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Female genital mutilation and female genital schistosomiasis-bourouwel, the worm: Traditional belief or medical explanation for a cruel practice?

Midwifery, 2013, 29(8), 73-77

Female genital mutilation and female genital schistosomiasis-bourouwel, the worm: Traditional belief or medical explanation for a cruel practice?

Wacker J, Zida A, Sitz C, Schweinfurth D, Briegel J

ABSTRACT

Female genital mutilation (FGM), defined as the partial or total removal of the external female genitalia for ritual or religious reasons, is routinely practised by ethnic groups in more than 20 countries across the North African savannah as well as in Egypt, the southern part of the Arab peninsula, Malaysia and Indonesia. The total number of women mutilated has been estimated 100–140 million (WHO, 2008; cf. 85–115 million: Dehne et al., 1997). In Africa, three million young women are at risk to be circumcised annually (WHO, 2008).

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Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis

BMJ Open. 2014 Nov 21;4(11):e006316. doi: 10.1136/bmjopen-2014-006316.FREE

Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis

Berg RC, Underland V, Odgaard-Jensen J, Fretheim A, Vist GE

ABSTRACT

OBJECTIVE: Worldwide, an estimated 125 million girls and women live with female genital mutilation/cutting (FGM/C). We aimed to systematically review the evidence for physical health risks associated with FGM/C.

DESIGN: We searched 15 databases to identify studies (up to January 2012). Selection criteria were empirical studies reporting physical health outcomes from FGM/C, affecting females with any type of FGM/C, irrespective of ethnicity, nationality and age. Two review authors independently screened titles and abstracts, applied eligibility criteria, assessed methodological study quality and extracted full-text data. To derive overall risk estimates, we combined data from included studies using the Mantel-Haenszel method for unadjusted dichotomous data and the generic inverse-variance method for adjusted data. Outcomes that were sufficiently similar across studies and reasonably resistant to biases were aggregated in meta-analyses. We applied the instrument Grading of Recommendations Assessment, Development and Evaluation to assess the extent to which we have confidence in the effect estimates.

RESULTS: Our search returned 5109 results, of which 185 studies (3.17 million women) satisfied the inclusion criteria. The risks of systematic and random errors were variable and we focused on key outcomes from the 57 studies with the best available evidence. The most common immediate complications were excessive bleeding, urine retention and genital tissue swelling. The most valid and statistically significant associations for the physical health sequelae of FGM/C were seen on urinary tract infections (unadjusted RR=3.01), bacterial vaginosis (adjusted OR (AOR)=1.68), dyspareunia (RR=1.53), prolonged labour (AOR=1.49), caesarean section (AOR=1.60), and difficult delivery (AOR=1.88).

CONCLUSIONS: While the precise estimation of the frequency and risk of immediate, gynaecological, sexual and obstetric complications is not possible, the results weigh against the continuation of FGM/C and support the diagnosis and management of girls and women suffering the physical risks of FGM/C.

TRIAL REGISTRATION NUMBER: This study is registered with PROSPERO, number CRD42012003321.

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A traditional practice that threatens health–female circumcision.

WHO Chron. 1986;40(1):31-6.

A traditional practice that threatens health–female circumcision.

[No authors listed]

ABSTRACT

PIP: A traditional practice that has attracted considerable attention in the last decade is female circumcision, the adverse effects of which are undeniable. 70 million women are estimated to be circumcised, with serveral thousand new operations performed each day. It is a custom that continues to be widespread only in Africa north of the equator, though mild forms of female circumcision are reported from some Asian countries. In 1979 a Seminar on Traditional Practices that Affect the Health of Women and Children was held in the Sudan. It was 1 of the 1st interregional and international efforts to exchange information on female circumcision and other traditional practices, to study their implications, and to make specific recommendations on the approach to be taken by the health services. There are 3 main types of female circumcision: circumcision proper is the mildest but also the rarest form and involves the removal only of the clitoral prepuce; excision involves the amputation of the entire clitoris and all or part of the labia minora; and infibulation, also known as Pharaonic circumcision, involves the amputation of the clitoris, the whole of the labia minora, and at least the anterior 2/3 and often the whole of the medial part of the labia majora. Initial circumcision is carried out before a girl reaches puberty. The operation generally is the responsibility of the traditional midwife, who rarely uses even a local anesthetic. She is assisted by a number of women to hold the child down, and these frequently include the child’s own relatives. Most of the adverse health consequences are associated with Pharaonic circumcision. Hemorrhage and shock from the acute pain are immediate dangers of the operation, and, because it is usually performed in unhygienic circumstances, the risks of infection and tetanus are considerable. Retention of urine is common. Cases have been reported in which infibulated unmarried girls have developed swollen bellies, owing to obstruction of the menstrual flow. Implantion dermoid cysts are a very common complication. Infections of the vagina, urinary tract, and pelvis occur often. A women who has been infibulated suffers great difficulty and pain during sexual intercourse, which can be excruciating if a neuroma has formed at the point of section of the dorsal nerve of the clitoris. Consummation of marriage often necessitates the opening up of the scar. During childbirth infibulation causes a variety of serious problems includind prolonged labor and obstructed delivery, with increased risk of fetal brain damage and fetal loss. A variety of reasons are advanced by its adherents for continuing to support the practice of female circumcision, but the reasons are rationalizations, and none of the reasons bear close scrutiny. The campaing against female circumcision is reviewed.

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