Complications Of Female Genital Mutilation Research Articles

Complications of female genital mutilation: epidemiology and management of cases at Ouahigouya regional teaching hospital, Burkina Faso

Female genital mutilation is still common in Burkina Faso, despite decades of struggle against its practice. The northern region of this country has one of the highest prevalence of this practice at the national level with 76% of women mutilated. The objective of our study was to describe the health complications of female genital mutilation treated in the referral hospital in this region. This was a descriptive cross-sectional study with retrospective data collection over a 13-year period, from September 15, 2009 to September 14, 2022. Patients admitted for genital or loco-regional complications related to genital mutilation were included. Mutilated parturients without infibulation, victims of vulvar tears or who had undergone episiotomy were not included. We recorded 204 patients, representing 3,1% of consultants, and an annual frequency of 15.7 cases. The ages of the victims ranged from 15 months to 31 years. The 15-20 age group was the most represented (49.3%). Victims were more likely to come from urban than rural areas. The main reasons for consultation were vulvar stricture, dyspareunia, impossibility of sexual intercourse, and dysuria. These were medium- and long-term complications of the mutilation. These complications were related to infibulation in 81.8% of cases and to type II mutilation in 18.2%. Surgery accounted for 89.9% of treatments, with drug treatments alone accounting for 10.1%. Deinfibulation was the most common surgical procedure. No clitoral reconstruction was performed. The outcome was favourable in all cases. There are many local and regional complications of genital mutilation, but fortunately their treatment has a good anatomical prognosis. However, psychological complications remain to be evaluated and managed in our context. The management of these complications should be an opportunity to raise awareness among the patients' family circles to abandon the practice.

Recurrent urethral obstruction secondary to large vulval inclusion cyst: a remote complication of female genital mutilation: a case report

BackgroundFemale genital mutilation/cutting (FGM/C) is a major public health problem, particularly in developing countries.Case presentationThe authors reported a case of 48-year old multiparous woman presented to Kassala Hospital, east Sudan, with recurrent urine retention resulting from urethral obstruction, which was caused by large vulval inclusion cyst. A traditional birth attendant circumcised her when she was 5 year old. Five years before her presentation the patient observed a painless swelling in her vulva, which was gradually increasing in size. She presented to the hospital with urine retention seeking medical care. Local examination showed a large cystic swelling originating in the circumcision line and covering the introitus. A diagnosis of inclusion cyst at the site of circumcision was made. The cyst was large enough causing bladder outlet obstruction and when the patient advised to tilt it away from the urethral orifice she passed urine without difficulties. The cyst was surgically removed by dissection along the lines of cleavage, which measured 10 × 9.2 cm and weighed 1.2 kg.ConclusionThis case report indicates that FGM is a serious public health problem and there should an urgent intervention such as planned health education campaigns to end FGM practice.

Delayed presentation of a giant clitoridal cyst following female genital mutilation: A case report

Background: Clitoridal cyst is an epidermal inclusion cyst occurring in the region of the clitoris. It is a complication of female genital mutilation. It is usually underreported and thus a rare clinical diagnosis. This may be because the cyst is usually asymptomatic and in a concealed location, as well as the proscribed status of female genital mutilation (FGM) in society. This is a case of a 36-year-old multipara with a giant clitoridal cyst following FGM in childhood. Case report: Mrs B.E was a 36-year-old P4+0(all alive) who presented on 18/4/22 with a 10year history of anterior vulval swelling which was progressive and painless. She had female genital mutilation in childhood. Treatment with cyst excision under anaesthesia was done and the postoperative period was satisfactory. Conclusion: The clitoridal cyst is a long term complication of FGM. Women with clitoridal cysts often present late when they can no longer cope with the size of the cyst or when complications have occurred. At this stage treatment may be complicated, hence there is a need to increase public awareness of this condition through reporting, female education and sensitization.

