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O'Dey DM, Kameh Khosh M, Boersch N. Anatomical Reconstruction following Female Genital Mutilation/Cutting. Plast Reconstr Surg 2024; 154:426-438. [PMID: 37647530 DOI: 10.1097/prs.0000000000011026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND International migration from high-prevalence regions has increasingly confronted nonendemic countries with female genital mutilation/cutting (FGM/C), and Western-based health care providers have seen a greater demand for surgical reconstruction of female anatomic units. The authors introduce novel surgical techniques developed by the first author for clitoral and vulvovestibular reconstruction and examine operative outcomes. METHODS The authors performed a retrospective cohort study of operative outcomes of the omega domed flap, neurotizing and molding of the clitoral stump (NMCS procedure), and anterior obturator artery perforator flap for preputial, clitoral, and vulvovestibular reconstruction, respectively. Between 2014 and 2021, the authors treated patients with all types of FGM/C, and analyzed various data, including demographics, clitoral sensation, and symptoms such as dysmenorrhea, dysuria, dyspareunia, and anorgasmia. The authors aimed to examine the efficacy and safety of these techniques in improving clitoral sensation and reducing symptoms. RESULTS A total of 119 women (mean age, 31.0 ± 10.4 years) were included. The authors performed the omega domed flap (85%), the NMCS procedure (82%), or the anterior obturator artery perforator flap (36%), and had a 1-year follow-up period, which was attended by 94.1% of patients. Patients reported significant postoperative reduction of dysmenorrhea, dysuria, and dyspareunia, as well as significant improvement of clitoral sensation and ability to achieve orgasm ( P < 0.001). There was 1 major complication (loss of flap) reported. Secondary ambulatory interventions were performed in 10 patients (8.4%). CONCLUSION By allowing for safe and effective anatomic reconstruction of the female genitalia, the described surgical techniques represent a new stage of treatment possibilities for women with FGM/C. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Dan Mon O'Dey
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Center for Reconstructive Surgery of Female Genitalia, Luisenhospital Aachen, Teaching Hospital of the Aachen University of Technology
| | - Masih Kameh Khosh
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Center for Reconstructive Surgery of Female Genitalia, Luisenhospital Aachen, Teaching Hospital of the Aachen University of Technology
| | - Nina Boersch
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Center for Reconstructive Surgery of Female Genitalia, Luisenhospital Aachen, Teaching Hospital of the Aachen University of Technology
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Ifechukwu Okpara P, Tekbaş S. Effect of Female Genital Mutilation on Sexual Function in Ibadan, Nigeria. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:167-176. [PMID: 38616797 PMCID: PMC11008539 DOI: 10.1080/19317611.2024.2328717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/04/2024] [Indexed: 04/16/2024]
Abstract
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.
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Affiliation(s)
| | - Serap Tekbaş
- Nursing Faculty, Near East University, Nicosia, Turkey
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Hassannezhad K, Asadzadeh F, Iranpour S, Rabiepoor S, Akhavan Akbari P. The comparison of sexual function in types I and II of female genital mutilation. BMC Womens Health 2024; 24:31. [PMID: 38191359 PMCID: PMC10775604 DOI: 10.1186/s12905-023-02860-9] [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: 05/24/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
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.
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Affiliation(s)
- Kosar Hassannezhad
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Firouzeh Asadzadeh
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sohrab Iranpour
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Soheila Rabiepoor
- Professor of Reproductive health, Reproductive Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Pouran Akhavan Akbari
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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Gnofam M, Crequit S, Renevier B, Abramowicz S. Prognostic factors of poor surgical outcome after clitoral reconstruction in women with female genital mutilation/cutting. J Sex Med 2023; 21:59-66. [PMID: 38014807 DOI: 10.1093/jsxmed/qdad150] [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: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Complications of surgical clitoral reconstruction for female genital mutilation/cutting (FGM/C) are a rare occurrence, but there has been reports of patients experiencing chronic pain or clitoral burial. AIM This study aims to assess which factors are predictive of the occurrence of surgical complications in women who had surgical reconstruction for FGM/C (type 1, 2, or 3). METHODS This monocentric retrospective study was conducted among patients who underwent clitoral reconstruction after FGM/C from January 2016 to March 2020. Demographic and clinical data were abstracted from the medical records. OUTCOMES The primary outcome was the occurrence of chronic pain (defined as occurrence or persistence of any clitoral pain >3 months after surgery), and the secondary outcome was the occurrence of clitoral burial. RESULTS A total of 87 women were included in the analysis. Univariate analysis indicated significantly higher rates of a history of physical abuse in the group of women who experienced chronic pain after surgery (4 [100%] vs 2 [37.1%], P = .049). Patients with clitoral burial were significantly younger than the rest of the sample in univariate analysis (median [IQR], 29.6 years [24.6-30.2] vs 33.8 [28.2-37.9]; P = .049). CLINICAL IMPLICATIONS Surgical treatment of women who underwent FGM/C should include the entire history of the patient and especially a record of experiencing physical abuse. STRENGTHS AND LIMITATIONS The study stands out for its originality, the extensive sample size gathered over nearly 4 years, the surgical clitoral reconstructions conducted by an experienced surgeon, and the minimal amount of missing data. However, because the occurrence of these complications was rare, the number of patients in the subgroups was extremely low, preventing a valid multivariate analysis to be conducted. CONCLUSION The study suggests that women with a history of physical abuse could be at greater risk for chronic pain after surgery and that younger women tend to experience more clitoral burial.
