Therapeutic drug monitoring of sirolimus: correlations with efficacy and toxicity

We sought to examine the potential benefits of therapeutic drug monitoring of sirolimus, a potent immunosuppressive agent that displays a pleiotropic array of side effects.

METHODS

A high-performance liquid chromatography (LC) procedure combined with ultraviolet detection (UV) was used to measure serial concentrations of parent compound sirolimus in 150 renal transplant recipients over a period of 4 yr. Drug concentrations in whole blood at trough time, as well as within pharmacokinetic profiles, were correlated with clinical events using contingency tables, logistic regression analysis, and receiver operating characteristic (ROC) curves.

RESULTS

The LC/UV method showed an excellent correlation with detection of LC-resolved components by tandem mass spectrometry, demonstrating that the LC/UV method selectively detected parent compound. Sirolimus displayed the characteristics of a critical-dose drug: Its concentration could not be predicted by a standard body or demographic measure, or by dose, and it showed high degrees of intra- and inter-individual variability. However, there was a good correlation between trough and area-under-the-curve measurements. There was a significant association between trough values expressed as either observed ( < 5 ng/mL) or dose-corrected parameter ( < 1.7 ng/mL per mg administered drug) and the occurrence and severity of acute rejection episodes - despite the low overall incidence of 23 episodes among the cohort of 150 patients. Similarly, ROC functions showed a correlation of the occurrence of hypertriglyceridemia, thrombocytopenia, and leukopenia, but not hypercholesterolemia, with trough concentrations above 15 ng/mL.

CONCLUSION

Due to its behavior as a critical-dose drug, therapeutic monitoring to measure sirolimus concentrations by a LC/UV method may provide clinicians with a tool to optimize outcomes.

Cellular mechanisms of osteoclast formation and lacunar resorption in giant cell granuloma of the jaw

BACKGROUND

Giant cell granuloma (GCG) is an osteolytic tumour of the jaw which is characterised by the presence of both mononuclear and multinucleated (osteoclast-like) giant cell components. The nature of these component cells and the pathogenesis of the extensive osteolysis associated with this lesion is uncertain.

METHODS

Using cell culture techniques and immunohistochemistry, we defined the phenotypic characteristics of the mononuclear and multinucleated cells present in four cases of GCG of the jaw. We also analysed the cellular and humoral factors associated with osteoclast formation and osteolysis in these tumours and determined whether GCG stromal cells are capable of supporting osteoclast formation.

RESULTS

GCG-derived giant cells expressed the phenotypic characteristics of osteoclasts (TRAP+, VNR+, and calcitonin responsive) and were capable of lacunar resorption. In addition to macrophages, the mononuclear cell population contained numerous spindle-shaped stromal cells which proliferated in culture and expressed RANKL; these GCG-stromal cells were capable of supporting human osteoclast formation from circulating monocyte precursors.

CONCLUSION

Our findings indicate that the giant cells in GCG of the jaw are osteoclast-like and formed from monocyte/macrophage precursors which differentiate into osteoclasts under the influence of RANKL-expressing mononuclear stromal cells found in this lesion.

Assessment of paediatric dental guidelines and caries management alternatives in the post COVID-19 period. A critical review and clinical recommendations

PURPOSE

The first aim of this paper is to provide dental professionals caring for children and adolescents during and after the COVID-19 pandemic with a reference to international dental guidelines. The second aim is to suggest minimally invasive treatment alternatives for caries management, minimising the risk of viral cross-infection and offering a safer clinical environment.

METHODS

An evidence-based pertinent literature search of different electronic databases was performed in addition to leading global dental authorities, royal colleges, and programmes.

RESULTS

All guidelines released in response to COVID-19 centred around minimising Aerosol Generating Procedures (AGP) impacting the provision of regular dental treatment of paediatric patients. There was an emphasis on triaging and only treating emergency and urgent cases. Special attention was given to medically compromised children in the guidelines. Detailed guidelines for the dental environment and equipment were given. This paper also summarised the relevant evidence-based guidelines for the use of non-invasive and minimally invasive caries management techniques.

CONCLUSION

 Specific recommendations for dental management of paediatric patients during and in the post-COVID-19 era are suggested. Minimisation of AGP procedures, and case-based selection of biological, non-invasive or minimally invasive methods are recommended.