Involving the health sector in the prevention and care of female genital mutilation: results from formative research in Guinea

BackgroundDespite efforts to reduce the burden of female genital mutilation (FGM) in Guinea, the practice remains prevalent, and health care providers are increasingly being implicated in its medicalization. This formative study was conducted to understand the factors that facilitate or impede the health sector in providing FGM prevention and care services to inform the development of health sector-based interventions.MethodsBetween April and May 2018, a mixed methods formative study was carried out using a rapid assessment methodology in three regions of Guinea—Faranah, Labe and Conakry. A structured questionnaire was completed by one hundred and fifty health care providers of different cadres and 37 semi-structured interviews were conducted with health care providers, women seeking services at public health clinics and key stakeholders, including health systems managers, heads of professional associations and schools of nursing, midwifery, and medicine as well as representatives of the Ministry of Health. Eleven focus group discussions were conducted with female and male community members.ResultsThis study revealed health systems factors, attitudinal factors held by health care providers, and other factors, that may not only promote FGM medicalization but also impede a comprehensive health sector response. Our findings confirm that there is currently no standardized pre-service training on how to assess, document and manage complications of FGM nor are there interventions to promote the prevention of the practice within the health sector. This research also demonstrates the deeply held beliefs of health care providers and community members that perpetuate this practice, and which need to be addressed as part of a health sector approach to FGM prevention.ConclusionAs integral members of FGM practicing communities, health care providers understand community beliefs and norms, making them potential change agents. The health sector can support them by incorporating FGM content into their clinical training, ensuring accountability to legal and policy standards, and promoting FGM abandonment as part of a multi-sectoral approach. The findings from this formative research have informed the development of a health sector intervention that is being field tested as part of a multi-country implementation research study in Guinea, Kenya, and Somalia.

Female genital mutilation (FGM) in Somaliland – why is change so slow?

Female genital mutilation (FGM) is defined as any procedure involving the alteration or excision of external female genitalia for no medical reason. Somaliland has among the highest prevalence rates of FGM globally. In this article we describe how the Civil Society Organisation (CSO) ‘Network against female genital mutilation in Somaliland’ (NAFIS) has approached the challenge to reduce the high FGM prevalence. From its start in 2006, NAFIS has developed a multifaceted program to reach the overall goal: the elimination of all forms of FGM in Somaliland. Alone among the group of CSOs in the network, NAFIS introduced in its activities medical care and counselling for women who suffer from the consequences of FGM. From 2011 and onwards, thousands of women have been relieved of their FGM-related health complications and participated in counselling sessions at project centres. Shortly after this visit they have been invited to participate in community group meetings to share their experiences with other women who also have received FGM care and counselling, and other community members. The aim of the article is to describe this model of work - combining FGM care and counselling with community dialogues. The article is basically descriptive, using the authors’ own observations and encounters with project clients and staff over eight years. We have also used findings from three Master's theses on aspects of the process, and from other small scale studies to highlight people’s understanding, experiences and opinions in a context of an on-going health intervention. A lesson learnt from NAFIS project is that it has helped to open up communicative spaces in community dialogues where experiences are shared and understanding created of the harm caused by FGM, without the habitual stigma and shame. We discuss this process in a context of behavioural change theories. A major challenge during the process has been to involve men in the project’s FGM information and counselling activities. The role of nurses/midwives, being the first to meet women with FGM complications, is also discussed and the need emphasised to strengthen capacity of this category of health workers. One type of FGM gaining in usage is the poorly defined sunna, the health risks of which are unclear.

Female genital mutilation (FGM): Is it still an existing problem in Egypt?

