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Infertility from female circumcision

Fertil Steril. 2004 81(6): 1692-1694

Infertility from female circumcision

Chen G, Dharia SP, Steinkampf MP, Callison S

ABSTRACT

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.

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The effects of type of female circumcision on infertility and fertility in Sudan

J Biosoc Sci. July 2002 34(03): 363-377

The effects of type of female circumcision on infertility and fertility in Sudan

Larsen U

ABSTRACT

This study explores the association between type of female circumcision and infertility and fertility in Sudan using the 1989–90 Demographic and Health Survey. It is hypothesized that women with either Pharaonic or Intermediate circumcision would have higher infertility and lower fertility compared with women with Sunna circumcision, and that uncircumcised women would have the lowest infertility and highest fertility of the three groups. This hypothesis, a widely held assumption, proved to be largely incorrect. Though women with Pharaonic or Intermediate circumcision did have a higher prevalence of primary infertility than uncircumcised women, women with Sunna circumcision had even lower rates of primary infertility compared with uncircumcised women. This pattern prevailed in multivariate models controlling for confounding variables, where women with Pharaonic or Intermediate circumcision had significantly higher primary infertility. Moreover, though women with Pharaonic or Intermediate circumcision also had the highest prevalence of secondary infertility, once confounding covariates were controlled in multivariate models, there was no significant difference among the three groups of women. With respect to fertility, the total fertility rate was 7·6 for women with Pharaonic or Intermediate circumcision, 8·1 for women with Sunna circumcision and 8·3 for uncircumcised women. Differences in fertility were found to be insignificant when covariates were controlled. The multivariate models were estimated using logistic regression. In conclusion, Pharaonic or Intermediate circumcision may be associated with higher primary infertility while there was no evidence suggesting that either secondary infertility or fertility was associated with a woman’s circumcision status.

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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. L.Almroth@telia.com

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

Abstract

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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