The traditional practice of female genital mutilation or cutting (FGM/C) covers a range of procedures (clitoridectomy, excision, infi bulation, and other) performed on the genitals of females of different ages. This systematic review aimed to summarize empirical quantitative research describing the gynecological consequences of FGM/C on girls and women. We included 136 primary studies, 42 of which compared groups of women who had been subjected to FGM/C with women who had no or different types of genital alterations. The main finding is that FGM/C has harmful consequences for a woman’s gynecological health.
We found that:
• Women with FGM/C seem to be more likely than women without FGM/C to experience urinary tract infection, bacterial vaginosis, and pain during intercourse.
• There seems to be a trend for women with FGM/C to be more likely than women without FGM/C to experience: burning/painful urination, problems with menstruation, vaginal discharge and vaginal itching.
• There seems to be no clear trend for either a greater or lower risk of HIV and sexually transmitted infections among women who have undergone FGM/C.
• There were insuffi cient data for us to conclude whether the risk of other gynecological complications (tissue damage, vaginal adhesions and obstructions, cysts, infertility) is different among women with FGM/C compared to women without FGM/C, and whether various FGM/C types differentially affect the risk of other gynecological complications (except regarding urinary tract infection).
This systematic review found that sufficient evidence exist to concludethat women who have undergone FGM/C suffer a greater risk of gynecological complications than women who have not undergone the procedure. There were no indications of gynecological benefi ts of FGM/C. Rather, there is a real chance of under-reporting of many of the health issues covered in this systematic review.
Background: Female genital mutilation/cutting (FGM/C) has been performed in various forms for millennia and involves the partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. In this systematic review we addressed harm occurring during the cutting or alteration modifi cation process and the short-term period. • We included 56 observational studies that documented immediate complications. There were 14 studies in which two or more groups of girls and women with different types of FGM/C were compared with regards to the occurrence of one or more acute complications. There are three main fi ndings: • The most common immediate FGM/C complications were pain, excessive bleeding, swelling, problems with wound healing, urine retention. • The girls and women undergoing FGM/C often suffered more than one immediate complication. • There were few differences in risk of immediate complications among different types of FGM/C, but there might be a greater risk of immediate complications for women with FGM/C type III (infi bulation) compared to types I-II. • There was evidence of underreporting of complications. However, the fi ndings show that the FGM/C procedure unequivocally causes immediate, and typically several, health complications during the FGM/C procedure and the short-term period. Each of the most common complications occurred in more than one of every ten girls and women who undergo FGM/C. The participants in these studies had FGM/C types I through IV, thus immediate complications such as bleeding and swelling occur in setting with all forms of FGM/C. Even FGM/C type I and type IV ’nick’, the forms of FGM/C with least anatomical extent, presented immediate complications. The results document that multiple immediate and quite serious complications can result from FGM/C. These results should be viewed in light of long-term complications, such as obstetric and gynecological problems, and protection of human rights.More info →
In November 2008, the Norwegian Knowledge Centre for Violence and Traumatic Stress Studies commissioned the Norwegian Knowledge Centre for the Health Services to do a systematic review about the effectiveness of interventions to prevent female genital mutilation/cutting (FGM/C). The review would answer the question: What is the effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting compared to no or any other intervention? Method: We searched systematically for relevant literature in international scientifi c databases, in databases of international organisations that are engaged in projects concerning FGM/C, and in reference lists of relevant reviews and included studies. We selected studies according to prespecifi ed criteria and appraised the methodological quality using checklists. We summarized the results using tables and calculated effect estimates in outcomes for which pre- and post scores for both intervention and comparison groups were reported. Results: We included and summarized results from six controlled before-after-studies. All studies were set in Africa and compared an intervention with no intervention. There was great variation in prevalence, ethnicity, religion, and education