BackgroundFemale Genital Mutilation (FGM) is one of those traditional practices whose origin can be traced back to antiquity. The worst types of FGM are practiced in Sudan, Egypt and Nigeria. The international movement against FGM gained momentum in the past two decades, and attempts were made to increase public awareness of the procedure and its complications. In addition, laws were passed in Egypt to criminally charge practitioners who perform FGM. ObjectivesThe aim of this study was to describe frequency, prevalence, complications of FGM and awareness of the women at the clinic visit about the latest update (2016) of the Egyptian law that criminalizes it. MethodologyThis was a cross sectional study of women in their childbearing years (18–45) who attended the Gynecology and Obstetrics outpatient clinics at Fayoum University hospitals between January 1st and December 31st, 2018. After giving their consent, one hundred women attending the clinic received a medical examination and structured interview related to their views and plans regarding FGM of female children. ResultsSixty two percent of women participants reported that they had been circumcised. In 88% of cases, the participant's mother was the person who made the decision to have their daughter circumcised. The most common type of circumcision reported was type II, in 86% of cases. Regarding intent to have a female child circumcised, 32% reported that they would have their own daughter circumcised. ConclusionDespite Egyptian law that criminalizes FGM, the know potential for serious complications of the procedure, including death, and the efforts of governmental, non-governmental, and international organizations to combat the use of FGM, one third of the women interviewed still planned to have their daughter circumcised.

Clitoridal Inclusion Cyst Following Female Genital Mutilation/Cutting - A Case Report

Introduction: Epithelial inclusion cyst is a common type of cutaneous cyst that results from implantation of epidermal elements in the dermis and can occur throughout the body. It is often seen in the perineum and posterior vaginal wall, and lined by stratified squamous epithelium. This desquamates and produces secretions to form a cystic mass. This is called clitoridal inclusion cyst when it involves the clitoris. It is usually a complication of female genital mutilation/ cutting. Case presentation: She was a 27-year-old young woman, who presented to the gynaecological clinic with a 15-year history of progressive swelling in her perineum. She was circumcised at the age of 10 years. She had surgical excision under anaesthesia, and was discharged home in good health condition. Conclusion: Evaluation of clitoridal inclusion cyst requires careful assessment by a good history, detailed physical examination and necessary imaging modality, as this will help to rule out differential diagnosis and manage the patient better.

Awareness of different forms of child abuse among Beni Suef University students: descriptive survey

BackgroundChild abuse is a worldwide phenomenon that can cause intense long-term aftereffects.AimTo evaluate the awareness of Beni Suef University students about different forms of child abuse as well as the size, causes, and complications of this problem in our society and determine the prevalence of physical child abuse.MethodsThe study included 1688 students from health science and non-health science colleges of Beni Suef University, Egypt. The study participants were asked to answer a questionnaire of two parts. The first part included questions about demographic data and personal experience of child abuse, and the second part included questions about opinions of participants on child abuse to assess their awareness and if there was any difference in the level of awareness between students of health science colleges and those of non-health science colleges.ResultsHealth science college students were more life satisfied and felt more loved. Only 28.91% of the included students were not exposed to child abuse, while 12.59% of them suffered from wounds or fractures as a result of the abuse they were exposed to. About one third of the students thought that the commonest form of child abuse is verbal punishment such as threatening or humiliation and that the age at the greatest risk for abuse was the primary school age. About 68.36% of students thought that sexual abuse is a huge problem in our society. Only 21.56% of students disapproved child corporal punishment. More than half of the students stated that the most dangerous complication of child abuse is psychological problems such as depression. Most of the included students would talk to the child’s parents and advise them if they saw a case of abuse, while the least would call the police. Only half of the students disapproved female genital mutilation (FGM). The strongest predictive factors for FGM approval were rural residence and male sex. Students mainly thought that FGM is a social habit that is carried out for ethical causes. About half of the students approved legal punishment by the court for FGM performers.ConclusionA significant proportion of the students experienced physical child abuse which left no injuries in most cases; males and first academic year students show more exposure to abuse. Moreover, most of the students think that child corporal punishment can be allowed although about half of them think that the most dangerous aftereffect of child abuse is psychological problems. Lack of reporting the exposure to child abuse is explained by the largest percentage of students to be due to lack of awareness. Rural resident males show more approval of female genital mutilation. A significant lack of awareness about FGM complications is observed in both groups (the health science and non-health science college groups) and the opinions of both groups are very close.

Effects of school-based health education on attitudes of female students towards female genital mutilation in Sudan.

