Tag Archives: Defibulation*

Female genital mutilation: implications for clinical practice

Br J Nurs. 2017 Oct 12;26(18):S22-S27. doi: 10.12968/bjon.2017.26.18.S22.

Female genital mutilation: implications for clinical practice

von Rège I, Campion D


Female genital mutilation (FGM) is an established cultural practice in over 30 countries. It has no health benefits, carries a high risk of physical and psychological harm, and is illegal in many countries including the UK. A sensitive approach is required, both in the management of complications and prevention of this practice. This article discusses the prevalence and classification of FGM, and offers practical advice to nurses and midwives involved in general and obstetric care. Legal aspects, including safeguarding responsibilities and the mandatory duty to report FGM in England and Wales, are outlined.

This article can be accessed in this LINK

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review.

FREEInt J Gynaecol Obstet. 2017 Feb;136 Suppl 1:30-33. doi:10.1002/ijgo.12045.

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review.

Effa E, Ojo O, Ihesie A, Meremikwu MM.


BACKGROUND: Women and girls who have undergone type III female genital mutilation (FGM) may suffer urologic complications such as recurrent urinary tract infections, obstruction, stones, and incontinence. OBJECTIVE: To assess the effectiveness of deinfibulation for preventing and treating urologic complications in women and girls living with FGM. SEARCH STRATEGY: The following major databases were searched from inception to August 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, SCOPUS, Web of Science, and ClinicalTrials.gov without language restrictions. SELECTION CRITERIA: Randomized controlled studies (RCTs) or observational studies with controls were considered. DATA COLLECTION AND ANALYSIS: We screened the results of the search independently for potentially relevant studies and applied inclusion and exclusion criteria for the full texts of the relevant studies. RESULTS: No RCTs were found. We found three case reports and a retrospective case review, all of which were excluded. CONCLUSION: There is no evidence on the use of deinfibulation to improve urologic complications among women with type III FGM. Current clinical practice may be informed by anecdotal evidence from case reports. Appropriate RCTs and observational studies with comparison groups in countries where FGM is common are needed. PROSPERO registration: CRD42015024901.

This article can be accessed in this LINK

Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta-analysis.

FREEInt J Gynaecol Obstet. 2017 Feb;136 Suppl 1:13-20. doi: 10.1002/ijgo.12056.

Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta-analysis.

Okusanya BO, Oduwole O, Nwachuku N, Meremikwu MM.


BACKGROUND: Deinfibulation is a surgical procedure carried out to re-open the vaginal introitus of women living with type III female genital mutilation (FGM). OBJECTIVES: To assess the impact of deinfibulation on gynecologic or obstetric outcomes by comparing women who were deinfibulated with women with type III FGM or women without FGM. SEARCH STRATEGY: Major databases including CENTRAL, MEDLINE, and Scopus were searched until August 2015. SELECTION CRITERIA: We included nonrandomized studies that compared obstetric outcomes of women with deinfibulation, type III FGM (not deinfibulated during labor), and no FGM. DATA COLLECTION AND ANALYSIS: Quality of evidence was determined following the GRADE methodology. Summary measures were calculated using odds ratios at 95% confidence intervals. RESULTS: We found no randomized controlled trials. We included four case-control studies. The quality of evidence was very low. Compared with women with type III FGM at delivery, deinfibulated women had a significant reduction in the risk of having a cesarean delivery or postpartum hemorrhage. Compared with women without FGM, deinfibulated women had a similar risk of episiotomy, cesarean delivery, vaginal lacerations, postpartum hemorrhage, and blood loss at vaginal delivery. The length of second stage of labor, mean maternal hospital stay, and Apgar scores less than 7 were also comparable. CONCLUSIONS: Low-quality evidence suggests deinfibulation improves birth outcomes for women with type III FGM.

This article can be accessed in this LINK

Virility, pleasure and female genital mutilation/cutting. A qualitative study of perceptions and experiences of medicalized defibulation among Somali and Sudanese migrants in Norway.

FREEReprod Health. 2017 Feb 10;14(1):25. doi: 10.1186/s12978-017-0287-4.

Virility, pleasure and female genital mutilation/cutting. A qualitative study of perceptions and experiences of medicalized defibulation among Somali and Sudanese migrants in Norway. 

Johansen RE.


