Blog Original research

Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice

BMC Int Health Hum Rights. 2015 Dec 10;15(1):32. doi: 10.1186/s12914-015-0070-y.

Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice

Zurynski Y, Sureshkumar P, Phu A, Elliott E


BACKGROUND: The World Health Organisation (WHO) estimates that 100-140 million girls and women have undergone female genital mutilation or cutting (FGM/C). FGM/C is an ancient cultural practice prevalent in 26 countries in Africa, the Middle East and Asia. With increased immigration, health professionals in high income countries including UK, Europe, North America and Australia care for women and girls with FGM/C. FGM/C is relevant to paediatric practice as it is usually performed in children, however, health professionals’ knowledge, clinical practice, and attitudes to FGM/C have not been systematically described. We aimed to conduct a systematic review of the literature to address this gap.

METHODS: The review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42015015540, ). Articles published in English 2000-2014 which used quantitative methods were reviewed.

RESULTS: Of 159 unique articles, 18 met inclusion criteria. The methodological quality was poor – six studies met seven of the eight quality criteria. Study participants included mainly obstetricians, gynaecologists and midwives (15 studies). We found no papers that studied paediatricians specifically, but two papers reported on subgroups of paediatricians within a mixed sample of health professionals. The 18 articles covered 13 different countries: eight from Africa and 10 from high income countries. Most health professionals were aware of the practice of FGM/C, but few correctly identified the four FGM/C categories defined by WHO. Knowledge about FGM/C legislation varied: 25 % of professionals in a Sudanese study, 46 % of Belgian labour ward staff and 94 % of health professionals from the UK knew that FGM/C was illegal in their country. Health professionals from high income countries had cared for women or girls with FGM/C. The need to report children with FGM/C, or at risk of FGM/C, to child protection authorities was mentioned by only two studies.

CONCLUSION: Further research is needed to determine health professionals’ attitudes, knowledge and practice to support the development of educational materials and policy to raise awareness and to prevent this harmful practice.

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[Genital mutilation of women. A new challenge for the health service]. [Article in Norwegian]

Tidsskr Nor Laegeforen. 1993 Sep 10;113(21):2704-7.
[Genital mutilation of women. A new challenge for the health service]. [Article in Norwegian]
Sundby J, Austveg B
Female circumcision, or genital mutilation is practised around the world. Because of war, conflicts and poverty, many women from cultures involving this practice now enter European communities. Some of them demand circumcision for their children. Genital mutilation of women has serious health effects, and in our societies there is a strong demand for its eradication. The cultural reasons for genital mutilation are varied, but it is not a compulsory part of the Islamic faith. Health workers in Norway may lack knowledge on how to handle these women when they meet them in their daily work. Sometimes unnecessary interventions are performed, sometimes ignorance may cause traumatic experiences for both patient and doctor. This article describes some of the social and cultural background for continued exposure to female mutilation, the health effects and some suggestions for interventions.
There is no LINK to see this article online
Original research

A mixed-method synthesis of knowledge, experiences and attitudes of health professionals to Female Genital Mutilation

J Adv Nurs. 2015 Oct 5. doi: 10.1111/jan.12823. [Epub ahead of print]

A mixed-method synthesis of knowledge, experiences and attitudes of health
professionals to Female Genital Mutilation

Reig-Alcaraz M, Siles-González J, Solano-Ruiz C.

AIM: To synthesize knowledge, attitudes and experiences of health professionals about Female Genital Mutilation.

BACKGROUND: Despite the World Health Organization campaigning to stop FGM, and it being illegal in many countries, the practice remains common in some countries and cultures. Migration has contributed to the growth of this practice in countries where it was not previously carried out.

DESIGN: Mixed-method synthesis.

DATA SOURCES: Search of ten electronic databases: 2006-2014. Manual scanning of reference lists and summary feeds from international organizations such as WHO, UN and UNICEF.

REVIEW METHODS: Thematic synthesis comparing country of origin where the practice was common with country of residence where migrant women affected by the practice reside. 17 included descriptive, quantitative, qualitative studies and grey literature studies in English or Spanish.

RESULTS: Seven themes were developed: Ignorance of FGM practice and its consequences; Lack of adherence to FGM protocols and guidelines; Socially constructed acceptance of FGM; Ignorance of legislation and legal status of FGM;  Condoning, sanctioning or supporting FGM; Lack of information and training; Nurses and Midwives as key to protecting and supporting girls and women.

CONCLUSIONS: Although some nurses and midwives are in the forefront of eradicating FGM this is counterbalanced by health professionals (including nurses and midwives) who condone, sanction or support the practice with some calling for medicalization of FGM as a legitimate procedure. Girls at risk need better protection and women affected need more competent and cultural care from health professionals. Health and legal systems, professional regulation and governance, and professional training require strengthening to eradicate FGM, prevent the medicalization of FGM as an acceptable procedure, and to better manage the lifelong consequences for affected girls and women.

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A multicentre study on knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation

Eur J Contracept Reprod Health Care. 2014 Apr;19(2):134-40. doi: 10.3109/13625187.2014.885940. Epub 2014 Mar 6.

A multicentre study on knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation.

Ashimi A, Aliyu L, Shittu M, Amole T.


Objective To determine the knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation (FGM). Methods Cross-sectional study in which 350 nurses working in three tertiary health institutions in northern Nigeria were assessed, using a self-administered questionnaire, with regard to their knowledge of, and attitude to, FGM.