The practice of female genital mutilation (FGM) is widespread in Sudan. Over the years, the government, civil society and the international community implemented multiple interventions to address the issue. However, due to a number of cultural and educational factors, this harmful practice continues. This study aimed to assess the effects of a secondary school-based health education intervention on the knowledge and attitude of female students towards FGM in Sudan. We conducted a quasi-experimental study in Karary Locality, Khartoum State, Sudan. A multistage sampling technique was used to determine targeted schools. Within the schools, students of two randomly selected classes received the intervention. The study included three phases; in the pre-intervention phase, data were collected from the totality of students (154 students) using a pre-tested questionnaire, after which students received health education sessions. The same questionnaire was used to re-collect the data in a post-intervention phase 6 weeks later. The participants were between 14 to 17 years old, 30.3% of which were subjected to FGM. The main source of information about FGM was family and friends (41.1%). The majority of participants had a negative attitude towards FGM. The means of knowledge and attitude scores increased from 8.63 (SD=2.562) and 5.76 pre-intervention (SD=1.937) to 11.99 (SD=2.264) and 6.53 post-intervention (SD=1.164), respectively. School-based health education has a positive impact on both knowledge and attitude of female students towards FGM in Sudan. As such, introducing health education about the complications of FGM in curricula of secondary schools in Sudan has the potential to improve students' knowledge and attitude. Ultimately, such interventions can help reduce the prevalence of the practice when students become responsible for future families.

Case report: epidermoid inclusion cyst of the clitoris as a long-term complication of female genital mutilation

BackgroundFemale genital mutilation is a common procedure in sub-Saharan Africa that causes serious short- and long-term complications. Although physicians can overcome these complications sometimes, they can be very confusing to diagnose. In this report, we discuss the surgical management of a patient with an epidermal inclusion cyst of the clitoris as a long-term complication of type III female genital mutilation.Case presentationA healthy 43-year-old African woman who was a nonsmoker and nonalcoholic presented with a large genital mass causing difficulty in urination and sexual discomfort. The patient had three full-term spontaneous vaginal deliveries without any complications. Perineal examination revealed a 6 × 10-cm, well-circumscribed, mobile, nontender, rounded cystic swelling in the right periclitoral area that was obstructing the urinary meatus and vaginal introitus. A surgical procedure was performed for total excision of the clitoral mass. Pathological findings showed an epidermoid inclusion cyst.ConclusionsBesides increasing clinicians’ awareness of female genital mutilation and its long-term complications, public education campaigns should be designed to eradicate this practice.

Obstetrical Complications of Female Genital Mutilation: Management Maternal-Fetal Medical Care and Prognosis, Obstetrical Gynecology Regional Hospital, Unit of N'zérékoré

Introduction: Female Genital Mutilation (FGM) is a public health problem. There are 100 to 140 million girls and women who suffer every year in the world [1]. The aim of this study is to improve the medical care and reduce complications of FGM at the Regionalhospital of N’zérékoré, to determine their frequency, and to evaluate the maternal-fetalprognosis. Methods: The study was conducted at the Regional Hospital of N’zérékoré. This was a cross-sectional, descriptive and analytic study of 6 months, from 1 September 2016 to 28 February 2017, including all pregnant women admitted for childbirth who had a complication of female genital mutilation. Results: A total of 1295 women gave birth in the service, of which 1204 women were women with female genital mutilation. Given a frequency of 92.97%, of these 1204 mutilated women, 223 presented obstetrical complications during their delivery, a proportion of 17.22%. They were mostly young patients, mostly housewives who were not in school. Type II FGM was the most common (53.06%). Obstetric complications were dominated by complicated perinatal tears (54.08%), and hemorrhages (40.81%). The catch was dominated by perineorrhaphy. Conclusion: The frequency of FGM was 92.97% and that of their obstetric complications 17.22%. Most were house-wives, not in school. There was FGM type II. The abandonment of FGM would reduce maternal and perinatal morbidity and mortality.

Genital and Urinary Tract Obstruction as a Late Complication of Female Genital Mutilation at Latifa Hospital, Dubai, UAE—Case Report

Female genital mutilation (FGM) is partial or total excision of female external genitalia or other deliberate injury to the female genital organs for non-therapeutic purpose. It is cultural and traditional practice. Female genital mutilation may result in immediate complications such as severe pain and bleeding and long-term complications such as: psychological, psychosexual, trauma, infertility, urinary and genital complications.

