Female genital mutilation/cutting and orgasm before and after surgical repair

Female genital mutilation/cutting in sudan and subsequent pelvic floor dysfunction

Background

We aimed to evaluate the socio-demographic characteristics of women with female genital mutilation/cutting (FGM/C) and the results of FGM/C due to pelvic floor dysfunction.

Results

The prevalence of FGM/C was 87.2% in Sudan and Type 3 (50.4%) was the most prevalent, followed by Type 2 (35%) and Type 1 (8.5%). In the multinominal logistic regression analysis performed to show the effect of FGM/C on pelvic organ prolapse (POP), it was observed that FGM/C frequency in POP group 2 was statistically similar when POP group 1 was taken as reference category. In the evaluation for symptomatic POP (POP group 3), risk of developing POP in patients without FGM/C was significantly lower than patients with type 3 FGM/C with a rate of 82.9% (OR(odds ratio): 0.171 (p: 0.002), (Confidence Interval (CI) %95; 0.058–0.511). Risk of developing POP rate in patients with type 1 FGM/C was 75% (OR:0.250 (p: 0.005), CI %95; 0.094–0.666) and in patients with type 2 FGM/C was 78.4% (OR:0.216 (p: 0.0001), CI%95; 0.115–0.406). In the multinominal logistic regression analysis including other variables affecting POP, when group 1 was taken as the reference category, it was found that the possibility of developing mild POP (group 2) decreased in FGM/C type 1 and 2 compared to FGM/C type 3 but it was not statistically significant. However, the evaluation for the symptomatic POP group showed up a significantly lower risk of developing POP in patients with type 2 FGM/C compared to patients with type 3 FGM/C, with a rate of 58.4%. (OR:0.419 (p: 0.016), CI%95; 0.206–0.851) (Table 3). In addition, older age was found to be significant risk factor for increasing symptomatic POP (p: 0.003).

Conclusions

Type 2 and 3 FGM/C continues to be an important health problem in terms of complications that may develop in advanced ages as well as many short-term complications as a result of mechanical or physiological deterioration of the female genital anatomy.

Surgical management of female genital mutilation-related morbidity: A scoping review

BACKGROUND

Over 200 million women and girls worldwide have suffered from the partial to total removal of external female genitalia for nonmedical purposes, referred to as female genital mutilation (FGM). Survivors of FGM may develop debilitating physical and psychological long-term sequelae. This is the first study to examine the scope of the extant surgical literature on the management of FGM-related morbidity.

METHODS

A systematic scoping review of five major research citation databases was conducted.

RESULTS

A total of 190 articles from 29 countries met the inclusion criteria. The majority (76%) were primary source articles and from obstetrics and gynecology literature (71%). Reported interventions for FGM-related morbidity were defibulation, cyst excision, clitoral and vulvar reconstruction, urological reconstruction, peripartum procedures, labial adhesion release, and reinfibulation.

CONCLUSIONS

Surgery for FGM complications spans multiple specialties, which suggests multidisciplinary collaboration benefit. Plastic and reconstructive surgeons have a clear role in the multidisciplinary care team for these patients. This scoping review identified a paucity of high-quality evidence with respect to functional quality of life outcomes and long-term follow-up.

Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis

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.

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

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

Towards a better estimation of prevalence of female genital mutilation in the European Union: a situation analysis

Background

Female genital mutilation (FGM) is a harmful cultural practice that is predominantly documented in Africa, but also occurs in other parts of the world. Due to migration, women who have undergone FGM can also be found in the European Union (EU). Due to a lack of systematic representative surveys on the topic in EU, the prevalence of FGM and the number of women and children subjected to the practice remains unknown. However, information on the magnitude of the problem in the EU is necessary for policy makers to design and track preventive measures and to determine resource allocation.

Methods

Between March 2015 and May 2015, we performed a situation analysis consisting of a critical interpretive synthesis and SWOT-analysis of available at the time peer reviewed and grey literature document on national prevalence studies on FGM in the EU. Studies estimating the prevalence of FGM and the number of girls and women subjected to the practice in the EU were mapped to analyse their methodologies and identify their Strengths, Weakness, Opportunities and Threats (SWOT). Distinction was made between direct and indirect estimation methods.

Results

Thirteen publications matched the prioritized inclusion criteria. The situation analysis showed that both direct and indirect methodologies were used to estimate FGM prevalence and the number of girls and women subjected to FGM in the EU. The SWOT-analysis indicated that due to the large variations in the targeted population and the available secondary information in EU Member States, one single estimation method is not applicable in all Member States.

Conclusions

We suggest a twofold method for estimating the number of girls and women who have undergone fgm in the EU. For countries with a low expected prevalence of women who have undergone fgm, the indirect method will provide a good enough estimation of the FGM prevalence. The extrapolation-of-fgm-countries-prevalence-data-method, based on the documented FGM prevalence numbers in DHS and MICS surveys, can be used for indirect estimations of girls and women subjected to FGM in the eu. For countries with a high expected prevalence of FGM in the EU Member State, we recommend to combine both a direct estimation method (e.g. in the form of a survey conducted in the target population) and an indirect estimation method and to use a sample design as developed by the FGM-PREV project. The choice for a direct or indirect method will ultimately depend on available financial means and the purpose for the estimation.