Results Two hundred and sixty-five respondents (76%) were female, 190 (54%) were married. Most (249; 71%) were Muslims, and 228 (65%), of Hausa/Fulani ethnicity. Their ages ranged from 18-60 years with a mean of 29.3 ± 8.9. Among the respondents, 318 (91%) had heard of FGM; of these 127 (40%) knew no particular type of FGM. Only 155 (49%) could identify ‘Angurya’ and ‘Gishiri’ cuts as forms of FGM. Two hundred and forty-five (77%), 231 (73%) and 200 (63%), respectively, identified haemorrhage; risk of HIV, hepatitis, and tetanus; and painful sexual intercourse as possible complications of FGM. Thirteen (4%) would perform it and also would have it done on their daughters.

Conclusion The nurses studied had a high level of awareness of FGM and a good general knowledge of complications associated with FGM. However, only half knew what ‘Angurya’ and ‘Gishiri’ cuts were. A few would perform FGM.

This article can be accessed in this LINK

Archives Blog News

Unprohibited crimes.

CMAJ. 2007 Nov 20;177(11):1345. FREE

Unprohibited crimes.

Jassam J.


A few years ago, when I was working in one of the Middle East countries …

It was a summer day, I was sitting in my office … waiting for the coming patient … somebody knocked the door. … Come in, I said.

Hello, doc … He embarrassingly sat in front of me … moving his head to the ceiling, then to the floor for a minute … He wanted to say something.

Okay, Akram, how can I help? Obviously, you have some embarrassing thing … Just say it … No worries … I said that, trying to break the ice.

I don’t know, doc, what to say. But I really need your help. … He forced himself …

And said: My wife is cold….

This article can be accessed in this LINK

Archives Blog Original research

Els professionals sanitaris davant la mutilació genital femenina

Revista Primarics. Barcelona. 2002, 14: 14-15.FREE

[Els professionals sanitaris davant la mutilació genital femenina] [Article in Catalan]

Moreno, J, Castany MJ

There is no abstract available for this article.

This article can be accessed for free in this LINK

Archives Blog Original research

The historical response to female sexuality.l

Maturitas. 2009 Jun 20;63(2):107-11.

The historical response to female sexuality.

Studd J, Schwenkhagen A.

London PMS & Menopause Clinic, 46 Wimpole Street, London W1G 8SD, UK.


In the past, medical attitudes to female sexuality were grotesque, reflecting the anxiety and hypocrisy of the times. In the medieval world, the population feared hunger, the devil, and women, being particularly outraged and threatened by normal female sexuality. The 19th century attitude was no better as academics confirmed the lower intellectual status of women, particularly if they ventured into education. The medical contribution to this prejudice was shocking, with gynaecologists and psychiatrists leading the way designing operations for the cure of the apparently serious contemporary disorders of masturbation and nymphomania. The gynaecologist, Isaac Baker Brown (1811-1873), and the distinguished endocrinologist, Charles Brown-Séquard (1817-1894) advocated clitoridectomy to prevent the progression to masturbatory melancholia, paralysis, blindness and even death. Even after the public disgrace of Baker Brown in 1866-1867, the operation remained respectable and widely used in other parts of Europe. This medical contempt for normal female sexual development was reflected in public and literary attitudes. There is virtually no novel or opera in the last half of the 19th century where the heroine with “a past” survives to the end. The wheel has turned full circle and in the last 50 years new research into the sociology, psychology and physiology of sexuality has provided a greater understanding of decreased libido and inadequate sexual response in the form of hypoactive sexual desire disorder (HSDD). This is now regarded as a disorder worthy of treatment.

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Ritual genital cutting of female minors.

Pediatrics. 2010 Jul;126(1):191. Epub 2010 Jun 7.

Ritual genital cutting of female minors.

American Academy of Pediatrics Board of Directors.

The American Academy of Pediatrics (AAP) reaffirms its strong opposition to female genital cutting (FGC) and counsels its members not to perform such procedures. As typically practiced, FGC can be life-threatening. Little girls who escape death are still vulnerable to sterility, infection, and psychological trauma.

The AAP does not endorse the practice of offering a “clitoral nick.” This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members.

The AAP is steadfast in its goal of protecting all young girls from the harms of FGC….

This article can be accessed for free in this LINK

Archives Blog Original research

Female circumcision: toward an inclusive practice of care.

Health Care Women Int. 2010 Aug;31(8):686-99.

Female circumcision: toward an inclusive practice of care.

Khaja K, Lay K, Boys S.

School of Social Work, Indiana University, Indianapolis, Indiana 46202, USA.


Female circumcision is a cultural tradition that includes cutting of female genitals without medical necessity. Over 130 million girls and women have been circumcised globally. This article reports on partial findings from a qualitative study that examined the lives of Somali Muslim women who were circumcised. A reoccurring theme of resentment toward North American health care practitioners who condemn the women for having experienced the practice of circumcision in their birth country was found. Discussion will include the physical and social stigma, the complex legal aspects, and ways to deal with female circumcision in a culturally competent manner.

This article can be purchased in this LINK

Archives Blog Original research

[Female sexual dysfunctions: myths, realities and perspectives].

Encephale. 2010 Oct;36(5):357-8. Epub 2010 Jan 27.

[Female sexual dysfunctions: myths, realities and perspectives].

[Article in French]

Douki Dedieu S.

No abstract is available for this article.

This article can be purchased in this LINK