Tag Archives: Urinary tract infections

Inflammatory responses of the epithelium of the URINARY TRACT to microbial invasions. They are often bacterial infections with associated BACTERIURIA and PYURIA.

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review.

FREEInt J Gynaecol Obstet. 2017 Feb;136 Suppl 1:30-33. doi:10.1002/ijgo.12045.

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review.

Effa E, Ojo O, Ihesie A, Meremikwu MM.


BACKGROUND: Women and girls who have undergone type III female genital mutilation (FGM) may suffer urologic complications such as recurrent urinary tract infections, obstruction, stones, and incontinence. OBJECTIVE: To assess the effectiveness of deinfibulation for preventing and treating urologic complications in women and girls living with FGM. SEARCH STRATEGY: The following major databases were searched from inception to August 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, SCOPUS, Web of Science, and ClinicalTrials.gov without language restrictions. SELECTION CRITERIA: Randomized controlled studies (RCTs) or observational studies with controls were considered. DATA COLLECTION AND ANALYSIS: We screened the results of the search independently for potentially relevant studies and applied inclusion and exclusion criteria for the full texts of the relevant studies. RESULTS: No RCTs were found. We found three case reports and a retrospective case review, all of which were excluded. CONCLUSION: There is no evidence on the use of deinfibulation to improve urologic complications among women with type III FGM. Current clinical practice may be informed by anecdotal evidence from case reports. Appropriate RCTs and observational studies with comparison groups in countries where FGM is common are needed. PROSPERO registration: CRD42015024901.

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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


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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Type I Female Genital Mutilation: A Cause of Completely Closed Vagina

J Sex Med. 2014 May 30. doi: 10.1111/jsm.12605. [Epub ahead of print]

Type I Female Genital Mutilation: A Cause of Completely Closed Vagina.

Rouzi AA, Sahly N, Alhachim E, Abduljabbar H.


INTRODUCTION: Female genital mutilation (FGM) ranges in severity from a nick of the clitoris to partial or total removal of the external genitalia. Sexual complications after FGM include sexual dysfunction, difficult intercourse, and dyspareunia. AIM: We report a case of Type I FGM presenting as complete vaginal closure and urinary retention.

METHODS: A 16-year-old adolescent was referred for obliterated vagina and urinary retention. She had recurrent urinary tract infections, difficulty in voiding, and cyclic hematuria. At the age of 1 year she had been taken by her mother to a pediatric surgeon to have a Type I FGM procedure. On examination, the urethral meatus and vaginal orifices were completely closed by the FGM scar. She underwent uneventful surgical opening of the vagina.

RESULTS: A normal vaginal orifice was created and normal flow of urine and menses occurred.

CONCLUSION: Type I FGM can present as complete vaginal closure and urinary retention. Proper diagnosis and treatment are of paramount importance.

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Female genital circumcision/mutilation: implications for female urogynaecological health.

Int Urogynecol J. 2013 Jul 16. [Epub ahead of print]

Female genital circumcision/mutilation: implications for female urogynaecological health.

Teufel K, Dörfler DM.

Hospital of St. Poelten, St. Poelten, Austria, katharinateufel@gmx.at.


“Female genital circumcision” or “female genital mutilation”, as it is called more often, is an operation that is primarily carried out in Africa. Owing to migration, physicians are increasingly confronted with this issue in Western countries as well. A range of negative effects may result from this operation and this article aims to address consequences for female pelvic health. Special emphasis is placed on urogynaecological health consequences; in particular, on “voiding difficulties”, “recurrent urinary tract infections” and “vesicovaginal fistula”. All of these occur mostly in infibulated women, i.e. in women whose genitalia are sealed by the most severe form of circumcision. Some of the problems that may emerge as a result of the operation can be resolved by defibulation (i.e. surgical reopening of the sealed vulva). Female genital circumcision is a sensitive topic even in the area of research and reliable data are therefore scarce.

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Female genital mutilation and infections: a systematic review of the clinical evidence.

Arch Gynecol Obstet. 2013 Jan 12. [Epub ahead of print]

Female genital mutilation and infections: a systematic review of the clinical evidence.

