Tag Archives: Infibulation

Subheading of MeSH Term Circumcision, Female

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.

ABSTRACT

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.

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Female genital mutilation: the role of medical professional organizations

Int Urogynecol J. 2016 Nov 17. [Epub ahead of print]

Female genital mutilation: the role of medical professional organizations

Bazi T

ABSTRACT

Female genital mutilation (FGM) refers to alteration of the external genitalia of girls without medical benefit. It is estimated by United Nations agencies that 200 million living girls and women have been subjected to different forms of FGM worldwide. Despite the criminalization of the procedure in the vast majority of countries where it is practiced, the decline in the incidence of this ritual is far from satisfactory. Immediate and long-term ill effects are well documented. Most publications of relevance originate from countries outside the map of FGM. In addition, there are major gaps in research related to this issue, considering the magnitude of the problem. International medical organizations and societies should assume their responsibility by providing a platform to professionals engaged in the prevention and treatment of the consequences of FGM, especially those living in the communities where the practice is endemic.

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Female genital cutting: confronting cultural challenges and health complications across the lifespan

Womens Health (Lond Engl). 2015 Jan;11(1):79-94. doi: 10.2217/whe.14.63.

Female genital cutting: confronting cultural challenges and health complications across the lifespan

Farage MA, Miller KW, Tzeghai GE, Azuka CE, Sobel JD, Ledger WJ.

ABSTRACT

Female genital cutting affects over 140 million women worldwide. Prevalent in certain countries of Africa and the Middle East, the practice continues among immigrants to industrialized countries. Female genital cutting is a deeply rooted tradition that confers honor on a woman and her family, yet also a traumatic experience that creates significant dermatological, gynecological, obstetric and infectious disease complications. Little is known about postmenopausal health in cut women. The international community views this practice as a human rights violation. In addition to genital health complications, the medical community must confront an understudied concern of what happens as this population ages. These challenges must be addressed to provide optimal care to women affected by female genital cutting.

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Female genital mutilation/cutting – towards abandonment of a harmful cultural practice.

Aust N Z J Obstet Gynaecol. 2014 May 6. doi: 10.1111/ajo.12206. [Epub ahead of print]

Female genital mutilation/cutting – towards abandonment of a harmful cultural practice.

Varol N, Fraser IS, Ng CH, Jaldesa G, Hall J.

ABSTRACT

Globally, the prevalence of, and support for, female genital mutilation/cutting (FGM/C) is declining. However, the entrenched sense of social obligation that propagates the continuation of this practice and the lack of open communication between men and women on this sensitive issue are two important barriers to abandonment. There is limited evidence on the role of men and their experiences in FGM/C. Marriageability of girls is considered to be one of the main driving forces for the continuation of this practice. In some countries, more men than women are advocating to end FGM/C. Moreover, men, as partners to women with FGM/C, also report physical and psychosexual problems. The abandonment process involves expanding a range of successful programs, addressing the human rights priorities of communities and providing power over their own development processes. Anecdotal evidence exists that FGM/C is practised amongst African migrant populations in Australia. The Australian Government supports a taskforce to improve community awareness and education, workforce training and evidence building. Internationally, an African Coordinating Centre for abandonment of FGM/C has been established in Kenya with a major global support group to share research, promote solidarity, advocacy and implement a coordinated and integrated response to abandon FGM/C.

 

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Female genital mutilation/cutting (FGM/C): Survey of RANZCOG Fellows, Diplomates & Trainees and FGM/C prevention and education program workers in Australia and New Zealand

Australian and New Zealand Journal of Obstetrics and Gynaecology. Article first published online: 23 SEP 2012

Female genital mutilation/cutting (FGM/C): Survey of RANZCOG Fellows, Diplomates & Trainees and FGM/C prevention and education program workers in Australia and New Zealand

Moeed SM, Grover SR

Background

Female genital mutilation/cutting (FGM/C) is traditionally practised in parts of Africa, the Middle East and South-East Asia. Migration has brought FGM/C to the attention of health practitioners in industrialised nations. It is not known whether FGM/C procedures are being performed in Australia and New Zealand, where legislation has been passed banning the practice.