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Affiliation(s)
- Mayi Gnofam
- Département d'obstétrique et de gynécologie, Hôpital Louis Mourier (Assistance Publique Hôpitaux de Paris), Colombes, 92700, France
- Département d'obstétrique et de gynécologie, Hôpital Maison Blanche (Centre hospitalier universitaire de Reims), Reims, 51092, France
| | - Simon Crequit
- Département d'obstétrique et de gynécologie, Centre hospitalier intercommunal André Grégoire, Montreuil, 93100, France
| | - Bruno Renevier
- Département d'obstétrique et de gynécologie, Centre hospitalier intercommunal André Grégoire, Montreuil, 93100, France
| | - Sarah Abramowicz
- Département d'obstétrique et de gynécologie, Centre hospitalier intercommunal André Grégoire, Montreuil, 93100, France
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Rodríguez-Sánchez V, Ventura-Miranda MI, Berthe-Kone O, Hernández-Padilla JM, Fernández-Sola C, Molina JG, Morante-García W, García-González J. Understanding the consequences of Female Genital Mutilation: a phenomenological study in sub-Saharan women living in Spain. Midwifery 2023; 123:103711. [PMID: 37172409 DOI: 10.1016/j.midw.2023.103711] [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: 09/26/2021] [Revised: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Female Genital Mutilation (FGM), which is culturally accepted in some African communities, has serious consequences on the physical, psychological, urogynecological, obstetrical and sexual health of girls and women. It is therefore important to understand women's experiences of the consequences of FGM. OBJECTIVE to understand the experiences of the consequences of female genital mutilation in sub-Saharan female survivors living in Spain. DESIGN a qualitative study based on Merleau-Ponty's hermeneutic phenomenology. PARTICIPANTS AND SETTING 13 sub-Saharan female survivors of female genital mutilation participated. The study was carried out in two south-eastern Spanish provinces where many jobs in the agricultural and service industry are done by African immigrants originating from ethnic groups in which FGM is still prevalent. FINDINGS In-depth interviews were carried out for data collection. ATLAS.ti was used for inductive analysis, from which two main themes were developed that represent the experiences of the consequences of FGM: (a) The impact of FGM: Hijacked sexual health and (b) The difficult process of genital reconstruction: overcoming the aftereffects and regaining integrity. CONCLUSION AND IMPLICATIONS FOR PRACTICE The mutilated women experienced serious consequences in their sexual, psychological and obstetrical health. Genital reconstruction was a difficult decision but contributed to regaining their sexual health and identity. The professionals involved play an important role in the care provided for the associated consequences of FGM, in identifying risk groups and in providing advice that allows the women to regain their sexual and reproductive health.
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Affiliation(s)
| | | | | | | | - Cayetano Fernández-Sola
- Department of Nursing Science, Physiotherapy and Medicine. University of Almeria. Spain; Associated Reseacher, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile. Santiago, Chile.
| | - José Granero Molina
- Department of Nursing Science, Physiotherapy and Medicine. University of Almeria. Spain; Associated Reseacher, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile. Santiago, Chile.