The management of drooling in children and patients with mental and physical disabilities: a literature review

Amongst the duties of the paediatric dentist is the provision of oral care to patients with the problem of drooling. Many, but certainly not all, of these patients have physical and/or learning disabilities. Various methods have been advocated for the management of drooling in the paediatric patient and older patients with disabilities, including behavioural programmes, biofeedback techniques, physiotherapy, biofunctional oral appliances, medication and surgery. It is of paramount importance that the patients and/or carers understand the advantages and disadvantages of any treatment method being considered. The paediatric dentist has an important role to play in explaining the different options to the patients and carers, and in implementing some treatment modalities, particularly non-surgical approaches. Referral to surgical specialists should be seen as 'a last resort' and suggested only if other treatment methods have been exhausted. If pharmacological or surgical treatment is carried out, careful monitoring for the development of dental caries and other problems is essential. The aim of this paper is to provide the paediatric dentist with concise overall knowledge of the causes of drooling and treatment options available.

Response of four indigenous cattle breeds to natural tsetse and trypanosomosis challenge in the Ghibe valley of Ethiopia

A comparative study on the response of four indigenous cattle breeds of Ethiopia, namely Abigar, Horro, Sheko and Gurage, to natural challenge of trypanosomosis in the Tolley-Gullele area of the Ghibe valley has been undertaken from August 2000 until August 2004. Fifty female yearlings each of Horro, Sheko and Abigar and 31 of the Gurage were purchased from their natural habitats and introduced in to medium to high tsetse-trypanosomosis challenge area of the Ghibe valley. While the natural habitats of first three breeds are naturally infested with tsetse flies and trypanosomosis, that of the Gurage is known to be very minimal, if any, and hence the Gurage breed was used in this study as the known susceptible breed. During the study animal health, production performance and tsetse fly situation were monitored monthly. The Sheko breed has manifested very significantly (p<0.001) high overall average packed cell volume (PCV) values (25%) compared to that of Abigar (24%), Horro (23%) and Gurage (22%). It also had the lowest mean trypanosome prevalence rate of 9% against 23% of Horro, 26% of Abigar and 27% of Gurage, and the least number of Berenil treatments (1.36) compared to Abigar (4.0), Horro (4.6) and Gurage (6.7). While the Abigar manifested high sensitivity and frequent death to PCV depression, the Horro showed strong resilience to PCV depression and better response to Berenil treatment assistance. At this stage the Sheko breed was also found to be equal to the other breeds in its reproductive performance. These results need to be substantiated with further in-depth investigation including immune response, animal behavior and environmental influences.

Medication take-home doses and contingency management

Two studies examined contingent take-home medication doses during treatment of opiate or cocaine dependence. In the first study, methadone maintenance patients were randomly assigned to one of two 8-week baseline take-home (TH) conditions differing in frequency of clinic visits per week. This was followed by a 12-week contingency management (CM) procedure in which frequent THs resulted from drug-free urines. Participants receiving more frequent THs during baseline had lower illicit drug use during the first 6 weeks of CM. In the second study, fluoxetine (0-, 20-, 40-mg) TH doses were similarly contingent in treatment of cocaine dependence. The 40-mg group used less cocaine during contingency than did other groups. The combination of fluoxetine and environmental contingencies may produce benefit where neither alone is sufficient.

A comparison of the effects of some extrinsic and intrinsic sugars on dental plaque pH

The aim of this study was to investigate the effects of some intrinsic and non-milk extrinsic sugars on plaque pH. Three fruits (apple, orange and banana) in three different physical forms (whole, homogenized and juice) were tested. Ten adult volunteers refrained from brushing their teeth for 48 hours and did not eat or drink for at least 2 1/2 hours before each test. Measurements of plaque pH were made at baseline to determine the resting plaque pH and at time intervals of 3, 7, 11, 15, 19, 23 and 27 minutes following a 1-minute rinse/chew of each test fruit. A pooled sample of plaque was removed from the buccal surfaces of six teeth representing all four quadrants of the mouth and thoroughly mixed with 20 microliters of distilled water. Plaque pH was determined using a micro-glass combination electrode. Data were compared with plaque pH changes resulting from rinsing with 10% sucrose solution. Analysis of pH minima and 'area under baseline pH', using ANOVA and multiple Turkey tests, indicated that there was no significant difference in any of the parameters between the different forms of preparation within one fruit, except for the minimum pH of whole orange and orange juice (P < 0.05). The results showed that homogenization of the fruits had little effect on acidogenicity even though the intrinsic sugars had been converted to extrinsic sugars. Both whole and mashed banana were of similar acidogenicity to 10% sucrose. Therefore it was concluded that there was no significant difference in the acidogenic potential between intrinsic sugars and extrinsic sugars derived from fruits.