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

Purpose: We aim to provide a comprehensive overview of the health consequences of female genital mutilation/cutting (FGM/C), with a particular focus on the psychosexual implications of this practice and the overall impact of reconstructive plastic surgery.

Methods: A MEDLINE search through PubMed was performed to identify the best quality evidence published studies in English language on long-term health consequences of FGM/C.

Results: Women with FGM/C are more likely to develop psychological disorders, such as post-traumatic stress disorder, anxiety, somatization, phobia, and low self-esteem, than those without FGM/C. Most studies showed impaired sexual function in women with FGM/C. In particular, women with FGM/C may be physiologically less capable of becoming sexually stimulated than uncut women. Reconstructive surgery could be beneficial, in terms of both enhanced sexual function and body image. However, prospective studies on the impact of reconstructive surgery are limited, and safety issues should be addressed.

Conclusion: Although it is clear that FGM/C can cause devastating immediate and long-term health consequences for girls and women, high-quality data on these issues are limited. Psychosexual complications need to be further analyzed to provide evidence-based guidelines and to improve the health care of women and girls with FGM/C. The best treatment approach involves a multidisciplinary team to deal with the multifaceted FGM/C repercussions.

Shame, Catastrophizing, and Negative Partner Responses Are Associated With Lower Sexual and Relationship Satisfaction and More Negative Affect in Men With Peyronie's Disease

Peyronie's disease (PD) has a negative impact on men's sexual functioning and quality of life, but little is known about why some men cope better than others and what the effects of PD are on their relationships. The aims of the present study were to describe negative affect, pain, and relationship and sexual satisfaction in men with PD, and to explore their psychosocial correlates. Participants were 110 men diagnosed with PD. All men completed questionnaires. The main outcome measures were as follows: Global Measure of Sexual Satisfaction, Dyadic Adjustment Scale, McGill Pain Questionnaire, and Negative Affect Scale. The predictor variables were the following: Experience of Shame Scale, Body Esteem Scale, Body Image Self-Consciousness Scale, Index of Male Genital Image, a modified Pain Catastrophizing Scale, and a modified Multidimensional Pain Inventory. Although men with PD had mean sexual/relationship satisfaction and negative affect scores indicating mild impairment, there was a wide range of variation, with 42% to 52% scoring in the clinical range. Catastrophizing was significantly associated with reduced sexual satisfaction and increased negative affect and pain. Shame was also associated with increased negative affect. The significant associations of relationship satisfaction were partner responses and shame. Given the lack of curative treatment in PD, understanding why some men cope better than others may guide therapy. Shame, catastrophizing, and partner responses may be important therapeutic targets.

Female Genital Mutilation Is a Violation of Reproductive Rights of Women: Implications for Health Workers

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons. This coercive practice is still prevalent in many parts of the world, in both developed and developing countries. However, FGM is more prevalent in African countries and some Asian countries. In this study, an attempt has been made to understand the prevalence and practice of FGM worldwide and its adverse effects on women's reproductive health. To fulfill the study objectives, the author collected evidence from various studies conducted by international agencies. Many studies found that FGM has no health benefits; is mostly carried out on girls before they reach the age of 15 years; can cause severe bleeding, infections, psychological illness, and infertility; and, most important, can have serious consequences during childbirth. The practice is mainly governed by the traditions and cultures of the communities without having any scientific or medical benefit. In conclusion, FGM is a practice that violates the human and reproductive rights of women.

Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study

INTRODUCTION

Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations.

AIM

To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image.

METHODS

A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index).

MAIN OUTCOME MEASURES

Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores.

RESULTS

Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores.

CONCLUSION

Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated.

Nursing Care of Women Who Have Undergone Genital Cutting

Female genital cutting (FGC), commonly called female genital mutilation, affects millions of women but is poorly understood by many health care providers. FGC procedures intentionally alter the female genital organs for nonmedical reasons and include partial or total removal of female genital organs. These procedures, which have no medical value, are usually done between birth and puberty. Health consequences vary in severity but can be devastating. Women who have experienced FGC may be reluctant to seek health care or to disclose their condition to providers. Suggestions for culturally competent care of women who have experienced FGC are outlined, focusing on understanding the cultural beliefs and values of women who have undergone these procedures and providing informed and sensitive care.

A systematic review of the evidence on clitoral reconstruction after female genital mutilation/cutting

BACKGROUND

Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C).

OBJECTIVES

To review evidence on the safety and efficacy of clitoral reconstruction.

SEARCH STRATEGY

PubMed and Cochrane databases were searched for articles published in any language from database inception until May 2014. Search terms related to FGM/C and clitoral reconstruction were used in various combinations.

SELECTION CRITERIA

Studies of any design that reported on safety or clinical outcomes (e.g. appearance, pain, sexual response, or patient satisfaction) associated with clitoral reconstruction after FGM/C were included.

DATA COLLECTION AND ANALYSIS

Evidence was summarized and systematically assessed via a standard data abstraction form.

MAIN RESULTS

Four of 269 identified articles were included. They were fair to poor in quality. Summary measures could not be computed owing to heterogeneity. The studies reported on immediate surgical complications, clitoral appearance, dyspareunia or chronic pain, and clitoral function postoperatively via non-standardized scales.

CONCLUSIONS

Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify both long-term outcomes and which women might benefit.