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Alidost F, Abbasi M, Ghamsari SR, Pakzad M. Mental Health Disorders in Circumcised Reproductive-age Women, Legal Dimensions and Prevention Strategies: A Narrative Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:281-288. [PMID: 37339648 PMCID: PMC10281771 DOI: 10.1055/s-0043-1770130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE Female genital mutilation/cutting (FGM/C) can affect women's lives through various physical, psychological, social and even sexual mechanisms. According to the World Health Organization guidelines for managing the health effects of FGM/C, further research into its psychological effects and preventative measures is required. In this study, a comprehensive review of the mental health consequences of circumcised women of reproductive age has been conducted with a special focus on providing preventive solutions. METHODS A comprehensive search of the Web of Science, PubMed(MEDLINE), Proquest, Scopus and Google scholar was carried outfrom 2000 to 2022. The second stage of search was conducted in grey literature. To facilitate a systematic approach to search the literature, the PECO framework, was adopted. RESULTS The result of this narrative review study showed that, the most common mental health disorder in reproductive age circumcised women were depression, anxiety and post-traumatic stress disorder. Some studies found a significant relationship between parents' education level and circumcised girls, so that parents of the circumcised women had a low level of education. Two studies considered religious beliefs, tradition, cleanness, sexual desire control and virginity as the reasons for FGM/C. CONCLUSION All forms of FGM/C may be harmful to one's health. Women, who have undergone widespread forms of circumcision, are more likely to develop mental disorders. As the psychosocial effects of circumcision can affect the sexual experience of circumcised women, addressing this issue, emphasizing its legal aspects, and providing preventative solutions can improve physical, mental, social, and even sexual health in circumcised women.
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Affiliation(s)
- Farzane Alidost
- Midwifery and Reproductive Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Abbasi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mona Pakzad
- Tehran University of Medical Sciences, Tehran, Iran
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Jones L, Danks E, Costello B, Jolly K, Cross-Sudworth F, Latthe P, Fassam-Wright M, Clarke J, Byrne A, Taylor J. Views of female genital mutilation survivors, men and health-care professionals on timing of deinfibulation surgery and NHS service provision: qualitative FGM Sister Study. Health Technol Assess 2023; 27:1-113. [PMID: 36946235 PMCID: PMC10041342 DOI: 10.3310/jhwe4771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
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.
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Affiliation(s)
- Laura Jones
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Danks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin Costello
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pallavi Latthe
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Joanne Clarke
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Byrne
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Tammary E, Manasi K. Mental and sexual health outcomes associated with FGM/C in Africa: a systematic narrative synthesis. EClinicalMedicine 2023; 56:101813. [PMID: 36880050 PMCID: PMC9985012 DOI: 10.1016/j.eclinm.2022.101813] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- Esho Tammary
- Deputy Vice Chancellor, Academic and Student Affairs, AMREF International University, Lang'ata Road. P.O. Box 27691-00506, Nairobi, Kenya
| | - Kumar Manasi
- Senior Implementation Scientist and Mental Health Consultant, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
- Corresponding author. Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
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Kalengo N, Isabirye A, Bukusuba J, Musinguzi LK, Twikirize JM. Psychosocial coping mechanisms among uncircumcised Pokot women in North-Eastern Uganda. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Noah Kalengo
- Department of Social Work and Social Administration, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
- Department of Social Work, Kyambogo University, Kampala, Uganda
| | - Alone Isabirye
- Department of Sociology, Anthropology and Population Studies (Demography), Kyambogo University, Kampala, Uganda
| | - John Bukusuba
- Department of Social Work and Social Administration, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Laban K Musinguzi
- Department of Social Work and Social Administration, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Janestic Mwende Twikirize
- Department of Social Work and Social Administration, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
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Kalengo N, Musinguzi LK, Twikirize JM. “You must cut that long and stinking thing”: uncovering the lived experiences of uncircumcised pokot women in North-Eastern Uganda. BMC Womens Health 2022; 22:433. [PMCID: PMC9636792 DOI: 10.1186/s12905-022-02005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Female circumcision remains a dominant practice among the Pokot of North-Eastern Uganda. This paper explores the lived experiences of uncircumcised Pokot women, as they continue to live in a community, where the practice is cherished.
Methods
This qualitative study adopted an ethnographic research design. The study was based on thirty [30] serial interviews with 15 uncircumcised women in the Pokot local language between August and October 2021. Five [5] Key Informant Interviews were also conducted with key informants from Amudat District. A Focus Group Discussion with women, irrespective of their circumcision status, was organized as an entry point to identify the initial uncircumcised woman. Uncircumcised women were recruited using respondent-driven sampling while key informants were purposively selected. Data were analyzed thematically. Participants were allocated codes to ensure anonymity.