Surgical management of a huge post-circumcision epidermoid cyst of the vulva presenting unusually in a postmenopausal woman: a case report

BackgroundEpidermoid cysts of the external genitalia are one of the late complications of female genital mutilation. These cysts are usually small and painless. The presentation of a giant vulvar cyst in a postmenopausal woman has not been reported; the surgical management of a large cyst is often challenging.Case presentationA 60-year-old, para VI, Ethiopian woman presented with an 18 cm by 12 cm sized, fluctuant, multi-lobulated, mobile, non-tender vulvar mass involving the mons pubis. She had undergone genital cutting and sewing during her childhood. Informed consent was obtained for surgery and the vulvar cyst was excised successfully without any significant bleeding or injury to the adjacent structures. Her postoperative course was smooth and histopathology confirmed epidermoid cyst of the vulva.ConclusionsHuge epidermoid vulvar cysts following genital mutilation are rare and presentation in a postmenopausal woman has not been reported. Practitioners in areas where female genital mutilation is prevalent should be aware of the peculiar anatomic and technical aspects of the surgical removal of these giant vulvar cysts for successful therapeutic and cosmetic outcomes.

The largest epidermal cyst with vitiligo lesions following female genital mutilation: a case report and literature review

Epidermoid vulvar cystic lesions are proliferations of epidermal cells that can occur as a complication of female genital mutilation (FGM), which is still a common practice in many cultures, especially in Africa. A 36-year-old Sudanese woman presented with an enlarged clitoral mass that had first appeared 2 years earlier. Her medical history showed that she had undergone FGM when she was 3 years old. A perineal examination revealed a mobile, nontender, rounded cystic swelling with vitiligo lesions. After the cyst was excised, it revealed a 13 ×11 × 11 cm unilocular round mass. An epidermoid cyst was reported following microscopy. Follow-up 6 months later revealed a good result with no recurrence. To date, this is the largest epidermoid cyst following FGM and the first one with vitiligo lesions reported in the literature.

Massive epidermal vulval cyst: an unusual late complication of female genital mutilation

Vulval epidermal cysts are rare and infrequently described in literature. They present a difficult diagnostic dilemma and surgical challenges. They most commonly occur as a late complication of female genital...

Psychosexual Complications of Female Genital Mutilation for Couples: A Comparative Study

Introduction: Female genital mutilation (FGM) comprises of various procedures that damage female genitalia for non-therapeutic intentions, and it offers multidimensional and interdependent effects. Objectives: The aim of this study was to determine whether FGM versus non-FGM couples in Kermanshah in Iran vary in relationship characteristics, such as relationship satisfaction, sexual satisfaction, and mental health. Methods: To achieve this goal of research, a sample of 414 couples (206 FGM couples and 208 normal couples) of Uramanat area in Kermanshah Province, were selected by non-randomized sampling. Enrich Marital Inventory, 25-SCL Mental Health Inventory and the Arizona Sexual Experience Scale were used for data collection. Data were analyzed between the two groups by utilizing independent t-test. The significance level was P < 0.05. Results: The findings indicated that there was a significant difference between FGM couples and normal couples. Besides, the results revealed that the two groups of participants had significant differences in mental health, marital satisfaction, and sexual function. Overall, FGM couples compared with normal couples had lower levels of mental health, marital satisfaction, and sexual function. Conclusion: FGM is associated with frequent psychosexual difficulties in Uramanat couples; notably orgasm difficulties, sense of incomplete sexual-needs fulfillment, and neurotic symptoms. Awareness of the psychosexual effects of this operation could help women cope with psychological and psychosexual problems, and could prevent the performing of this inhuman action on others.

Supportive psychotherapy or client education alongside surgical procedures to correct complications of female genital mutilation: A systematic review.