BACKGROUND: The most pervasive form of female genital mutilation/cutting-infibulation-involves the almost complete closure of the vaginal orifice by cutting and closing the labia to create a skin seal. A small opening remains for the passage of urine and menstrual blood. This physical closure has to be re-opened-defibulated-later in life. When they marry, a partial opening is made to enable sexual intercourse. The husband commonly uses his penis to create this opening. In some settings, a circumciser or traditional midwife opens the infibulated scar with a knife or razor blade. Later, during childbirth, a further opening is necessary to make room for the child’s passage. In Norway, public health services provide surgical defibulation, which is less risky and painful than traditional forms of defibulation. This paper explores the perceptions and experiences of surgical defibulation among migrants in Norway and investigates whether surgical defibulation is an accepted medicalization of a traditional procedure or instead challenges the cultural underpinnings of infibulation. METHODS: Data derived from in-depth interviews with 36 women and men of Somali and Sudanese origin and with 30 service providers, as well as participant observations in various settings from 2014-15, were thematically analyzed. RESULTS: The study findings indicate that, despite negative attitudes towards infibulation, its cultural meaning in relation to virility and sexual pleasure constitutes a barrier to the acceptance of medicalized defibulation. CONCLUSIONS: As sexual concerns regarding virility and male sexual pleasure constitute a barrier to the uptake of medicalized defibulation, health care providers need to address sexual concerns when discussing treatment for complications in infibulated women. Furthermore, campaigns and counselling against this practice also need to tackle these sexual concerns.

This article is available in this LINK

Reasons for and Experiences With Surgical Interventions for Female Genital Mutilation/Cutting (FGM/C): A Systematic Review

J Sex Med. 2017 Aug;14(8):977-990. doi: 10.1016/j.jsxm.2017.05.016. Epub 2017 Jun

Reasons for and Experiences With Surgical Interventions for Female Genital Mutilation/Cutting (FGM/C): A Systematic Review

Berg RC, Taraldsen S, Said MA, Sørbye IK, Vangen S


BACKGROUND: Because female genital mutilation/cutting (FGM/C) leads to changes in normal genital anatomy and functionality, women are increasingly seeking surgical interventions for their FGM/C-related concerns. AIM: To conduct a systematic review of empirical quantitative and qualitative research on interventions for women with FGM/C-related complications. METHODS: We conducted systematic searches up to May 2016 in 16 databases to obtain references from different disciplines. We accepted all study designs consisting of girls and women who had been subjected to FGM/C and that examined a reparative intervention for a FGM/C-related concern. We screened the titles, abstracts, and full texts of retrieved records for relevance. Then, we assessed the methodologic quality of the included studies and extracted and synthesized the study data. OUTCOMES: All outcomes were included. RESULTS: Of 3,726 retrieved references, 71 studies including 7,291 women were eligible for inclusion. We identified three different types of surgical intervention: defibulation or surgical separation of fused labia, excision of a cyst with or without some form of reconstruction, and clitoral or clitoral-labial reconstruction. Reasons for seeking surgical interventions consisted of functional complaints, sexual aspirations, esthetic aspirations, and identity recovery. The most common reasons for defibulation were a desire for improved sexual pleasure, vaginal appearance, and functioning. For cyst excision, cystic swelling was the main reason for seeking excision; for reconstruction, the main reason was to recover identity. Data on women’s experiences with a surgical intervention are sparse, but we found that women reported easier births after defibulation. Our findings also suggested that most women were satisfied with defibulation (overall satisfaction = 50-100%), typically because of improvements  in their sexual lives. Conversely, the results suggested that defibulation had low social acceptance and that the procedure created distress in some women who disliked the new appearance of their genitalia. Most women were satisfied with clitoral reconstruction, but approximately one third were dissatisfied with or perceived a worsening in the esthetic look. CLINICAL TRANSLATION: The information health care professionals give to women who seek surgical interventions for FGM/C should detail the intervention options available and what women can realistically expect from such interventions. STRENGTHS AND LIMITATIONS: The systematic review was conducted in accordance with guidelines, but there is a slight possibility that studies were missed. CONCLUSION: There are some data on women’s motivations for surgery for FGM/C-related concerns, but little is known about whether women are satisfied with the surgery, and experiences appear mixed.

This article is available in this LINK

Surgical techniques: defibulation of Type III female genital cutting

J Sex Med. 2007 Nov;4(6):1544-7.

Surgical techniques: defibulation of Type III female genital cutting.

Johnson C, Nour NM.

Obstetrics & Gynecology, Robert Wood Johnson Clinical Scholar, Division General Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

There is no abstract available for this article.

This article can be accessed in this LINK.

Infertility from female circumcision

Fertil Steril. 2004 81(6): 1692-1694

Infertility from female circumcision

Chen G, Dharia SP, Steinkampf MP, Callison S


OBJECTIVE: To present a case report of a patient with primary infertility from female circumcision, the management of the patient, and a review of the literature. DESIGN:Case report and literature review. SETTING: University hospital. PATIENT(S): A 31-year-old woman referred for a history of primary infertility. INTERVENTION(S): Complete history and physical exam of the patient and subsequent deinfibulation. MAIN OUTCOME MEASURE(S): Diagnosis, surgical management, and postoperative sexual function and pregnancy. RESULT(S)Resolution of dyspareunia, satisfactory postoperative sexual function, and pregnancy. CONCLUSION(S): Awareness of this type of female circumcision and familiarity with its surgical management may prevent delays and any subsequent complications.