Results
Participants expressed understanding of female circumcision, and the procedure although they were not circumcised. Denial of participation in community and cultural functions, rejection by elders and relatives, difficulties in getting marriage partners, denial of conjugal rights and basic needs, refusal to give names to their children, and home desertion were the negative experiences reported by uncircumcised women. Sexual enjoyment during sexual intercourse, epitomized by the ease of reaching orgasms, fewer complications while giving birth as well as reduced risk of exposure to sexually transmitted diseases were mentioned by participants as their positive experiences.
Conclusion
Uncircumcised Pokot women continue to experience unbearable challenges since female circumcision is perceived as the only rite of passage to womanhood. This calls for intensified awareness of the population on the challenges associated with female circumcision refusal while demonstrating the positive experiences mentioned by uncircumcised women, that can be exploited as the beacon of hope.
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Ozer O, Keles E, Eker HH, Abdi Nor I, Baydili KN. Effect of COVID-19 pandemic on female sexual function in women with female genital mutilation. J OBSTET GYNAECOL 2022; 42:3224-3229. [PMID: 35980853 DOI: 10.1080/01443615.2022.2109954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We aimed to evaluate the impact of the COVID-19 pandemic on female sexual function in women with female genital mutilation (FGM) in Somalia. This cross-sectional study was conducted on women with FGM attending the gynaecologic outpatient clinic of our hospital, between March and June 2021, using a validated Female Sexual Function Index (FSFI) questionnaire with a physical examination based on FGM typing. Those women who refused to participate, those with mental illness, uncontrolled systemic disease, drug, alcohol, or khat addiction, pregnant, genital prolapse, gynaecological or urological cancer, previous pelvic surgery, premature ovarian failure, genital skin diseases, drug use that affects sexual function and those with or suspected of having COVID-19 infection were excluded. A total of 201 sexually active women enrolled, with a mean age of 29 (14-55) years. Comparison of FSFI scores and the COVID-19 pandemic, a statistically significant worsening in the mean FSFI scores and all its domains (p<.001, for each). All of the domains of the FSFI were determined higher before and during the pandemic except pain. There is a decline in female sexual functioning during the COVID-19 outbreak in women with FGM. FGM is a major public health concern necessitating urgent response in Somalia.Impact statementWhat is already known on this subject? As it stands, there is a body of research on sexual behaviour during COVID-19 pandemic, but a lack of conclusive evidence. However, our knowledge of the sexual function of women with FGM during the COVID-19 pandemic is largely based on very limited data.What do the results of this study add? There is a decline in female sexual functioning during COVID-19 pandemic in women with female genital mutilation in Somalia.What are the implications of these findings for clinical practice and/or further research? FGM is a major public health problem necessitating urgent response worldwide. There is an urgent need to implement FGM prevention programmes and raise public awareness in order to eradicate this harmful practice.
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Affiliation(s)
- Ozgur Ozer
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Esra Keles
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Hasan Huseyin Eker
- Department of Public Health, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Istanbul, Turkey.,Department of Public Health, University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Ifrah Abdi Nor
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Kurşad Nuri Baydili
- Department of Biostatistics, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Istanbul, Turkey
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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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Management of Female Genital Mutilation/Cutting-Related Obstetric Complications: A Training Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159209. [PMID: 35954566 PMCID: PMC9367947 DOI: 10.3390/ijerph19159209] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/25/2022]
Abstract
Although female genital mutilation/cutting (FGM/C) is a prevalent practice in Liberia, healthcare workers lack the capacity to provide adequate care for FGM/C survivors. Therefore, Liberian nurses, physician assistants, midwives and trained traditional midwives were trained in sexual, obstetric and psychosocial care for FGM/C survivors in 2019. Through questionnaires, we assessed knowledge acquisition, trainee attitudes towards FGM/C care and acceptability to implement WHO-endorsed recommendations. The questionnaires were analyzed using descriptive statistics for quantitative data and an inductive approach for qualitative data. A total of 99 female and 34 male trainees participated. Most trainees perceived FGM/C as harmful to women’s health, as a violation of women’s rights and showed a willingness to change their clinical practice. While 82.8% (n = 74/90) perceived their role in advocating against FGM/C, 10.0% (n = 9/90) felt that they should train traditional circumcisers to practice FGM/C safely. The pre-training FGM/C knowledge test demonstrated higher scores among physician assistants (13.86 ± 3.02 points) than among nurses (12.11 ± 3.12 points) and midwives (11.75 ± 2.27 points). After the training, the mean test score increased by 1.69 points, from 12.18 (±2.91) points to 13.87 (±2.65) points. The trainings successfully increased theoretical knowledge of FGM/C-caused health effects and healthcare workers’ demonstrated willingness to implement evidence-based guidelines when providing care to FMG/C survivors.
