified factors are recommended to abandon FGM in Ethiopia.

Sexual and Reproductive Health Outcomes of Violence Against Women and Girls in Lower-Income Countries: A Review of Reviews

Gender-based violence (GBV) against women and girls is pervasive and has negative consequences for sexual and reproductive health (SRH). In this systematic review of reviews, we aimed to synthesize research about the SRH outcomes of GBV for adolescent girls and young women in low- and middle-income countries (LMICs). GBV exposures were child abuse, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PsycINFO, PubMed, and Scopus searches were supplemented with expert consultations, reference-list searches, and targeted organizational website searches. Reviews had to contain samples of girls and young women ages 10-24, although inclusion criteria were expanded post-hoc to capture adolescent-adult combined samples. Twenty-seven reviews were quality-rated. Study-level data were extracted from the 10 highest quality reviews (62 unique studies, 100 samples). Reviews were mostly from Africa and Asia and published between 2011 and 2015. We found consistent associations between GBV and number of sexual partners, gynecological conditions (e.g., sexually transmitted infections [STIs]), unwanted/unplanned pregnancy, and abortion. Some types of IPV also were associated with greater use of contraception/STI prevention. Addressing GBV is essential to improve SRH for girls and women in LMICs.

Association of female genital mutilation and female sexual dysfunction: A systematic review and meta-analysis

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.

Clinical Features Associated with Female Genital Mutilation/Cutting: A Pilot Longitudinal Study

(1) Background: Female genital mutilation/cutting (FGM/C) is associated with physical and psychological complications. However, there is scarce literature on how women with FGM/C respond to treatment interventions. (2) Methods: In the present pilot longitudinal study, we assessed changes in general psychopathology (Symptom Check List-90-R), sexual functioning and distress (Female Sexual Function Index, Female Sexual Distress Scale-Revised, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) female sexual dysfunction criteria), body image (Body Shape Questionnaire), and sexual body image (Female Genital Self-Image Scale) in a sample of n = 15 women with FGM/C before and after reconstructive surgery. (3) Results: Sexual distress was significantly improved following surgery. We also observed an improvement in general psychopathology and genital self-image. However, sexual function was not improved. (4) Conclusions: These results provide evidence for the benefits of reconstructive surgery on sexual distress in women with FGM/C. The impact of surgery on sexual function cannot be conclusively evaluated.

Estimating utility value for female genital mutilation

BACKGROUND

Female genital mutilation/cutting (FGM/C) is a clear violation of women's rights and can have adverse and irreversible health effects as well. Worldwide, more than 200 million women and girls have undergone FGM/C. Utility value of FGM/C has not been estimated yet, so we designed this study to extract the health utility value of FGM/C for the first time in the world.

METHODS

In a cross-sectional study in Iran, 125 girls and women who underwent FGM/C procedure were examined by the trained midwives in order to determine its type. In addition, a questionnaire was completed for identifying the socio-demographic factors and extracting the health utility of these individuals. Health utility was measured using Time Trade-off method and also to determine the effects of the socio-demographic factors on the health utility a two-limit censored regression model was applied.

RESULTS

The mean and median of the health utility of women with FGM/C were 0.971 (SE: 0.003) and 0.968 (IQR: 1-0.95), respectively. Number of non-traders was 58 (46.4%) who reported perfect health utility. However, the mean of health utility among traders was 0.946 (SE: 0.002). Only type 1 (Clitoridectomy) and type 2 (Excision) FGM/C were seen in this study. Women with Type 1 FGM/C had significantly lower health utility value (Mean: 0.968, Median: 0.957) than their type 2 counterparts (Mean: 0.987, Median: 1.00). Moreover, women in the age group of 31-45 years (Mean: 0.962, Median: 0.956), single (Mean: 0.950, Median: 0.954), divorced (Mean: 0.951, Median: 0.950), employed (Mean: 0.959, Median: 0.956), and with supplementary insurance (Mean: 0.962, Median: 0.950) had significantly lower health utility than their counterparts.

CONCLUSION

FGM/C affects physical and psychological well-being of these individuals, resulting in a lack of personal and marital satisfaction, which ultimately leads to a 3% reduction in their health related quality of life. Therefore, preventing from this practice is very important and should be considered by health system policy makers more than before.

Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway

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.

