Tag Archives: Reproductive Health

The status of one’s reproductive system and its function.

Childhood vaginal bleeding due to a missed foreign body in the vagina following female genital mutilation

International Journal of Gynecology & Obstetrics. 2012 July;118(1):75-76

Childhood vaginal bleeding due to a missed foreign body in the vagina following female genital mutilation

Rasheed S, Abdel Monem A, Abdel Ghaffar H

(Short communication)Foreign bodies within the vagina have been reported to constitute about 3.6% of all causes of childhood vaginal bleeding . A variety of vaginal foreign bodies have been retrieved from prepubescent gir…

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Female genital mutilation: have we made progress?

International Journal of Gynecology & Obstetrics. 2003 Sept;82(3):251-261

Female genital mutilation: have we made progress?

Toubia NF, Sharief EH

RAINBO (Research, Action and Information Network for Bodily Integrity of Women), London, UK


Interest curtailing the practice of female genital mutilation (FGM) has increased in the past 20 years. Although the political and legal environment towards the practice is more hostile, this awareness has yet to translate itself to measurable changes in prevalence. At the local level activities are shifting from a clinical, health risk, model to an understanding of the phenomenon in its social context. Under patriarchal structures of social control of sexuality and fertility, women and girls are the primary social group to suffer from as well as to perpetuate the practice of FGM. With appropriate investments in psychological and economic empowerment, women are also the most likely group to resist the practice.

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The impact of female genital cutting on health of newly married women

International Journal of Gynecology & Obstetrics. 2007 June;97(3):238-244

The impact of female genital cutting on health of newly married women.

Elnashar A, Abdelhady R


Objective To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems.

Methods Randomly selected (264) newly married women were the subjects of this work.

Results Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P<0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband’s unsatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P<0.001).

Conclusion Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women’s life particularly the time of consummation of marriage and the time of childbirth.

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Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation

Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation

Raouf SA, Ball T, Hughes A, Holder R, Papaioannou S


Objective To record and compare obstetric and neonatal complication rates in women with reversed and non-reversed type III femalegenital mutilation (FGM).

Methods A retrospective observational study comparing cesarean delivery rates and neonatal outcomes of primiparous and multiparous women who had or had not undergone reversal of FGM III.

Results Of the 250 women, 230 (92%) had an FGM reversal. Of these, 50 (21.7%) were primiparous (cesarean delivery rate 17/50; 34%) and 180 (78.3%) were multiparous (cesarean delivery rate 28/180; 15.6%). Of the 20 women who had not had an FGM reversal, 7 (35%) were primiparous (cesarean delivery rate 5/7; 71.4%) and 13 (65%) were multiparous (cesarean delivery rate 7/13; 53.8%). The cesarean delivery rates for primiparae and multiparae were 32.9% and 25%, respectively. Multiparous women with FGM III reversal had a lower possibility of cesarean delivery compared with the hospital multiparous population (P=0.003) and multiparae who had not undergone FGM III reversal (P=0.007). There was no significant association between Apgar scores or blood loss at vaginal delivery and FGM reversal.

Conclusion Reversal of FGM III significantly reduced the increased risk of cesarean delivery seen with multiparae who have FGM III.

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Female genital mutilation and the responsibility of reproductive health professionals

Female genital mutilation and the responsibility of reproductive health professionals

Toubia N

Global Action Against FGM Project, P.O. Box 1554, Cooper Station, New York, NY 10276, USA


No abstract is available for this article.

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The burden of reproductive-organ disease in rural women in The Gambia, West Africa.

Lancet. 2001 Apr 14;357(9263):1161-7.

The burden of reproductive-organ disease in rural women in The Gambia, West Africa.

Walraven G, Scherf C, West B, Ekpo G, Paine K, Coleman R, Bailey R, Morison L.

Medical Research Council Laboratories, Farafenni Field Station, PO Box 273, The, Banjul, Gambia. gwalraven@mrc.gm


BACKGROUND: Data on the epidemiology of reproductive-organ morbidity are needed to guide effective interventions, to set health-care priorities, and to target future research. This study aimed to find out the prevalence of reproductive-organ disease in a sample of rural Gambian women.

METHODS: A questionnaire on reproductive health was administered by fieldworkers to women aged 15-54 years living in a rural area under demographic surveillance. A female gynaecologist questioned and examined the women (including speculum and bimanual pelvic examinations). Vaginal swabs were taken to test for Trichomonas vaginalis, Candida albicans, and bacterial vaginosis, cervical smears for cytology, cervical swabs for Chlamydia trachomatis PCR and Neisseria gonorrhoeae culture, and venous blood for haemoglobin, HIV, herpes simplex virus 2, and syphilis serology.

FINDINGS: 1348 (72.0%) of 1871 eligible women took part. Reproductive-organ symptoms were more likely to be reported to the gynaecologist (52.7% of women) than to the fieldworker (26.5%). Menstrual problems, abnormal vaginal discharge, and vaginal itching were the most commonly reported symptoms. A minority of women said they had sought health care for their symptoms. The frequencies of reproductive-organ morbidity were high: menstrual dysfunction 34.1% (95% CI 29.6-39.1), infertility 9.8% (8.2-11.6), reproductive-tract infections 47.3% (43.7-51.0), pelvic tenderness 9.8% ((7.0-13.5), cervical dysplasia 6.7% (5.2-8.4), masses 15.9% (12.5-20.1), and childbirth-related damage to pelvic structures 46.1% (40.1-52.3). 948 (70.3%) women had at least one reproductive-organ disorder.