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Contending with Health Outcomes of Sanctioned Rituals: The Case of Puberty Rites. RELIGIONS 2022. [DOI: 10.3390/rel13070609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper explores the rites of passage rituals as the loci of health outcomes. It highlights how religiously sanctioned practices play a central role in healthcare in defiance of the perceived private and public dichotomy that dominates the modern secular mindset. Highlighted in the chapter are African rites of passage, specifically breast “ironing”, female genital mutilation/cutting (FGM/C), and child marriage. Drawing from findings of a survey of 50 respondents, the chapter illustrates how these practices exemplify how rituals invoke health concerns in Africa and amongst Africans in the diaspora. The elevation of scientific knowledge and the privatization and categorization of religious knowledge as non-scientific in the mid-19th century resulted in the separation of the cure for the physical body from the spiritual factors, thus eliciting statements like “medicine is secular” and “religion is sacred and private.” In reality, however, medicine and religion have been interwoven for centuries and ancient holistic paradigms of healthcare have been present in many cultures even as society has modernized.
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Villani M. Clitoral reconstruction: challenges and new directions. Int J Impot Res 2022; 35:196-201. [PMID: 35418603 PMCID: PMC10159845 DOI: 10.1038/s41443-022-00572-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 01/18/2023]
Abstract
Clitoral reconstruction (CR) has been the subject of several studies in recent years, mainly in the medical field. Women with female genital mutilation or cutting (FGM/C) seek clitoral reconstructive surgery to improve their sexual well-being, but also because they are affected by poor self- and body image. CR is supposed to help women with FGM/C reconstruct their sense of self, but the benefits and risks of this surgery have not been sufficiently explored. There are currently no recommendations supporting CR from mainstream medical bodies, and there have been very few ethical studies of the procedure. This article critically discusses the principal studies produced in the medical field and available reflections produced in the social sciences. Through the theoretical frameworks of postcolonial and feminist studies, the article discusses sexuality and pleasure, gender and identity, and race and positionality, with the aim of promoting collaborative work on CR between researchers and social and health professionals.
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Affiliation(s)
- Michela Villani
- HES-SO, School of Social Work Fribourg, Delémont, Switzerland.
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16
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Martínez‐Linares JM, López‐Entrambasaguas OM, Fernández‐Medina IM, Berthe‐Kone O, Fernández‐Sola C, Jiménez‐Lasserrotte MDM, Hernández‐Padilla JM, Canet‐Vélez O. Lived experiences and opinions of women of sub‐Saharan origin on female genital mutilation: A phenomenological study. J Clin Nurs 2022; 32:2547-2558. [PMID: 35312126 DOI: 10.1111/jocn.16294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to describe and understand the lived experiences and opinions of sub-Saharan women living in Spain in relation to female genital mutilation. BACKGROUND Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. DESIGN A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. METHODS A total of 12 in-depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. RESULTS Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. CONCLUSIONS Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. RELEVANCE TO CLINICAL PRACTICE Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research.