Provider Knowledge and Attitudes About Female Genital Mutilation/Cutting in Philadelphia

BACKGROUND

Due to an increase in immigration from African countries, U.S. healthcare professionals are encountering women affected by Female Genital Mutilation/Cutting (FGM/C). Little formal education exists in medical, nursing or midwifery schools. Additionally, very few studies assess attitudes and knowledge of U.S. providers to care for these women. In order to eventually offer FGM/C-affected women informed and culturally competent care, assessments of provider readiness and attitudes must guide future educational efforts.

METHODS

A voluntary survey was administered to healthcare providers prior to thirteen separate education sessions on FGM/C at Philadelphia institutions.

RESULTS

Of the 229 surveys distributed, 227 were returned > 50% complete. 61.2% reported encountering FGM/C at least once in the past 5 years, yet 13.7% of participants reported receiving formal training in FGM/C; 77.5% felt unprepared and 47.1% uncomfortable serving patients with FGM/C. 34.1% of participants knew the matriarchal influence on the custom. The majority of providers accurately identified the short and long-term clinical consequences of FGM/C, but 67.7% of participants denied familiarity with laws regarding FGM/C. Attitude assessment revealed beliefs that all types of FGM/C are harmful and a practice rooted in tradition.

DISCUSSION

While most providers reported encountering patients with FGM/C, lack of formal training leaves them unprepared and uncomfortable serving them. Results demonstrate misunderstanding of the tradition and motives of FGM/C. Our findings support the need for expansion of provider education to provide culturally competent care for women affected by FGM/C.

Psychosexual Consequences of Female Genital Mutilation and the Impact of Reconstructive Surgery: A Narrative Review

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.

Female Genital Mutilation Reconstruction for Plastic Surgeons-A Call to Arms

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.

Living with mutilation: A qualitative study on the consequences of female genital mutilation in women's health and the healthcare system in Spain

INTRODUCTION

Female genital mutilation is a health and human rights issue which extends to western countries. It is estimated that there are some seventeen thousand women and girls living in Spain who have either been mutilated or are at risk of being so. Healthcare professionals face the challenge of providing adequate care in response to this emerging problem.

AIM

To discover the repercussions of female genital mutilation on the health of sub-Saharan women residing in Spain, as well as the healthcare received.

METHODS

A life-history qualitative research design was utilized. The study population included 14 genitally mutilated women residing in the Region of Murcia who had given birth in Spain and been attended to by the national public healthcare system.

RESULTS

Women suffer physical, psychological, obstetric and sexual health issues as a result of female genital mutilation and despite having a favourable perception of the healthcare received during the pregnancy and the delivery, the provision of health education, detection and treatment of female genital mutilation by healthcare professionals was seen to be lacking.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Healthcare policy must address insufficiencies in delivering adequate care to immigrant women who have been the victim of female genital mutilation by implementing the necessary resources and training for professionals to effectively meet the specific healthcare needs of this population and prevent this cruel practice from being perpetuated.

The Impact of Migration on Attitudes to Female Genital Cutting and Experiences of Sexual Dysfunction Among Migrant Women with FGC

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.

Effect of female genital mutilation/cutting; types I and II on sexual function: case-controlled study

Background

The existing literature is contradictory regarding effects of female genital mutilation/cutting (FGM/C) on sexual functions. The aim of this study was to explore the impact of type I and II FGM/C on sexual function of Egyptian women.

Methods

We recruited 197 cut women and 197 control women from those visiting Assiut University hospitals for different reasons. We asked each woman to fill the Arabic female sexual function index (FSFI) (a self reported 19-item questionnaire assessing the main domains of female sexual function). Genital Examination was done to confirm the type of FGM.

Results

Female sexual dysfunction (FSD) was found in 83.8% of FGM/C cases in contrast to 64.5% of the control. The total FSFI score in the FGM/C group (19.82 ± 7.1) was significantly lower than in the control group (23.34 ± 8.1). Concerning the types of FGM/C, type 73.6% of cases had type I and 26.4% had type II. Type I FGM/C was performed mainly by physicians (62.1%) while type II was performed mainly by midwives (44.4%).

FSD was found in 83.4% of FGM/C I cases and in 84.6% of FGM/C II cases. There was no statistically significant difference between the two types of FGM/C as regards total and individual domain scores except for the pain domain. There were significantly lower total and individual domain scores in both FGM/C types except for the desire domain compared to control.

Conclusion

In this study, FGM/C was associated with reduced scores of FSFI on all domains scores, and among both types I and II, both were associated with sexual dysfunction.