Supportive psychotherapy, in individual or group settings, may help improve surgical outcomes for women and girls living with female genital mutilation (FGM). To assess whether supportive psychotherapy given alongside surgical procedures to correct complications of FGM improves clinical outcomes. We searched major databases including CENTRAL, Medline, African Index Medicus, SCOPUS, PsycINFO, and others. There were no language restrictions. We checked the reference lists of retrieved studies for additional reports of relevant studies. We included studies of girls and women living with any type of FGM who received supportive psychotherapy or client education sessions alongside any surgical procedure to correct health complications from FGM. Two team members independently screened studies for eligibility. There were no eligible studies identified. There is no direct evidence for the benefits or harms of supportive psychotherapy alongside surgical procedures for women and girls living with FGM. Research evidence is urgently needed to guide clinical practice. 42015024639.

Surgical and nonsurgical interventions for vulvar and clitoral pain in girls and women living with female genital mutilation: A systematic review

Vulvar and clitoral pain are known complications of female genital mutilation (FGM). Several interventions have been used to treat these conditions. This review focuses on surgical and nonsurgical interventions to improve vulvar and clitoral pain in women living with FGM. To evaluate the impact of nonsurgical and surgical interventions for alleviating vulvar and clitoral pain in women living with any type of FGM and to assess the associated adverse events. The search included the following major databases: Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov. These were searched from inception until August 10, 2015 without any language restrictions. Study designs included randomized controlled trials, cluster randomized trials, nonrandomized trials, cohort studies, case-control studies, controlled before-and-after studies, historical control studies, and interrupted time series with reported data comparing outcomes among women with FGM who were treated for clitoral or vulvar pain with either surgical or nonsurgical interventions. Two team members independently screened studies for eligibility. No studies were included. Limited information exists on management of vulvar and clitoral pain in women living with FGM. This constitutes an important area for further research. CRD42015024521.

Psychological and counselling interventions for female genital mutilation.

Women and girls living with female genital mutilation (FGM) are more likely to experience psychological problems than women without FGM. As well as psychological support, this population may need additional care when seeking surgical interventions to correct complications of FGM. Recent WHO guidelines recommend cognitive behavioral therapy for women and girls experiencing anxiety disorders, depression, or post-traumatic stress disorder. The guidelines also suggest that preoperative counselling for deinfibulation, and psychological support alongside surgical interventions, can help women manage the physiological and psychological changes following surgery. This synthesis summarizes evidence on women's values and preferences, and the context and conditions that may be required to provide psychological and counselling interventions. Understanding women's views, their own ways of coping, as well social and cultural factors that influence women's mental well-being, may help identify the types of interventions this population needs at different times and stages of their lives.

Knowledge and Attitude of Secondary School Students toward Female Genital Mutilation in Khartoum State, Sudan

Background: Female genital mutilation is a deeply rooted harmful practice in Sudan. Objective: This study aims to assess the knowledge and attitude of secondary school students toward Female Genital Mutilation. Methods: A school-based, descriptive cross-sectional study was conducted in Karary Locality, Khartoum State, Sudan. Four secondary schools for girls were involved in the study. From each school, two second grade classes were randomly selected, and data were collected from all students (292) in these two classes using an author-designed questionnaire. Results: The students were between 14 to 19 years old. Most of them (61.3%) were not circumcised. Regarding students’ knowledge about female genital mutilation types, 23.6% of them knew type 1 and 21.2% knew type 4. On the other hand, only 15.1% and 8.6% knew type 2 and 3, respectively. The majority of the students knew that bleeding, delivery problems and recurrent infections are possible female genital mutilation complications. Additionally, 78.8% of the student thought that circumcision should be stopped, and 70.9% of them would disagree if one of the families wants to circumcise a girl. Furthermore, 74.3% would advise their family members not to practice circumcision, and 68.8% agreed to join activities that aim to stop female genital mutilation. In fact, 68.8% perceive female genital mutilation as a violation to human rights, and 76.0% encourage legislations that fight female genital mutilation. Last of all, 79.8% of the students will not circumcise their daughters. Conclusion: The majority of the students showed good knowledge about female genital mutilation complications. While, minority of them knew its types. Moreover, respondents showed a good attitude toward stopping female genital mutilation.