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Affiliation(s)
| | | | | | - Ousmane Berthe‐Kone
- Surgical Critical Resuscitation Ward Torrecárdenas University Hospital Almeria Spain
| | - Cayetano Fernández‐Sola
- Nursing, Physiotherapy and Medicine Department University of Almería Almería Spain
- Faculty of Health Sciences Autonomous University of Chile Santiago Chile
| | | | | | - Olga Canet‐Vélez
- Nursing Department Faculty of Health Sciences Blanquerna University Ramon Llull Barcelona Spain
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Berthe-Kone O, Ventura-Miranda MI, López-Saro SM, García-González J, Granero-Molina J, Jiménez-Lasserrotte MDM, Fernández-Sola C. The Perception of African Immigrant Women Living in Spain Regarding the Persistence of FGM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413341. [PMID: 34948950 PMCID: PMC8704587 DOI: 10.3390/ijerph182413341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Approximately 200 million women and girls have undergone female genital mutilation (FGM) worldwide. Migration has spread the practice of FGM around the world, thus making it a global public health issue. The objective of this descriptive qualitative study was to explore the perceptions of Sub-Saharan immigrant women in Spain in relation to the causes of the persistence of FGM. In-depth interviews were carried out with 13 female FGM survivors of African origin, followed by inductive data analysis using ATLAS.ti software. Two main themes emerged from the analysis: (1) A family ritual symbolic of purification and (2) a system of false beliefs and deception in favour of FGM. The FGM survivors living in Europe are aware that FGM is a practice that violates human rights yet persists due to a system of false beliefs rooted in family traditions and deception that hides the reality of FGM from young girls or forces them to undergo the practice. The ritualistic nature of FGM and the threat of social exclusion faced by women who have not had it performed on them contributes to its persistence nowadays.
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Affiliation(s)
- Ousmane Berthe-Kone
- Surgical Critical Resuscitation, Torrecárdenas University Hospital, 04009 Almeria, Spain;
| | - María Isabel Ventura-Miranda
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
- Correspondence:
| | | | - Jessica García-González
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - María del Mar Jiménez-Lasserrotte
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
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Abdullah FZ. The effect of female genital mutilation/cutting (FGM/C) on girls/women's mental health: a case-control study in Kurdistan Region of Iraq. Arch Womens Ment Health 2021; 24:721-726. [PMID: 33829321 DOI: 10.1007/s00737-021-01125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
Female genital mutilation/cutting (FGM/C) is a violation of human rights and is associated with a range of health effects and consequences. It is common in Kurdistan region of Iraq. Therefore, the present study aimed to investigate the effect of female genital mutilation/cutting on girls and women's mental health in Iraqi Kurdistan. The present case-control study was carried out on 145 girls and women with FGM/C and 145 girls and women without FGM/C in the city of Halabja, in the east of Iraqi Kurdistan, in 2020. Mental health status of the participants was measured using the 28-item version of General Health Questionnaire. Chi-square test was used in order to compare mental health and its dimensions in both groups. The multivariate logistic model with odds ratio was applied to determine the relationship of independent variables with the outcome variable (mental health status). In total, almost 72% (n = 104) of girls and women with FGM/C and 56% (n = 81) of girls and women without FGM/C presented the symptoms of mental health disorders and this difference was statistically significant (P-value = 0.005). Also, the prevalence of depression and somatic disorders among girls and women with FGM/C was higher than among girls and women without FGM/C and this difference was significant (P-value < 0.05). Based on the results of multivariate logistic regression, the variables of having a history of FGM/C (AOR = 2.14, 95% CI: 1.29-3.54), and being in an age group of 30-40 years (AOR = 2.01, 95% CI: 1.07-3.76) had a significant effect on presenting the symptoms of mental problems. A significant percentage of women and girls with a history of FGM/C had symptoms of mental disorders. FGM/C was a risk factor for a higher chance of presenting symptoms of mental disorders. We need to try to reduce and eradicate FGM/C by educating the public about the health consequences of FGM/C and enacting restrictive laws and monitoring proper implementation of them.
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Affiliation(s)
- Farman Zahir Abdullah
- College of Education and Language, Charmo University, Chamchamal, Kurdistan Region, Iraq.
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Ahmed CA, Khokhar AT, Erlandsson K, Bogren M. Defibulated immigrant women's sexual and reproductive health from the perspective of midwives and gynaecologists as primary care providers in Sweden - A phenomenographic study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100644. [PMID: 34265570 DOI: 10.1016/j.srhc.2021.100644] [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: 02/01/2021] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To capture care providers' perceptions of defibulated immigrant women's sexual and reproductive health, illuminated by their experiences as care providers for these women. METHODS Individual interview study with 13 care providers at Swedish healthcare facilities: six gynaecologists and seven midwives caring for defibulated immigrant women, analysed with a phenomenographic method. FINDINGS One of the care providers' perceptions of women who had been defibulated was that they had an altered genital function, meaning a wider introitus, improved vaginal intercourse, and more ease urinating and menstruating. The care providers also perceived that women who were defibulated had to balance their wellbeing, struggling between a positive self-image and handling their emotions. Existing in-between cultural values led to a fear of being excluded while at the same time having a desire to be included in the new culture. CONCLUSION Defibulation affects women's sexual and reproductive health and calls for a holistic perspective when providing services, individualized according to the woman's care needs. Support and counselling, should include information about defibulation already during the adolescent years to promote sexual and reproductive health and well-being.