A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States

OBJECTIVES

The aim of the study was to evaluate the prevalence and severity of dental caries in pre-school children in the Gulf Cooperation Council (GCC) area.

METHODS

A search of literature was conducted to identify articles of dental caries in primary dentitions published during the period from January 1st, 1992 to June 30th, 2016. PubMed, Google Scholar search, and hand searching of journals was conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms.

RESULTS

Out of a total of 193 studies that fit the initial inclusion criteria, 159 studies were further excluded. Only 34 studies were included in the systematic review and meta-analyses. The overall mean dmft in the primary teeth was 5.14 with prevalence of 80.9% in the GCC area. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 2538.501 (df = 21) and I2 value of 99.17%. However, the funnel plots showed symmetrical shape at the bottom in both dmft and prevalence studies indicating absence of publication bias, which was also confirmed by insignificant result of Egger's regression statistical test (Egger's test P = 0.179-0.358).

CONCLUSION

Caries in the primary dentition in the GCC States was high both in terms of mean dmft (5.14) and prevalence (80.95%).

Sirolimus improves the two-year outcome of renal allografts in African-American patients

The present study evaluated whether the addition of sirolimus to a cyclosporine (CyA)/prednisone (Pred) regimen mitigated the greater proclivity to acute rejection episodes and graft loss characteristic of African-American renal transplant recipients. Using Kaplan-Meier and log-rank tests, African-American renal transplant recipients treated with either CyA/Pred (n = 90) or sirolimus/CyA/Pred (n = 47) were compared with 120 Caucasian patients treated with sirolimus/CyA/Pred for 2-year rates of patient and graft survival as well as acute rejection episodes. Mean laboratory values were compared using analysis of variance and F-tests. Addition of sirolimus to the CyA/Pred regimen reduced the incidence of acute rejection episodes in African-Americans from 43.3% to 19.2% (P = 0.004), a value similar to Caucasian patients. The 97.9% 2-year graft survival rate among 47 African-American patients treated with sirolimus/CyA/Pred was significantly higher than the 85.6% rate shown among the 90 CyA/Pred-treated African-American transplant recipients (P = 0.0479) and similar to that in Caucasians. The 95.7% patient survival rate among the African-American sirolimus/CyA/Pred group was similar to the 97.8% rate in the African-American CyA/Pred cohort. Interestingly, there was no evident toxicity from the addition of sirolimus. The addition of sirolimus to a CyA-based regimen reduced acute rejection episodes and graft loss experienced by African-American renal transplant recipients.

Medication take-home doses and contingency management

Two studies examined contingent take-home medication doses during treatment of opiate or cocaine dependence. In the first study, methadone maintenance patients were randomly assigned to one of two 8-week baseline take-home (TH) conditions differing in frequency of clinic visits per week. This was followed by a 12-week contingency management (CM) procedure in which frequent THs resulted from drug-free urines. Participants receiving more frequent THs during baseline had lower illicit drug use during the first 6 weeks of CM. In the second study, fluoxetine (0-, 20-, 40-mg) TH doses were similarly contingent in treatment of cocaine dependence. The 40-mg group used less cocaine during contingency than did other groups. The combination of fluoxetine and environmental contingencies may produce benefit where neither alone is sufficient.

Prevalence of iodine deficiency disorders among school children in Saudi Arabia: results of a national iodine nutrition study

This study aimed at establishing updated data on iodine nutrition among schoolchildren in Saudi Arabia. A cross-sectional cluster survey among schoolchildren aged 8-10 years was conducted during February-April 2012. Children were clinically examined for goitre, urine and household salt samples were collected to estimate urinary iodine concenteration (UIC) and iodine content in salt. The overall goitre prevalence at the national level among 4 016 children was 4.2%. The prevalence was < 5% in all regions of the country except southern region with a prevalence of 12.7%. The median UIC of 2224 samples was 133 μg/L, with 74.3% of the surveyed children with UIC ≥ 100 μg/L. Analysis of salt samples (n = 4242) revealed that 69.8% of households were consuming adequately iodized salt. The findings suggest iodine sufficiency at the national level, however southern region still has a goitre prevalence of mild degree severity and the proportion of households consuming adequately iodized salt is still below recommendations.

