Tag Archives: Prospective studies

Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.

Female genital mutilation and efforts to achieve Millennium Development Goals 3, 4, and 5 in southeast Nigeria.

Int J Gynaecol Obstet. 2014 May;125(2):125-8. doi: 10.1016/j.ijgo.2013.11.008. Epub 2014 Feb 8.

Female genital mutilation and efforts to achieve Millennium Development Goals 3, 4, and 5 in southeast Nigeria.

Lawani LO, Onyebuchi AK, Iyoke CA, Okeke NE.


OBJECTIVE: To determine the prevalence of female genital mutilation (FGM), the common forms of FGM, reasons for the practice, associated obstetric outcomes, and how these have affected efforts to achieve Millennium Development Goals (MDGs) 3, 4, and 5 in southeast Nigeria.

METHODS: A prospective descriptive study of parturients in southeast Nigeria was conducted from January to December 2012. All primigravid women attending delivery services at 2 health institutions during the study period were recruited, examined, and classified using the 2008 WHO classification for FGM.

RESULTS: The mean age of the 516 participants was 27.24±4.80years and most (66.3%) had undergone FGM. Type II FGM was the most common form, accounting for 59.6% of cases. Most FGM procedures were performed in infancy (97.1%) and for cultural reasons (60.8%). Women who had undergone FGM had significantly higher risk for episiotomy, perineal tear, hemorrhage, cesarean delivery, neonatal resuscitation, fresh stillbirth/early neonatal death, and longer hospitalization, with higher risk ratios associated with higher degrees of FGM.

CONCLUSION: FGM is still a common practice in southeast Nigeria, where its association with adverse reproductive outcomes militates against efforts to achieve MDGs 3, 4, and 5.

This article can be accessed in this LINK.

Genital lesions complicating female genital cutting in infancy: a hospital-based study in south-east Nigeria.

Ann Trop Paediatr. 2007 Dec;27(4):285-90.

Genital lesions complicating female genital cutting in infancy: a hospital-based study in south-east Nigeria.

Ekenze SO, Ezegwui HU, Adiri CO.

Paediatric Surgical Unit, Department of Surgery, Federal Medical Centre, Owerri, Nigeria. soekenze@yahoo.com


BACKGROUND: Despite the global outcry against female genital cutting (FGC), the practice continues in many African communities. The morbidity of this practice on the girl child deserves more attention.

OBJECTIVE: To determine the genital lesions complicating childhood FGC and the underlying factors that sustain this practice among the Igbos in south-east Nigeria.

METHODS: Prospective evaluation of girls with genital complications of FGC between January 2003 and June 2005 at the Federal Medical Centre, Owerri, south-east Nigeria. The girls’ mothers were interviewed at presentation and subsequent visits to determine their perception and attitudes towards FGC.

RESULTS: The average age at presentation was 3.5 years (range 1-5) and the genital cutting procedures were performed 8-90 days after birth. The procedure was undertaken by traditional practitioners in 14 (66.7%) girls and by nurses in 7 (33.3%) girls. Twelve girls (57.1%) had type I genital cutting and nine (42.9%) type II. Inclusion clitoral dermoid cyst and labial fusion were the complications in 13 (61.9%) and eight (38.1%), respectively. Treatment involved complete excision of the cysts and operative division of the labial fusion. Post-operative complications were wound infection (5) and labial adhesion (2). With duration of admission ranging from 3 to 5 days, the average cost of managing each child was $120. Of the girls’ mothers, 15 (71.4%) had been educated to secondary level and 17 (80.1%) were aware of the campaign against FGC. Regrettably, all the mothers had genital cutting themselves during childhood and 13 (61.9%) stated that they would like to perpetuate the practice for socio-cultural reasons. Despite this, they all volunteered that FGC is enforced by the child’s paternal relations.

CONCLUSION: Childhood FGC contributes to appreciable morbidity among girls, a large proportion of whom are not managed in a hospital setting. The cost of managing these complications can be enormous, especially in low-resource settings. Girl child education to tertiary level and the involvement of traditional rulers and local decision-makers in the campaign against FGC might help to eradicate the practice.

This article can be accessed in this LINK.

Female genital mutilation among Edo people: the complications and pattern of presentation at a pediatric surgery unit, Benin City.

Afr J Reprod Health. 2009 Mar;13(1):17-25. FREE

Female genital mutilation among Edo people: the complications and pattern of presentation at a pediatric surgery unit, Benin City.

Osifo DO, Evbuomwan I.

Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria. Leadekso@yahoo.com


This prospective study on female genital mutilation among Edo people was based on female children and parents who presented on account of it at the University of Benin Teaching Hospital, Benin City, Nigeria, between January 2002 and December 2007. During the period, 51 female children aged 10 days and 18 years presented with complications following genital mutilation. Twenty-nine were brought by their parents for mutilation while 67 parents interviewed believed strongly on female genital mutilation with 47 mothers mutilated. Religio-cultural and superstitious beliefs were the main indications and the type of mutilation ranged from excision of clitoridal tip in 10 (19.6%) children to complete excision of the clitoris, labia minora and inner layer of majora in 7 (13.7%). Complications ranged from clitoridal cyst formation in 21 (41.2%) to life threatening infections with one mortality due to tetanus infection.

This article can be accessed in this LINK


Infibulated women have an increased risk of anal sphincter tears at delivery: a population-based Swedish register study of 250 000 births

Acta Obstet Gynecol Scand. 2013 Jan;92(1):101-8. doi: 10.1111/aogs.12010. Epub 2012 Nov 1.

Infibulated women have an increased risk of anal sphincter tears at delivery: a population-based Swedish register study of 250 000 births.

Berggren V, Gottvall K, Isman E, Bergström S, Ekéus C.

Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden.


OBJECTIVE: To investigate the risk for anal sphincter tears (AST) in infibulated women. DESIGN: Population-based cohort study. SETTING: Nationwide study in Sweden. POPULATION: The study population included 250 491 primiparous women with a vaginal singleton birth at 37-41 completed gestational weeks during 1999-2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalia group, n = 929, where over 95% are infibulated; the Eritrea-Ethiopia-Sudan group, n = 955, where the majority are infibulated, compared with other African countries, n = 1035, where few individuals are infibulated but had otherwise similar anthropometric characteristics. These women were compared with 247 572 Swedish-born women. METHODS: Register study with data from the National Medical Birth Registry. MAIN OUTCOME MEASURES: AST in non-instrumental and instrumental vaginal delivery. RESULTS: Compared with Swedish-born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95%CI 2.08-3.54), followed by women from Eritrea-Ethiopia-Sudan 1.80 (1.41-2.32) and other African countries 1.23 (0.89-1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. CONCLUSION: Delivering African women from countries where infibulation is common carries an increased risk of AST compared with Swedish-born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.

This article can be purchased in this LINK.

[External genital after-effects of excision in national hospital Yalgado Ouedraogo (CHN-YO): epidemiology and surgery]

Gynecol Obstet Fertil. Abril 2001 29(4): 295–300

Séquelles génitales externes de l’excision au centre hospitalier national Yalgado Ouedraogo (CHN-YO) : épidémiologie et traitement chirurgical

[External genital after-effects of excision in national hospital Yalgado Ouedraogo (CHN-YO): epidemiology and surgery] [Article in French]

Akotionga M, Traore O, Lakoande J, Kone B


By a prospective study in one year time, the authors noticed that femal genital mutilation complications were 7,3 per cent of external gynecologic consultations and most complications were overdraft between 15 and 24 years old (36 cases out of 49). The main consultation motives were dyspareunia and difficult sexual relationship. Surgery under local anesthetic was very efficient (more than 90 % success) and cheaper than surgery under general anesthetic.

This article can be purchased in this LINK

Female genital mutilation in Greece.

Clin Exp Obstet Gynecol. 2012;39(3):346-50.FREE

Female genital mutilation in Greece.

Vrachnis N, Salakos N, Iavazzo C, Iliodromiti Z, Bakalianou K, Kouiroukidou P, Creatsas G.

2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. nvrachnis@hotmail.com


The number of migrants and refugees with a female genital mutilation (FGM) living in Greece is rising. This study explores the characteristics and psychosexual issues of women with FGM who were examined in the 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Greece during the year 2009. The women were asked to fill out an anonymous questionnaire asking for demographic data, obstetric history, current complaints, and psychosexual problems. The results are presented and discussed, as FGM is a new reality for Greece. Healthcare providers have to familiarize themselves with issues related to FGM and improve their skills in transcultural care, so as to manage and support women with FGM adequately.

This article can be accessed in this LINK.

Comment: Female genital mutilation and obstetric outcome

Lancet. 2006 June;367(9525):1799 – 1800

Comment: Female genital mutilation and obstetric outcome

Eke N, Nkanginieme KEO


In today’s Lancet, the WHO study group report a multicentre prospective study of the obstetric outcome in women who have had genital mutilation. Their study strengthens the evidence base about complications of such mutilation. For a subject with many important confounding factors, we congratulate the researchers for the study design and tenacity in execution. The finding of a causal relation between complications and type of mutilation indicates that the more brutal the type of procedure, the worse the complication…

This article can be accessed in this LINK

Sexual function in women with female genital mutilation.