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Affiliation(s)
- Caisha Arai Ahmed
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Kerstin Erlandsson
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; School of Education, Health and Social Studies, Dalarna University, Dalarna, Sweden.
| | - Malin Bogren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
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Connor JJ, Brady SS, Chaisson N, Mohamed FS, Robinson BBE. Response to Commentaries: Understanding Women's Responses to Sexual Pain After Female Genital Cutting. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1907-1912. [PMID: 34100144 DOI: 10.1007/s10508-021-02047-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
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 180, Minneapolis, MN, 55454, USA.
| | - Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicole Chaisson
- Smiley's Clinic, 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 180, Minneapolis, MN, 55454, USA
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Nzinga AM, De Andrade Castanheira S, Hermann J, Feipel V, Kipula AJ, Bertuit J. Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis. J Sex Med 2021; 18:750-760. [PMID: 33618990 DOI: 10.1016/j.jsxm.2021.01.173] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Female genital mutilation (FGM) can leave a lasting mark on the lives and minds of those affected. AIM To assess the consequences of FGM on women's sexual function in women who have undergone FGM compared to women who have not undergone FGM. METHODS A systematic review and meta-analysis were conducted from 3 databases; inclusion and exclusion criterions were determined. Studies included adult women having undergone FGM and presenting sexual disorders assessed by the Female Sexual Function Index (FSFI). RESULTS Of 129 studies, 5 that met the criteria were selected. The sexual function of mutilated women, based on the FSFI total score and its different domains, was compared to the sexual function of non-mutilated women. There was a significant decrease in the total FSFI scores of mutilated women compared to non-mutilated women. However, the results obtained for the different domains were not the same for all authors. The meta-analysis highlighted a high heterogeneity with inconsistency and true variance in effect size between-studies. CONCLUSION Analysis of studies showed that there is a significant decrease in the total FSFI score, indicating that FGM of any type may cause impaired sexual functioning. But a firm conclusion on this topic is not yet achievable because the results of this analysis do not allow to conclude a cause and effect relationship of FGM on sexual function. Nzinga A-M, De Andrade Castanheira S, Herklmann J, et al. Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis. J Sex Med 2021;18:750-760.
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Affiliation(s)
- Andy-Muller Nzinga
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of Congo (DRC)
| | | | - Jessica Hermann
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Anatomy, Biomechanics, and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Augustin Joseph Kipula
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of Congo (DRC)
| | - Jeanne Bertuit
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.
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Binkova A, Uebelhart M, Dällenbach P, Boulvain M, Gayet-Ageron A, Abdulcadir J. A cross-sectional study on pelvic floor symptoms in women living with Female Genital Mutilation/Cutting. Reprod Health 2021; 18:39. [PMID: 33581732 PMCID: PMC7881631 DOI: 10.1186/s12978-021-01097-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/31/2021] [Indexed: 12/29/2022] Open
Abstract
Background Female Genital Mutilation/Cutting (FGM/C) concerns over 200 million women and girls worldwide and is associated with obstetric trauma and long-term urogynaecological and psychosexual complications that are often under-investigated and undertreated. The aim of this study was to assess the pelvic floor distress and the impact of pelvic floor and psychosexual symptoms among migrant women with different types of FGM/C. Methods This cross-sectional study was conducted between April 2016 and January 2019 at the Division of Gynaecology of the Geneva University Hospitals. The participants were interviewed on socio-demographic and background information, underwent a systematic gynaecological examination to assess the presence and type of FGM/C and eventual Pelvic Organ Prolapse (POP), and completed six validated questionnaires on pelvic floor and psychosexual symptoms (PFDI-20 and PFIQ7 on pelvic floor distress and impact, FISI and WCS on faecal incontinence and constipation, PISQ-IR and FGSIS on sexual function and genital self-image). The participants’ scores were compared with scores of uncut women available from the literature. The association between selected variables and higher scores for distress and impact of pelvic floor symptoms was assessed using univariate and multivariable linear regression models. Results 124 women with a mean age of 31.5 (± 7.5), mostly with a normal BMI, and with no significant POP were included. PFDI-20 and PFIQ-7 mean (± SD) scores were of 49.5 (± 52.0) and 40.7 (± 53.6) respectively. In comparison with the available literature, the participants’ scores were lower than those of uncut women with pelvic floor dysfunction but higher than those of uncut women without such disorders. Past violent events other than FGM/C and forced or arranged marriage, age at FGM/C of more than 10, a period of staying in Switzerland of less than 6 months, and nulliparity were significantly associated with higher scores for distress and impact of pelvic floor symptoms, independently of known risk factors such as age, weight, ongoing pregnancy and history of episiotomy. Conclusions Women with various types of FGM/C, without POP, can suffer from pelvic floor symptoms responsible for distress and impact on their daily life. Trial registration. The study protocol was approved by the Swiss Ethics Committee on research involving humans (protocol n°15-224).