Iavazzo C, Sardi TA, Gkegkes ID.

Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, Marousi, 151 23, Athens, Greece, christosiavazzo@hotmail.com.

AIM: Female genital mutilation (FGM) is a common practice especially performed in women with no anaesthesia or antibiotics and in absence of aseptic conditions. The aim of this systematic review is to explore and analyze for first time in the current literature, the clinical evidence related to the presence of infections in the practice of FGM.

METHOD: A systematic search of PubMed and Scopus was performed. A combination of the terms “female circumcision”, “genital mutilation”, “genital cutting” and “infection” were used. Studies reporting data on the infections related to patients with FGM were included.

RESULTS: A total of 22,052 patients included, in the study, from African countries. The age ranged from 10 days to 20 years. The procedure was done by physicians, paramedical staff, and other specialties. Type I FGM was performed in 3,115 women while 5,894, 4,049 and 93 women underwent Type II, Type III and unknown type of FGM, respectively. Different types of infections were identified including UTIs, genitourinary tract infections, abscess formation and septicemia or even HIV infection. Moreover, most infections were identified in Type III FGM. The isolated pathogens in the different type of infections, were HIV, Clostridium tetani, Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Candida albicans, Trichomonas vaginalis, HSV-2, Pseudomonas pyocyanea, Staphylococcus aureus. The univariate risk of infection ranged from 0.47 to 5.2.

CONCLUSION: A variety of infections can occur after FGM. The management of these complications in a low-income economy can be a great burden for the families.

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Incomplete bladder emptying due to labial fusion in a pubertal girl: A delayed consequence of female circumcision

Australian and New Zealand Journal of Obstetrics and Gynaecology. August 2004 44(4) 372–373

Incomplete bladder emptying due to labial fusion in a pubertal girl: A delayed consequence of female circumcision

Nor Azlina bt. AWANG, Claire VIEGAS, Osborn A. C. VIEGAS


No abstract is available for this article.

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What’s “normal”: female genital mutilation, psychology, and body image.

J Am Med Womens Assoc. 2004 Summer;59(3):168-70.

What’s “normal”: female genital mutilation, psychology, and body image.

Adams KE.

Department of Obstetrics and Gynecology, Oregon Health and Sciences University, USA.


Despite international efforts to halt the practice of female genital mutilation (FGM), the number of African girls and women undergoing the procedure is not declining as rapidly as international observers had hoped when the World Health Organization began focusing attention on the practice in the 1960s. This article focuses on the psychological effects of FGM through the example of a patient who had undergone the procedure in childhood and now felt that her closed appearance was “normal” and that to be opened would be “abnormal.” Western advocates must educate themselves about the various cultural forces that lead to FGM in order to help women who have undergone the procedure heal psychologically, thereby breaking the pattern of abuse from generation to generation.

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Urogenital complications among girls with genital mutilation: a hospital-based study in Khartoum.

Afr J Reprod Health. 2005 Aug;9(2):118-24.

Urogenital complications among girls with genital mutilation: a hospital-based study in Khartoum.

Almroth L, Bedri H, El Musharaf S, Satti A, Idris T, Hashim MS, Suliman GI, Bergström S.

Division of International Health, Karolinska Institutet, SE-17676 Stockholm, Sweden. L.Almroth@telia.com


To explore paediatric complications of female genital mutilation (FGM), 255 consecutive girls aged 4-9 years presenting to an emergency ward in Sudan were included in this clinical study. Full examination, including inspection of genitalia, was performed. Dipsticks for nitrite and leucocytes were used to diagnose suspected urinary tract infection (UTI). Girls with a form of FGM narrowing vulva had significantly more UTI than others, and among girls below the age of seven there was a significant association between FGM and UTI. Only 8% of girls diagnosed as having UTI reported urogenital symptoms. In spite of the fact that 73% of the girls subjected to FGM were reported to have been bedridden for one week or more after the operation, only 10% stated immediate complications. We conclude that FGM contributes significantly to morbidity among girls, a large share of which does not come to medical attention.

This article can be purchased in this LINK