An Educational Initiative for Dubai School Nurses and Physical Education Teachers on the Management of Traumatic Dental Injuries

The aim of this study was to assess the knowledge of school nurses and physical education teachers (SN and PE teachers) about the emergency management of traumatic dental injuries (TDIs) in schools and to measure the impact of education on their knowledge. A longitudinal prospective study based on a questionnaire survey completed by 68 SN and PE teachers at three time periods (prior to, immediately after, and 3 months-post-educational intervention). Pre- and post t-test and repeated measures (analysis of variance) were used to compare the three group means for the same participants (p < .05 was considered significant). Significant improvement in the knowledge score among participants was observed between the initial survey to immediately after the educational session and to 3 months after (p = .047). Significant improvement in the choice of immediately seeking attention after tooth avulsion was observed (p = .001). The initial knowledge deficiency about the emergency management of TDIs among SN and PE teachers was improved and sustained.

The use of behaviour management techniques amongst paediatric dentists working in the Arabian region: a cross-sectional survey study

Purpose

The purposes of this study were to investigate paediatric dental practitioners’ training and confidence in using dental behaviour management techniques in the Arabian region and to assess the factors influencing the application of advanced behaviour management techniques. Methods: An online questionnaire was distributed to paediatric dental practitioners in the Arabian region. Data were analysed using descriptive statistics and Pearson Chi Square.

Results

A total of 113 responses were obtained. Of these, the majority were from Egypt (45%, n = 51). Just over half of the respondents were registered as specialists at the country where they were practicing paediatric dentistry (53%, n = 60). The use of behaviour management techniques varied amongst participants with tell-show-do (95%, n = 107) and positive reinforcement (89%, n = 101) being the most routinely used techniques. The majority of participants reported using voice control (83%) and parental separation (68%) techniques. Hand over mouth exercise (HOME) was only used by 24% (n = 27) of participants, whilst just over half of the participants, 53%, reported using protective stabilisation. A significant association was shown between country of practice, country of obtaining paediatric dental training, speciality status and the use of advanced behaviour management techniques, whilst confidence in using HOME and sedation were associated with work setting and country of practice, respectively.

Conclusion

The use of advanced behaviour management techniques was found to be high amongst respondents in the Arabian region. The lack of training in using these techniques, however, is of concern. Further assessment of the factors affecting the use of and confidence in applying advanced behaviour management techniques in the Arabian region is needed.

COVID-19 outbreak at a reception centre for asylum seekers in Espoo, Finland

Background shared accommodation may increase the risk of SARS-CoV-2 transmission. In April 2020, an increasing number of asylum seekers at a reception centre in Espoo, Finland presented with COVID-19 despite earlier implementation of preventive measures. We decided to screen the entire population of the centre for SARS-CoV-2.

Methods we offered nasopharyngeal swab collection and SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) analysis to the centre's clients. Symptoms were recorded at the time of diagnostic sample collection using electronic forms and followed up for two weeks through phone interviews and a review of medical records.

Findings 260 clients were screened. Of them, 96 (37%) were found positive for SARS-CoV-2 and isolated. The high attack rate prompted the local public health authority to set the other clients in quarantine for 14 days to prevent further spread. Of the positive cases, 61 (64%) reported having had symptoms at the time of the screening or one week prior. Of the 35 initially asymptomatic individuals, 12 developed symptoms during follow-up, while 23 (or 18% of all screened SARS-CoV-2 positive clients) remained asymptomatic. No widespread transmission of COVID-19 was detected after the quarantine was lifted.

Interpretation in this large COVID-19 outbreak, voluntary mass screening provided valuable information about its extent and helped guide the public health response. Comprehensive quarantine and isolation measures were likely instrumental in containing the outbreak.