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Affiliation(s)
- Alzbeta Binkova
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - Marion Uebelhart
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - Patrick Dällenbach
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1211, Geneva, Switzerland
| | - Michel Boulvain
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Clinical Research Center & Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva & Geneva University Hospitals, Geneva, Switzerland
| | - Jasmine Abdulcadir
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1211, Geneva, Switzerland.
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Shakirat GO, Alshibshoubi MA, Delia E, Hamayon A, Rutkofsky IH. An Overview of Female Genital Mutilation in Africa: Are the Women Beneficiaries or Victims? Cureus 2020; 12:e10250. [PMID: 33042689 PMCID: PMC7536110 DOI: 10.7759/cureus.10250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/04/2020] [Indexed: 12/16/2022] Open
Abstract
Female Genital Mutilation (FGM) is a social phenomenon that is deeply rooted in African socio-cultural and religious facets. It covers a sequence of procedures carried out on the genitals of females of different ages, including total or partial removal of the female external genitalia or other injuries to the female genital organs for non-medical reasons. Several studies have shown beyond a reasonable doubt that FGM is more of a detriment than benefit to the mutilated women. Hence, this review comprehensively presents the narratives and experience of African women about FGM with a focus on whether they are beneficiaries or victims of the practice. The method adopted involved searching for relevant studies through PubMed and Google Scholar databases coupled with some prominent internet materials. This method was done majorly to identify and utilize the best quality published studies on FGM in Africa. Having lent due credence to the relevant studies pooled together, it was established that the practice of FGM in the African continent is highly undesirable. It creates numerous health complications coupled with psychosocial, psychological, and psychosexual issues for the mutilated women. Prominent among these repercussions are infection, the formation of scarring and keloid, monthly menstrual difficulties, urinary symptoms, infertility, obstetric complications during pregnancy and labor, depression, anxiety, and post-traumatic stress disorder. Despite these complications, it was revealed that FGM is still extant in many African countries. However, the fear of becoming a social outcast is the biggest hindrance facing anti-FGM campaigners. FGM is unequivocally a cankerworm that has eaten the freedom and wellbeing of African women, making them choiceless victims. Therefore, it is quite pertinent for governments and community leaders to provide medical support to the victims and fight the prevalence of FGM in their jurisdictions. This can be achieved through increased awareness about its adverse effects, women's education, and community shunning of the practice coupled with appropriate sanctioning of the erring members.
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Affiliation(s)
- Ganiyu O Shakirat
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Muhammad A Alshibshoubi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Eldia Delia
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anam Hamayon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, Neuroscience, Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Clinical Features Associated with Female Genital Mutilation/Cutting: A Pilot Longitudinal Study. J Clin Med 2020; 9:jcm9082340. [PMID: 32707951 PMCID: PMC7463820 DOI: 10.3390/jcm9082340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022] Open
Abstract
(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.
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Piroozi B, Alinia C, Safari H, Kazemi-Karyani A, Moradi G, Farhadifar F, Yousefi F, Mohamadi Bolbanabad A, Azadnia A. Effect of female genital mutilation on mental health: a case–control study. EUR J CONTRACEP REPR 2020; 25:33-36. [DOI: 10.1080/13625187.2019.1709815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bakhtiar Piroozi
- Social Determinants of Health Research Centre, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Cyrus Alinia
- Reproductive Health Research Centre, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemi-Karyani
- School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Centre, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fariba Farhadifar
- Social Determinants of Health Research Centre, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fayegh Yousefi
- Social Determinants of Health Research Centre, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Centre, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arian Azadnia
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
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