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Are obstetric outcomes affected by female genital mutilation?

Int Urogynecol J. 2017 Sep 9. doi: 10.1007/s00192-017-3466-5. [Epub ahead of

Are obstetric outcomes affected by female genital mutilation?

Balachandran AA, Duvalla S, Sultan AH, Thakar R


INTRODUCTION AND HYPOTHESIS: Female genital mutilation (FGM) has been associated with adverse obstetric and neonatal outcomes, such as postpartum haemorrhage (PPH), perineal trauma, genital fistulae, obstructed labour and stillbirth. The prevalence of FGM has increased in the UK over the last decade. There are currently no studies available that have explored the obstetric impact of FGM in the UK. The aim of our study was to investigate the obstetric and neonatal outcomes of women with FGM when compared with the general population. METHODS: We conducted a retrospective case-control study of consecutive pregnant women with FGM over a 5-year period between 1 January 2009 and 31 December 2013. Each woman with FGM was matched for age, ethnicity, parity and gestation with subsequent patients without FGM (control cohort) over the same 5-year period. Outcomes assessed were mode of delivery, duration of labour, estimated blood loss, analgaesia, perineal trauma and foetal outcomes. RESULTS: A total of 242 eligible women (121 FGM, 121 control) were identified for the study. There was a significant increase in the use of episiotomy in the FGM group (p = 0.009) and a significant increase in minor PPH in the control group during caesarean sections (p = 0.0001). There were no differences in all other obstetric and neonatal parameters. CONCLUSIONS: In our unit, FGM was not associated with an increased incidence of adverse obstetric and foetal morbidity or mortality.

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Effect of female genital mutilation/cutting on sexual functions.

Sex Reprod Healthc. 2016 Dec;10:3-8. doi: 10.1016/j.srhc.2016.07.002. Epub 2016 Jul 28.

Effect of female genital mutilation/cutting on sexual functions.

Biglu MH, Farnam A, Abotalebi P, Biglu S, Ghavami M


BACKGROUND: Female Genital Mutilation/Cutting (FGM/C) or female circumcision is the procedure of eliminating some or all parts of the external female genitalia. FGM/C is carried out by traditional circumcisers. They usually use cutting tools like a blade or straight-razor. Although FGM/C is well described in the African continent and some Arabic countries, data from Iran are scarce.

OBJECTIVES: The major objective of this current study was to investigate the effects of FGM/C on the female sexual function of married women compared to the non-circumcised women in the Kurdistan province of Iran.

METHODS: A case-control study was conducted in a sample of 280 married women (140 circumcised-women and 140 non-circumcised-women) who referred to the healthcare centers for vaccination, midwifery, or family planning services. Participants were requested to complete the Persian-translated version of the Female Sexual Function Index.

MAIN OUTCOME MEASURES: The total score of the FSFI and its individual domains.

RESULTS: Of the circumcised women, 51.4% reported circumcision procedures before the age of 3 years. Religion motivation (53.6%) was mentioned as the most important factor for the family leading to FGM/C. Almost all operations were performed by traditional circumcisers. Non-circumcised women had significantly higher Persian-FSFI total score (25.3 ± 4.34) compared to the circumcised women (17.9 ± 5.39).

CONCLUSION: Sexual function in women with FGM/C is adversely altered. In Kurdistan province women, FGM/C is associated with reduction of scores of Persian-FSFI on all domain scores. Education in general and informing the people that FGM/C is not a religious Hadith certainly would have a great impact on the suffering of the women from FGM/C as well as the level of “desire, arousal, lubrication, orgasm, satisfaction, and pain in the sexual function of women”.

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The relationship between female genital cutting and obstetric fistulae.

Obstet Gynecol. 2010 Mar;115(3):578-83. doi: 10.1097/AOG.0b013e3181d012cd.

The relationship between female genital cutting and obstetric fistulae.

Browning A, Allsworth JE, Wall LL.

Barhirdar Hamlin Fistula Centre, Barhirdar, Ethiopia.

OBJECTIVE: To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor.

METHODS: A comparison was made between 255 fistula patients who had undergone type I or type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age; parity; length of labor; labor outcome (stillbirth or not); type of fistula; site, size, and scarring of fistula; outcomes of surgery (fistula closed; persistent incontinence with closed fistula; urinary retention with overflow; site, size, and scarring of any rectovaginal fistula; and operation outcomes), and specific methods used during the operation (use of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure.

RESULTS: The only statistically significant differences between the two groups (P=.05) were a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, a slightly higher use of a pubococcygeal sling at the time of fistula repair, and a slightly longer length of labor (by 0.3 day) in women who had undergone genital cutting.

CONCLUSION: Type I and type II female genital cutting are not independent causative factors in the development of obstetric fistulae from obstructed labor.