among these settings. All studies were judged to have weak methodological quality and the quality of the evidence was low. Conclusion: There is a paucity of high quality evidence regarding the effectiveness of interventions to prevent FGM/C and the evidence base is insuffi cient to draw solid conclusions. While fi rst generation anti-FGM/C intervention studies are informative, there is an urgent need for additional studies. Such second generation studies should be randomized or at a minimum secure similar distribution of prognostic factors in the intervention and comparison groups; long term to ensure viability and reliable assessment of changes in prevalence; take into account regional, ethnic and socio demographic variation in the practice of FGM/C; focus on prevalence – assessed by physical examinations – behaviours, and intentions; and they should be cross disciplinary, if possible through international collaborative initiatives.More info →
An Updated Systematic Review and Meta-Analysis of the Obstetric Consequences of Female Genital Mutilation/Cutting
TheNorwegian Knowledge Centre for theHealth Services, P.O. Box 7004, St.Olavs Plass, 0130 Oslo,Norway
Correspondence should be addressed to R. C. Berg; [email protected]
Received 18 March 2014; Accepted 29 October 2014; Published 23 November 2014
Academic Editor: John R. VanNagell
Copyright © 2014 R. C. Berg et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
In our recent systematic review in Obstetrics and Gynecology International of the association between FGM/C and obstetric harm
we concluded that FGM/C significantly increases the risk of delivery complications.The findings were based on unadjusted effect
estimates from both prospective and retrospective studies. To accommodate requests by critics, we aimed to validate these results
through additional analyses based on adjusted estimates fromprospective studies.We judged that 7 of the 28 studies included in our
original systematic review were prospective. Statistical adjustments for measured confounding factors were made in eight studies,
including three prospective studies. The adjusted confounders differed across studies in number and type. Results from metaanalyses
based on adjusted estimates, with or without data from retrospective studies, consistently pointed in the same direction
as our earlier findings. There were only small differences in the sizes or the level of statistical significance. Using GRADE, we
assessed that our confidence in the effect estimates was very low or low for all outcomes. The adjusted estimates generally show
similar obstetric harms fromFGM/C as unadjusted estimates do.Thus, the current analyses confirmthe findings fromour previous
systematic review.There are sufficient grounds to conclude that FGM/C, with respect to obstetric circumstances, involves harm.
Female Genital Mutilation/ Cutting (FGM/C) is a traditional practice that involves partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. FGM/C is mainly practiced on prepubescent girls in 28 countries in Africa. Recent figures for African countries show a prevalence of FGM/C of more than 70% in Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, Guinea, Mali, Mauritania, Northern Sudan, Sierra Leone, and Somalia. However, there is considerable variation in prevalence between and within countries, reflecting ethnicity and tradition. The practice is also rooted in religio-social beliefs within a frame of psycho-sexual and personal reasons such as control of women’s sexuality and family honour, which is enforced by community mechanisms. Girls exposed to FGM/C are at risk of immediate physical consequences, such as severe pain, bleeding, and shock, difficulty in passing urine and faeces, and infections. Long term consequences can include chronic pain and infections. For many girls and women, undergoing FGM/C is a traumatic experience that may adversely affect their mental health.More info →
Evidence to End FGM/C: Research to Help Women Thrive is led by the Population Council, Nairobi in partnership with the Africa Coordination Centre for Abandonment of Female Genital Mutilation/Cutting, Kenya (ACCAF); Gender and Reproductive Health & Rights Resource Centre, Sudan (GRACE); Global Research and Advocacy Group, Senegal (GRAG); Population Council, Nigeria; Population Council, Egypt; Population Council, Ethiopia; MannionDaniels, Ltd. (MD); Population Reference Bureau (PRB); University of California, San Diego (Dr. Gerry Mackie); and University of Washington, Seattle (Dr. Bettina Shell-Duncan).More info →
Effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting
Background: In November 2008, the Norwegian Knowledge Centre for Violence and Traumatic Stress Studies commissioned the Norwegian Knowledge Centre for the Health Services to do a systematic review about the effectiveness of interventions to prevent female genital mutilation/cutting (FGM/C). The review would answer the question: What is the effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting compared to no or any other intervention?More info →