Aims

To survey RANZCOG Fellows, Trainees and Diplomates, and FGM/C education and prevention program workers, about their experience with women and children affected by FGM/C, specifically to identify whether FGM/C is being performed in Australia or New Zealand.

Methods

Electronic survey distributed via e-mail to RANZCOG Fellows, Trainees and Diplomates and FGM/C program workers in Australia and New Zealand between November 2010 and February 2011.

Results

530 responses were received from RANZCOG Fellows, Trainees and Diplomates, with an overall response rate of 18.5%. Thirty-four responses were received from FGM/C program workers. Five RANZCOG respondents and two FGM/C program workers cited anecdotal evidence that FGM/C is being performed in Australia and New Zealand. 21.2% (82) of RANZCOG respondents had been asked to re-suture following delivery, and 11 respondents had done so at least once. Two RANZCOG respondents had been asked to perform FGM/C on a baby, girl or young woman.

Conclusions

There is no conclusive evidence of FGM/C being performed in Australia and New Zealand, either from direct reports or children presenting with complications, although re-suturing post-delivery is occurring. Anecdotal evidence suggests that it is most likely that people other than registered health practitioners are performing FGM/C.

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Qualitative study of perinatal care experiences among Somali women and local health care professionals in Norway

European Journal of Obstetrics & Gynecology and Reproductive Biology. 2004 Jan;112(1):29-35

Qualitative study of perinatal care experiences among Somali women and local health care professionals in Norway

Vangen S, Johansen REB, Sundby J, Træen B, Stray-Pedersen B

ABSTRACT

Objective: To explore how perinatal care practice may influence labor outcomes among circumcised women. Study design: In-depth interviews were conducted with 23 Somali immigrants and 36 Norwegian health care professionals about their experiences from antenatal care, delivery and the management of circumcision. Results: Circumcision was not recognized as an important delivery issue among Norwegian health care professionals and generally the topic was not addressed antenatally. The Somalis feared lack of experience and sub-optimal treatment at delivery. All of the women expressed a strong fear of cesarean section. Health care professionals were uncertain about delivery procedures for infibulated women and occasionally cesarean sections were performed in place of defibulation. Conclusion: We hypothesize that neglect of circumcision may lead to adverse birth outcomes including unnecessary cesarean sections, prolonged second stage of labor and low Apgar scores. We suggest that infibulated women need a carefully planned delivery, correctly performed defibulation and adequate pain relief.

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[Medical, psychological and sexual consequences of female genital mutilations]

Arch Pediatr. 2008 Jun;15(5):820-1.

[Medical, psychological and sexual consequences of female genital mutilations]. [Article in French]

Carton V, Philippe HJ.

Unité de Gynécologie Obstétrique Médico-Psycho-Sociale, HME, CHU de Nantes, 38 boulervard Jean-Monnet, 44093 Nantes cedex, France. veronique.carton@caramail.com <veronique.carton@caramail.com>

No abstract is available for this article.

 

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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.

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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.

ABSTRACT

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.

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Special commentary on the issue of reinfibulation

International Journal of Gynecology & Obstetrics. 2010 May;109(2):97-99

Special commentary on the issue of reinfibulation

Cook RJ, Dickens BM

Faculty of Law, Faculty of Medicine and Joint Centre for Bioethics, University of Toronto, Toronto, Canada

ABSTRACT

Policy on reinfibulation exposes the interface between individual or micro-ethics and population-wide or macro-ethics. If, following childbirth, an infibulated woman requests reinfibulation, a gynecologist may respectfully advise her of its negative implications, but would not act in breach of ethical or usually legal requirements in undertaking the procedure. However, as a matter of health policy and professional responsibility, physicians should refuse to initiate infibulation, and advise their patients and communities that the procedure is harmful, not required by religious or other ordinance, and frequently if not always unlawful. Reinfibulation is not genital cutting (or “mutilation”) in itself, but when undertaken by a physician may appear to condone infibulation. This is contrary to medical professional ethics, which condemn medicalization of infibulation and generally of reinfibulation, even as a harm-reduction strategy to spare women the risks of injury and infection from unskilled interventions.

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