Funding Finnish Institution for Health and Welfare, Finnish Immigration Agency, City of Espoo

Use of theatre time for dentoalveolar operations under general anaesthesia

Efficient use of hospital resources is essential if waiting lists are to be reduced. We undertook this study because there seems to be little information on the use of theatre time for dentoalveolar surgery under general anaesthesia. The time taken for each sequence of events (from start of case, induction, operation to recovery, and so on) for each patient was recorded. Of the 30 lists examined, 22 lists (73%) finished on time or early, and 8 lists (27%) ran late. The time spent operating occupied less than 50% of theatre time available. The 'total time' for each case was increased (by about 10 minutes a patient) when a junior anaesthetist was anaesthetizing rather than a consultant. The overall time used per list was 79% with the remaining 21% of the list being 'unused'. Where these lists did over-run, then this was usually because the operation took longer, although grade of anaesthetist was a factor. We identified several areas in which efficiency could be improved.

Dentists' knowledge of the guidelines of traumatic dental injuries in the United Arab Emirates

AIM

This study aimed to assess general dental practitioners' (GDPs) knowledge within the United Arab Emirates (UAE) regarding the management of traumatic dental injuries (TDIs), and to compare their level of knowledge with that of paediatric dentists (PDs).

METHODS

Dentists were asked to complete a two-part questionnaire (seven questions covering demographic data and 13 questions about trauma cases scenarios) in electronic and paper format. A total of 296 returned questionnaires were analysed to identify GDPs' knowledge in managing TDIs, and to compare the score of GDPs' knowledge with that of PDs'.

RESULTS

Out of a total score of 13, the mean knowledge score (MKnS) for GDPs was 4.87±1.82 (only 37.5% of the 13 questions were answered correctly) while the MKnS of paediatric dentists was 5.56±1.47 (with 42.8% correct answers); both scores indicated poor knowledge and the difference was statistically significant (p=0.005).

CONCLUSION

There was poor knowledge of TDIs among the surveyed UAE GDPs as well as the PDs, although PDs scored higher, indicating the need for further training.

A 24-month retrospective study of preformed metal crowns: the Hall technique versus the conventional preparation method

PURPOSE

Conventional and Hall Technique (HT) Preformed Metal Crowns (PMCs) are used for treatment of carious primary molars. The aim was to evaluate the clinical and radiographic success of conventional and HT PMCs in a postgraduate dental setting.

METHODS

A retrospective study using patients' electronic case-notes and radiographic images of carious primary molars treated with either conventional or HT PMCs was conducted to assess clinical and radiographic success/failure. A Kaplan-Meier curve was used to assess PMC survival.

RESULTS

187 PMCs (110 HT and 77 conventional) in 65 children (34 females and 31 males) at 6, 12, 18 and 24 months were assessed. At 24 months, the success rates of conventional and HT PMCs were 97.6% and 93.5%, respectively. Two HT (perforated/abscessed) and four conventional (abscessed) PMCs failures occurred. There was no significant difference in success/failure (p = 0.362) at 12 months, but the HT was more successful at 24 months (p = 0.002) with similar survival times for both methods.

CONCLUSION

HT and conventionally placed PMCs, when placed in a postgraduate paediatric dentistry setting, were clinically and radiographically very successful at 6, 12, 18 and 24 months post operatively with a slightly higher success of the HT at 24 months.

Children's dental anxiety (self and proxy reported) and its association with dental behaviour in a postgraduate dental hospital

PURPOSE

Child dental anxiety (CDA) and uncooperative dental behaviour are common. We aimed to assess the prevalence of CDA (self- and proxy- reported) in the United Arab Emirates (UAE) children related to their dental behaviour.

METHODS

Data were collected from 312 questionnaires obtained from 156 parent/child (mean age 9.95 ± 2.17 years) pairs attending a postgraduate dental hospital. Demographics, self/proxy- reported CDA scores via a six-question, five-point Likert scale, of the Modified CDA Scale-faces version (MCDAS-f: where ≥ 19 was severe CDA) and Frankl Behaviour Rating Scale (FBRS) scores were compared and analysed. Chi-square test, Pearson's correlation, Kappa- coefficient, one-way ANOVA and independent t test statistical analysis were used (p < 0.05).

RESULTS

The prevalence of self and proxy severe CDA was 22.4% (n = 35) and 33.3% (n = 52) respectively, with 9% (n = 14) being dentally- uncooperative. In both groups, extractions caused the highest CDA followed by injections and fillings (p < 0.001). The mean scores for self-reported/proxy-reported CDA were 15.02 (± 4.90)/15.70 (± 6.07) respectively. There was a positive linear correlation between self- and proxy- reported CDA scores and a negative linear correlation between self/proxy- reported CDA scores and the FBRS (p < 0.001). Self/proxy concordance of severe anxiety/none-to-moderate- anxiety was fair (68.6%, kappa = 0.23, p = 0.003). Both self/FBRS and proxy/FBRS concordance of severe anxiety/none-to-moderate- anxiety/behaviour was fair (78.8%, kappa = 0.23, p = 0.001) and (71.8%, kappa = 0.22, p < 0.001) respectively.