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Sexual quality of life in women who have undergone female genital mutilation: a case–control study

BJOAn International Journal of Obstetrics & Gynaecology. Article first published online: 10 OCT 2012. DOI: 10.1111/1471-0528.12004.

Sexual quality of life in women who have undergone female genital mutilation: a case–control study

Andersson SHA, Rymer J, Joyce DW, Momoh C, Gayle CM


Objective  To investigate the sexual quality of life of women who have undergone female genital mutilation (FGM) and compare them with a similar group who has not undergone FGM.

Design  Case–control study.

Setting  A large central London teaching hospital.

Population  A total of 73 women who had undergone FGM and 37 control women, who had not undergone FGM but were from a similar cultural background where FGM is practiced.

Methods  The women completed a questionnaire containing the Sexual Quality of Life-Female (SQOL-F) questionnaire.

Main outcome measures  SQOL-F score.

Results  Women who have undergone FGM of any type have a significantly lower (P < 0.001) overall SQOL-F score than control women (mean = 62.44, SD = 27.93 versus mean = 88.84, SD = 13.73). Women who were sexually active and had undergone FGM type III differed the most from sexually active controls (< 0.05) in their SQOL-F score. Women who were sexually inactive but who had undergone FGM reported significantly lower overall SQOL-F scores (P = 0.015) than sexually inactive controls, but were not differentiated by type of FGM.

Conclusion  FGM significantly reduces women’s sexual quality of life, based on the results of the SQOL-F questionnaire.

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Sexual function in women with female genital mutilation.

Fertil Steril. 2010 Feb;93(3):722-4. Epub 2008 Nov 25.

Sexual function in women with female genital mutilation.

Alsibiani SA, Rouzi AA.

Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.


OBJECTIVE: To compare the sexual function of women with female genital mutilation (FGM) to women without FGM.

DESIGN: A prospective case-control study.

SETTING: A tertiary referral university hospital.

PATIENT(S): One hundred and thirty sexually active women with FGM and 130 sexually active women without FGM in Jeddah, Saudi Arabia.

INTERVENTION(S): Women with and without FGM were asked to answer the Arabic-translated version of the female sexual function index (FSFI) questionnaire.

MAIN OUTCOME MEASURE(S): The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score of the FSFI were calculated.

RESULT(S): The two groups were comparable in demographic characteristics. There were no statistically significant differences between the two groups in mean desire score (+/- standard deviation) or pain score. However, there were statistically significant differences between the two groups in their scores for arousal, lubrication, orgasm, and satisfaction as well as the overall score.

CONCLUSION(S): Sexual function in women with FGM is adversely altered. This adds to the well-known health consequences of FGM. Efforts to document and explain these complications should be encouraged so that FGM can be abandoned.

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Primary infertility after genital mutilation in girlhood in Sudan: a case-control study.

Lancet. 2005 Jul 30-Aug 5;366(9483):385-91.

Primary infertility after genital mutilation in girlhood in Sudan: a case-control study.

Almroth L, Elmusharaf S, El Hadi N, Obeid A, El Sheikh MA, Elfadil SM, Bergström S.

Division of International Health, Karolinska Institutet, Stockholm SE-17176, Sweden.

Comment in Lancet. 2005 Jul 30-Aug 5;366(9483):347-9.


BACKGROUND: In theory, infections that arise after female genital mutilation (FGM) in childhood might ascend to the internal genitalia, causing inflammation and scarring and subsequent tubal-factor infertility. Our aim was to investigate this possible association between FGM and primary infertility.

METHODS: We did a hospital-based case-control study in Khartoum, Sudan, to which we enrolled women (n=99) with primary infertility not caused by hormonal or iatrogenic factors (previous abdominal surgery), or the result of male-factor infertility. These women underwent diagnostic laparoscopy. Our controls were primigravidae women (n=180) recruited from antenatal care. We used exact conditional logistic regression, stratifying for age and controlling for socioeconomic status, level of education, gonorrhoea, and chlamydia, to compare these groups with respect to FGM.

FINDINGS: Of the 99 infertile women examined, 48 had adnexal pathology indicative of previous inflammation. After controlling for covariates, these women had a significantly higher risk than controls of having undergone the most extensive form of FGM, involving the labia majora (odds ratio 4.69, 95% CI 1.49-19.7). Among women with primary infertility, both those with tubal pathology and those with normal laparoscopy findings were at a higher risk than controls of extensive FGM, both with borderline significance (p=0.054 and p=0.055, respectively). The anatomical extent of FGM, rather than whether or not the vulva had been sutured or closed, was associated with primary infertility.

INTERPRETATION: Our findings indicate a positive association between the anatomical extent of FGM and primary infertility. Laparoscopic postinflammatory adnexal changes are not the only explanation for this association, since cases without such pathology were also affected. The association between FGM and primary infertility is highly relevant for preventive work against this ancient practice.

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