This article can be purchased in this LINK

Erian & Goh: Female Circumcision

Australian and New Zealand Journal of Obstetrics and Gynaecology. Feb 1995 25(1) 83–85

Female Circumcision

Mark M.S. Erian, Judith T.W. Goh


Three cases of female circumcision are presented together with a literature review. Unfortunately, this procedure frequently results in genital mutilation. Treatment with deinfibulation enables restoration of the external genitalia and vagina. Obstetric and gynaecological complications have been documented, but emotional and psychological effects may be difficult to assess. These women should be treated without bias and with sensitivity.

This article can be purchased in this LINK.

Pleasure and orgasm in women with female genital mutilation/cutting (FGM/C).

J Sex Med 2007;4:1666–1678.

Pleasure and orgasm in women with female genital mutilation/cutting (FGM/C). 

Catania L, Abdulcadir O, Puppo V, Baldaro Verde J, Abdulcadir J, and Abdulcadir D.

Introduction.  Female genital mutilation/cutting (FGM/C) violates human rights. FGM/C women’s sexuality is not well known and often it is neglected by gynecologists, urologists, and sexologists. In mutilated/cut women, some fundamental structures for orgasm have not been excised.

Aim.  The aim of this report is to describe and analyze the results of four investigations on sexual functioning in different groups of cut women.

Main Outcome Measure.  Instruments: semistructured interviews and the Female Sexual Function Index (FSFI).

Methods.  Sample: 137 adult women affected by different types of FGM/C; 58 young FGM/C ladies living in the West; 57 infibulated women; 15 infibulated women after the operation of defibulation.

Results.  The group of 137 women, affected by different types of FGM/C, reported orgasm in almost 86%, always 69.23%; 58 mutilated young women reported orgasm in 91.43%, always 8.57%; after defibulation 14 out of 15 infibulated women reported orgasm; the group of 57 infibulated women investigated with the FSFI questionnaire showed significant differences between group of study and an equivalent group of control in desire, arousal, orgasm, and satisfaction with mean scores higher in the group of mutilated women. No significant differences were observed between the two groups in lubrication and pain.

Conclusion.  Embryology, anatomy, and physiology of female erectile organs are neglected in specialist textbooks. In infibulated women, some erectile structures fundamental for orgasm have not been excised. Cultural influence can change the perception of pleasure, as well as social acceptance. Every woman has the right to have sexual health and to feel sexual pleasure for full psychophysical well-being of the person. In accordance with other research, the present study reports that FGM/C women can also have the possibility of reaching an orgasm. Therefore, FGM/C women with sexual dysfunctions can and must be cured; they have the right to have an appropriate sexual therapy.

This article can be purchased in this LINK

Clitoral neuroma after female genital mutilation/cutting: A rare but possible event.

J Sex Med 2012;9:1220–1225.

Clitoral neuroma after female genital mutilation/cutting: A rare but possible event. 

Abdulcadir J, Pusztaszeri M, Vilarino R, Dubuisson JB, and Vlastos A-T.


Introduction.  Female genital mutilation/cutting (FGM/C), in particular, type III, also called infibulation, can cause various long-term complications. However, posttraumatic neuroma of the clitoris is extremely rare; only one case was previously reported in the literature.

Aim.  The aim of this study was to describe the case of a patient presenting a clitoral neuroma post-FGM/C in detail and her successful multidisciplinary treatment.

Methods.  We report the case of a 24-year-old woman originating from Somalia presenting a type III a–b FGM/C who attended our outpatient clinic at the Geneva University Hospitals complaining of primary dysmenorrhea and a post-mutilation painful clitoral mass. The mass was clinically diagnosed as a cyst and surgically removed. Histopathological analysis revealed that it was a posttraumatic neuroma and a foreign body granuloma around the ancient surgical thread. Our patient was also offered a multidisciplinary counseling by a specialized gynecologist on FGM/C, a sexologist, and a reproductive and sexual health counselor.

Results.  One month after surgical treatment, the vulvar pain was over.

Conclusions.  This is the second case of clitoral neuroma after FGM/C reported and the first with complete clinical, as well as histopathological documentation and multidisciplinary care. Considering the high frequency of clitoral cysts in case of infibulation, clitoral neuroma should be considered in the differential diagnosis. In this case, if symptomatic, the treatment should be surgery, clinical follow-up, and counseling. If necessary, appropriate sexual therapy should be offered too.

This article can be purchased in this LINK.