CONCLUSIONS

Considering the limitations of the present study in a UAE child population sample, the prevalence of CDA from extractions, injections and fillings was 22.4% (self- reported) and 33% (proxy reported). There was fair agreement between child- self and parent- proxy- reported CDA. Increased CDA led to uncooperative dental behaviour.

Assessment of the knowledge of United Arab Emirates dentists of Child Maltreatment, protection and safeguarding

AIM

Child safeguarding is society's responsibility. Dentists are uniquely positioned to recognise Child Abuse and Neglect (CAN) in dental practice and the wider society. The United Arab Emirates (UAE) introduced a child protection law in 2016. We aimed to assess the awareness of UAE dentists of child maltreatment, protection and safeguarding. Study Design A cross-sectional survey.

MATERIALS AND METHODS

We surveyed 381 UAE dentists about the knowledge and practice of CAN and safeguarding issues using a self-administered anonymous questionnaire. Statistical analysis was carried out using Chi-square, t-test, ANOVA and Pearson's correlation test and statistical significance was set as p <0.05.

RESULTS

Over 39 % (n=152) of the responders suspected CAN; male dentists suspected more CAN than females (p=0.015). Orthodontists, paediatric dentists (p<0.001) and female dentists (p=0.001) were more knowledgeable about diagnosing CAN. Paediatric dentists attended more CAN-related postgraduate training (p<0.001) than other specialties. Over 90% (n=346) believed that CAN should be addressed, 58.1% (n=224) and 54.1% (n=206) had CAN undergraduate and postgraduate training respectively but 53.5% (n=204) were unaware of local child protection guidelines. Dentists barriers to child protection reporting were; fear of family violence (59.6%, n=227), lack of knowledge of referral process (60.2%, n=228) and lack of diagnosis certainty (54.9%, n=206). UAE dentists qualified in Western and Asian countries had fewer barriers for child protection reporting (p=0.022) than the Arab and Gulf Cooperation Council qualified dentists.

CONCLUSIONS

A large minority of UAE dentists suspected CAN. Factors influencing child protection reporting were identified. Dentists' gender, specialty, and country of qualification affected their knowledge of CAN and practice of safeguarding. Child protection training is recommended.

Ultrasound detection rate of childhood urolithiasis

A retrospective study of 42 children with 45 proven urinary tract stones who had had intravenous urography (IVU), ultrasound examination and a plain abdominal X-ray (KUB) was undertaken in order to evaluate the prediction rate of each method. Ultrasound was more sensitive than KUB (91% vs 80%) in detecting stones. All renal stones were detected by ultrasound. KUB was superior to ultrasound in detecting ureteral stones (66.6% vs 55.5%). All stones were detected by the combination of ultrasound and KUB. Two renal radiolucent stones were missed by IVU. The results of this study suggest that the combination of ultrasound examination and KUB is more sensitive in detecting stones than IVU and is more convenient and less invasive.

Our Body Our Health (Jirkeena, Caafimaadkeena): Somali Women's Narratives on Sexual Health

Women across the globe have been subject to female genital cutting (FGC), with the highest rates in Somalia. FGC can result in sexual concerns, especially sexual pain and lower pleasure. Due to ongoing civil war and climate disasters, there is a large number of Somali immigrants and refugees living in countries where healthcare providers may be unfamiliar with the impact of FGC. In this qualitative study, sixty Somali women between the ages 20 and 45 and living in the U.S. shared their perspectives on how FGC has affected their sexual lives, including how they have coped with any complications attributed to FGC. Participants were recruited through convenience sampling and interviewed by a bilingual community researcher in either Somali or English. Data were analyzed through a participatory analysis process by academic and community researchers. Themes included sexual desire, arousal, and pleasure; sexual satisfaction; sexual pain at first intercourse; coping with sexual pain at first intercourse; long-term sexual pain, coping with long-term sexual pain. Results are discussed with a focus on agency of the participants, role of partners, and implications for healthcare professionals.