Tag Archives: Middle East

Thirty-year trends in the prevalence and severity of female genital mutilation: a comparison of 22 countries

FREEBMJ Glob Health. 2017 Nov 25;2(4):e000467. doi: 10.1136/bmjgh-2017-000467. eCollection 2017.

Thirty-year trends in the prevalence and severity of female genital mutilation: a comparison of 22 countries.

Koski A, Heymann J


Introduction: Female genital mutilation (FGM) harms women’s health and well-being and is widely considered a violation of human rights. The United Nations has called for elimination of the practice by 2030. Methods: We used household survey data to measure trends in the prevalence of FGM in 22 countries. We also examined trends in the severity of the practice by measuring changes in the prevalence of flesh removal, infibulation and symbolic ‘nicking’ of the genitals. We evaluated the extent to which measurement error may have influenced our estimates by observing the consistency of reports for the same birth cohorts over successive survey waves. Results: The prevalence of all types of FGM fell in 17 of 22 countries we examined. The vast majority of women who undergo FGM have flesh removed from their genitals, likely corresponding to the partial or total removal of the clitoris and labia. Infibulation is still practised throughout much of sub-Saharan Africa. Its prevalence has declined in most countries, but in Chad, Mali and Sierra Leone the prevalence has increased by 2-8 percentage points over 30 years. Symbolic nicking of the genitals is relatively rare but becoming more common in Burkina Faso, Chad, Guinea and Mali. Conclusion: FGM is becoming less common over time, but it remains a pervasive practice in some countries: more than half of women in 7 of the 22 countries we examined still experience FGM. The severity of the procedures has not changed substantially over time. Rigorous evaluation of interventions aimed at eliminating or reducing the harms associated with the practice is needed.

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Symptoms of posttraumatic stress disorder after ritual female genital surgery among bedouin in Israel: myth or reality?

Prim Care Companion J Clin Psychiatry. 2008;10(6):453-6.FREE

Symptoms of posttraumatic stress disorder after ritual female genital surgery among bedouin in Israel: myth or reality?

Applebaum J, Cohen H, Matar M, Abu Rabia Y, Kaplan Z.

Ministry of Health, Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. juliaa@bgu.ac.il


OBJECTIVE: Ritual female genital surgery (RFGS), or female circumcision, is common among certain ethnic groups in Asia and Africa and describes a range of practices involving complete or partial removal of the female external genitalia for nonmedical reasons. Several studies in African populations, in which more severe forms of RFGS are performed, reported an increased prevalence of posttraumatic stress disorder and other psychiatric syndromes among circumcised women than among uncircumcised controls. Among the Bedouin population in southern Israel, RFGS has become a symbolic operation without major mutilation. However, in a study performed in 1999, Bedouin women after RFGS reported difficulties in mother-daughter relationships and trust. This pilot study assessed the mental health of Bedouin women from southern Israel after RFGS compared to age-matched controls without RFGS.

METHOD: The psychological impact of RFGS was assessed in 19 circumcised Bedouin women compared to 18 age-matched controls. The Post Traumatic Stress Disorder Scale, Symptom Checklist, Impact of Event Scale, and a demographics and background questionnaire were used to assess traumatization and psychiatric illnesses. The study was conducted from March to July 2007.

RESULTS: No statistically significant differences were found between the 2 groups.

CONCLUSIONS: The prevailing procedure of RFGS among the Bedouin population of southern Israel had no apparent effect on mental health.

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Fewer younger women are undergoing female genital mutilation, study finds.

BMJ. 2013 Jul 25;347:f4754. doi: 10.1136/bmj.f4754. FREE

Fewer younger women are undergoing female genital mutilation, study finds.

Gulland A.


The practice of female genital mutilation is becoming less widespread in countries with low prevalence of the practice, prompting the children’s charity Unicef to say there are strong signs it will become a “vestige of the past.”

A statistical report on the 29 countries in Africa and the Middle East where the practice is most prevalent shows that in some countries the practice is declining rapidly.1 Researchers used 70 household surveys conducted over a 20 year period, as well as carrying out new surveys, to look at the changing landscape surrounding female genital mutilation.

Researchers asked women and girls aged 15 to 19 years whether they had undergone the procedure, which in most cases takes place before the age of 10. They asked the same question …

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Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

Mayo Clin Proc. 2013 Jun;88(6):618-29. doi: 10.1016/j.mayocp.2013.04.004.

Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

Hearst AA, Molnar AM.

Department of Medicine, University of Washington, Seattle, WA 98104, USA.


The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue.

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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….

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Epidermal clitoral inclusion cysts: not a rare complication of female genital mutilation.

FREEHum Reprod. 2010 Jul;25(7):1672-4. doi: 10.1093/humrep/deq126. Epub 2010 May 22.

Epidermal clitoral inclusion cysts: not a rare complication of female genital mutilation.

Rouzi AA.

Department of Obstetrics and Gynecology, King Abdulaziz University, PO Box 80215, Jeddah 21589, Saudi Arabia. aarouzi@gmail.com

BACKGROUND: Although female genital mutilation (FGM) does not feature in Judeo-Christian populations, it is estimated that, 100-140 million women in the world have undergone some form of FGM. Given the increasing diversity of the western populations, a review of specific complications of FGM is of paramount importance to practicing clinicians. The objective of this study is to report a case series of epidermal clitoral inclusion cysts after FGM in a Muslim population primarily from the Middle East. METHODS: Between January 1998 and July 2009, 32 females underwent surgical removal of epidermal clitoral inclusion cysts in a tertiary referral university hospital. Data regarding age, clinical presentation, operation time, estimated blood loss, presence of intraoperative and post-operative complications, duration of admission to the hospital and long-term follow-up were extracted from the records. RESULTS: There were 15 women (46.9%) with a definitive history of FGM, 14 (43.8%) did not know whether they had FGM or not and 3 (9.3%) had no history of FGM and were excluded from the analysis. The mean age of subjects was 28.1 years (range 5-91 years). All presented with increasing clitoral mass over a mean duration of 5.2 +/- 4.1 years. The mean diameter of the cyst was 4.2 +/- 2 cm. Regarding treatment, 28 subjects underwent surgical excision, and one underwent incision and drainage of a clitoral abscess. No short- or long-term complications occurred. CONCLUSIONS: Clitoral cysts appear to be a more common complication of FGM than previously thought. Publication of studies that highlight the medical complications of FGM should be encouraged to advocate abandonment of the procedure.

This article can be accessed in this LINK

For the sake of purity (and control). Female genital mutilation.

Links 1993 Winter;9(5):6-8, 30.

For the sake of purity (and control). Female genital mutilation.

Gilbert D.


PIP: In 1973 approximately 1 million girls will be victimized by female genital mutilation (FGM), widely practiced in more than 20 African nations from Mauritania to the Ivory Coast in the west, to Egypt and North Tanzania in the east, as well as in Oman, Bahrain, North and South Yemen, and the United Arab Emirates. FGM takes place among the Moslem populations of the Philippines, Indonesia, and Malaysia and the Jewish Falashas in Ethiopia. FGM is practiced on babies just a few days old to girls right before marriage or young women pregnant with their first child. The most extreme mutilation is called infibulation. In Somalia, almost 100% of the women are infibulated, and so are more than 80% of the women in north and central Sudan. In Ethiopia/Eritrea, Mali, and Sierra Leone, 90% of the women have undergone some form of genital mutilation. The rate reaches 70% in Burkina Faso; 60% in Kenya, Gambia, and the Ivory Coast; and 50% in Senegal, Egypt, Guinea Bissau, and Nigeria. The mutilation often results in accumulation of menstrual blood and pelvic inflammatory disease often leading to infertility. Between 20% and 25% of infertility in Sudan has been attributed to female genital mutilation. The practice of FGM has existed for centuries, and some claim it originated in the Nile Valley during the Pharaonic era. On the other hand, Muslim countries like Iraq, Syria, and Tunisia do not practice FGM. The London Black Women’s Health Action Project set up an educational network to prevent mutilations and to dispel the myth of religion about FGM. FORWARD convened the First Study Conference on Genital Mutilation of Girls in Europe in 1992 and deemed FGM a form of child abuse. Local campaigns in Africa, Asia, and the Arab world educate against FGM. The Inter-Africa Committee on Traditional Practices Affecting the Health of Women and Children, based in Addis Ababa, Ethiopia, has offices in more than 20 African nations to sensitize the public about the harmful effects of FGM. In Nigeria, the National Association of Nigerian Nurses and Midwives presents plays in the local markets about the complications of FGM.

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