INTERPRETATION: For these rural women, whose lives depend heavily on their reproductive function, reproductive-organ disease is a large burden. In inadequately resourced rural areas, with poor education, heavy agricultural and domestic labour, and limited access to quality health care, many women are not able to attain and maintain reproductive health and wellbeing.

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Female sexual dysfunction in Lower Egypt

BJOG. 2007 Feb; 114(2):201-206

Female sexual dysfunction in Lower Egypt

Elnashar AM, EL-Dien Ibrahim M, EL-Desoky MM, Ali OM, El-Sayd Mohamed Hassan M


Objective  The aim of this study was to assess the prevalence and associated factors of female sexual dysfunction (FSD) in Lower Egypt.

Design  A cross-sectional clinic-/hospital-based survey.

Setting  Five district medical centres in Dakahlia Governorate: Shirbin, Bilquas, Samblawen, Dekrinis and Mansoura City.

Population  One thousand married women aged between 16 and 49 years.

Methods  Data were collected by personal interview in a questionnaire format in addition to physical examination (when allowed).

Main outcome measures  FSD and associated risk factors.

Results  The response rate was 93.6%. 68.9% of women had one or more sexual problems; however, 23% of the women with sexual problems were not distressed by these issues. 31.5% of women suffered from dyspareunia. 49.6% of the women had decreased sexual desire, 36% had difficult arousal and 16.9% had anorgasmia (primary and secondary). Marital disharmony, ‘hate’ and unfavourable socio-economic circumstances were the most common aggravating factors (28.1%) for sexual dysfunction among the participants, followed by pregnancy-related events (15.7%). Most women (84.5%) received no help for their sexual problems. 90.3% of the women were circumcised. Only 7.1% (46 of 645) of women with sexual problems had received treatment, with no real improvement reported in 58.7% (27 of the 46 women).

Conclusions FSD is a highly prevalent problem within the scope of this study. Low reporting rates and very low treatment rates were identified in the sample from Lower Egypt.

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Management of female genital mutilation : the Northwick Park Hospital experience

BJOG. 1995 Oct: 102(10):787–790.

Management of female genital mutilation: the Northwick Park Hospital experience

M. McCafrey Research Registrar, A. Jankowska S.H.O., H. Gordon Consultant


Objective To outline the problems associated with female genital mutilation and to highlight the need for deinfibulation before delivery.

Design A review of women attending a newly established African Well Woman Clinic. Age at infibulation, gravidity of clinic attenders and adequacy of introitus for management of labour were assessed.

Setting Northwick Park Hospital, Harrow, Middlesex.

Subjects Fifty women attending a newly established African Well Woman Clinic, of whom 13 were nulliparous, 14 were primigravid and 23 were multigravid.

Results The average age at which infibulation had occurred was 6–7 years. At the time of clinic attendance the mean age of pregnant and nonpregnant patients was 26 and 23.3 years, respectively. Of the 14 primigravid patients, only 50% had an adequate introitus to allow management of the first and second stages of labour. Five had deinfibulation performed antenatally or at delivery. Ninety-three percent of the primigravid patients and 74% of the multigravid patients had a vaginal delivery.

Conclusions We believe that the Northwick Park Hospital management policy for intibulated women closely mirrors the cultural practices in Somalia. The policy also improves obstetric management of infibulated patients. Twenty-six percent of referrals were of nonpregnant women, and this practice is to be encouraged.

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The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

BJOG. 2002 October; 109(10): 1089–1096

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

Okonofua FE, Larsen U, Oronsaye F, Snow RC, Slanger TE


Objective To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria.

Design Cross sectional study.

Setting Women attending family planning and antenatal clinics at three hospitals in Edo State, South–south Nigeria.

Population 1836 healthy premenopausal women.

Methods The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women’s socio-demographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models.

Main outcome measures Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections.

Results Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26–0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51–2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11–2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54–5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09–2.49) and genital ulcers (OR = 4.38, 95% CI = 1.13–17.00).

Conclusion Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

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Female genital mutilation: analysis of the first twelve months of a southeast London specialist clinic

BJOG. 2001 FEB; 108(2): 186-191

Female genital mutilation: analysis of the first twelve months of a southeast London specialist clinic

Momoh C, Ladhani S, Lochrie DP, Rymer J


Objectives To analyse the sources and reasons for referral of women who have undergone genital mutilation to a recently established specialist clinic, and to determine the consequences of the genital mutilation procedure.

Design Retrospective descriptive case series.

Setting The maternity units of Guy’s and St. Thomas’s Hospital, London.

Population One hundred and sixteen women attending the clinic over a one-year period.

Main outcome measures (1) sources and reasons for referral to the specialist clinic; (2) characteristics of the women attending the clinic; (3) acute and chronic complications of the genital mutilation procedure; (4) attitudes towards female genital mutilation.

Results Complete case records were available for 108 women. Of the 86 women who could remember the procedure, 78% were performed by a medically unqualified person, usually at home (71%), at a median age of seven years. Acute and chronic complications were each present in 86% of women with Type III genital mutilation. Most women (82%) were referred by their midwife because they were pregnant, of whom 48% were primigravid. Eighteen non-pregnant women also attended the clinic to request either defibulation or for advice. None of the 89 pregnant women requested re-infibulation after delivery, but almost 6% were seriously considering having their daughter undergo genital mutilation outside the United Kingdom. In addition, fewer than 10% of the women refused to continue the tradition of female genital mutilation.

Conclusions During its first year, the recently established African Well Woman Clinic has provided specialist care for 116 women with genital mutilation. Such women may attend with a variety of common medical or psychiatric conditions and often do not volunteer that they have undergone the procedure. Doctors and midwives in particular, should enquire specifically about genital mutilation when caring for women from high risk countries, and offer the services of specialist clinics for female genital mutilation.

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