Fertil Steril. 2010 Feb;93(3):722-4. Epub 2008 Nov 25.

Sexual function in women with female genital mutilation.

Alsibiani SA, Rouzi AA.

Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.


OBJECTIVE: To compare the sexual function of women with female genital mutilation (FGM) to women without FGM.

DESIGN: A prospective case-control study.

SETTING: A tertiary referral university hospital.

PATIENT(S): One hundred and thirty sexually active women with FGM and 130 sexually active women without FGM in Jeddah, Saudi Arabia.

INTERVENTION(S): Women with and without FGM were asked to answer the Arabic-translated version of the female sexual function index (FSFI) questionnaire.

MAIN OUTCOME MEASURE(S): The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score of the FSFI were calculated.

RESULT(S): The two groups were comparable in demographic characteristics. There were no statistically significant differences between the two groups in mean desire score (+/- standard deviation) or pain score. However, there were statistically significant differences between the two groups in their scores for arousal, lubrication, orgasm, and satisfaction as well as the overall score.

CONCLUSION(S): Sexual function in women with FGM is adversely altered. This adds to the well-known health consequences of FGM. Efforts to document and explain these complications should be encouraged so that FGM can be abandoned.

This article can be accessed in this LINK

Female sexual mutilation: Features of this practice

Revista Cubana de Obstetricia y Ginecología. 2009; 35(3)

Female sexual mutilation: Features of this practice [article in Spanish]

Rafael Orestes Vanegas EstradaFatou Atji, Orlando Valdez Álvarez


The practice of female sexual mutilation (FSM), excision or circumcision is abundantly treated in literature by social sciences authors, health professionals, religion, women rights activists and the victims of this violent practice carried out on many African girls and women.

OBJECTIVE: to identify the different factors involved in this practice, and frequency of physical consequences and psychological sequelae.

METHODS: we made a longitudinal, prospective and descriptive study of all patients seen in Gynecology and Obstetrics Service of the Point G Hospital-University Center, and of III level care, from December, 2006 to December, 2007.

Sample included the women with excision and after to be informed they gave its consent to inclusion.

RESULTS: we found a 90% prevalence of this practice in study patients. In study sample there was a predominance of housewives, illiterates, married, and Muslims.

The 60,8% of polled patients ignore complications of this practice. In all the cases we found a cicatricial lesion. The 89% of patients recognized the presence of psychosexual disorders. Tradition and religion were the causes stated for thecarrying out of their daughters with a significant difference (p <0,001).

CONCLUSIONS: it is a cultural practice perpetuating the social and economic injustices of women, moved away from international attention, violating thus the human rights.  

This article can be accessed in this LINK

New attempt using labio-vestibular flap technique to manage circumcised women with Rokitansky syndrome.

Acta Obstet Gynecol Scand. 2008;87(1):94-8.

New attempt using labio-vestibular flap technique to manage circumcised women with Rokitansky syndrome.

Thabet SM, Ali AH

Cairo University, Edypt. Dr_saeedth@hotmail.com



To assess the efficacy of the labio-vestibular flap technique in managing circumcised women with Rokitansky syndrome and in correcting the sexuality defects caused by the anomaly present and by female circumcision.


A prospective, comparative, clinical study.


Kasr El Aini School of Medicine, Cairo University, Egypt.


Thirty-four circumcised patients with Rokitansky syndrome were divided into 2 groups; Group 1 consisted of 22 cases treated with the labio-vestibular flap technique, and Group 2 consisted of 12 cases treated with McIndoe’s technique.


Pre and postoperative clinical assessment of the newly formed vagina and sexuality. The new flap is formed of the remaining parts of the labia minora and the adjoining parts of the vestibule, and is used to cover the posterior and lateral walls. Meanwhile, the anterior wall is covered by the epithelium of the original blind vaginal pouch. The modified Kasr El Aini sexual assessment sheet assesses sexuality.


Rokitansky syndrome could be classified into 4 clinical types according to the degree of development of the uterus. The labio-vestibular technique was simple and not associated with any graft rejection, hair growth or contraction of the reformed tract. Dyspareunia and marital failure were less significantly recorded in the labio-vestibular technique than in McIndoe’s technique. But, the most significant results were the improvement in sexuality, in addition to restoration of genital continuation, menstruation and fertility in some cases.


The labio-vestibular flab technique is the most simple and most suitable line of treatment for circumcised cases with Rokitansky syndrome. In these cases, the technique achieved good results in correcting sexual defects after circumcision.

This article can be purchased online in this LINK.