Female Genital Mutilation Research Articles

Female genital mutilation: trends, economic burden of delay and basis for public health interventions.

The practice of female genital mutilation (FGM) is a health and social problem. Millions of girls and women have undergone FGM or will soon, and more information is needed to effectively reduce the practice. The aim of this research is to provide an overview of the FGM trendlines, the inequality of its prevalence, and the economic burden. The findings shed light on 30-year trends and the impact of the pandemic on planned efforts to reduce FGM which helps with public health interventions. Temporal trend analysis, and graphical analysis were used to assess the change and inequality over the last 30 years. We included 27 countries in which FGM is prevalent. We calculated the extra economic burden of delayed interventions to reduce FGM like COVID-19. For the 27 countries analyzed for temporal trendlines, 13 countries showed no change over time while 14 had decreasing trends. Among the 14, nine countries, Uganda, Togo, Ghana, Benin, Kenya, Nigeria, Central African Republic, Chad, and Ethiopia had high year-decrease (CAGR - 1.01 and - 10.26) while five, Côte d'Ivoire, Egypt, Gambia, Djibouti, and Mali had low year-decrease (CAGR>-1 and < 0). Among these five are the highest FGM prevalence similar distribution regardless the wealth quintiles or residence. There is an economic burden of delay or non-decline of FGM that could be averted. Findings indicate that some countries show a declining trend over time while others not. It can be observed that there is heterogeneity and homogeneity in the FGM prevalence within and between countries which may indicate inequality that deserves further investigation. There is considerable economic burden due to delays in the implementation of interventions to reduce or eliminate FGM. These insights can help in the preparation of public health interventions.

“Why shouldn’t I Be Wanted, Even loved?”: Eugenics, Reproduction, and the Postcolonial in Indra Sinha’s Animal’s People and Nnedi Okorafor’s Who Fears Death

ABSTRACT This article focuses on two postcolonial novels, Indra Sinha’s Animal’s People and Nnedi Okorafor’s Who Fears Death, and argues that through the novels’ explorations of sex, both narratives reconstruct eugenic views that haunt postcolonial societies today. Through sex scenes (and their interruption or absence), the novels illustrate how the characters from India and Sudan respectively experience oppression and discrimination. These experiences are direct outcomes of eugenic views on and practices aimed at selected groups. Through its focus on masturbation and female genital mutilation, as described in the two novels, this article frames the analysis of Animal’s People and Who Fears Death in relation to eugenics, sexual deviance, and sterilization, and foregrounds the ongoing oppression of postcolonial nations. This article carefully examines how eugenics has shaped or further intensified inequality. In particular, it draws parallels between eugenic practices and two kinds of oppression described in Animal’s People and Who Fears Death: the control exercised by the West over postcolonial countries, highlighted through western industrial capitalism’s lack of concern about the genetic health of postcolonial nations and the dysgenic impact of their industries, and patriarchal control of women.

Malay-Muslim women’s perceptions of sunat perempuan in the Malaysian context

Female circumcision (genital cutting) in Malaysia is largely understudied at present. This study unpacks the perceptions of Malay-Muslim women with regards to sunat perempuan (female circumcision) in Malaysia. Through stakeholder engagement discussions organised by a civil society organisation, 17 Malay-Muslim women shared their views in relation to the practice with a particular focus on: (1) their awareness and personal experience of it; (2) their opinions and knowledge about the practice; (3) beliefs related to the practice; and (4) the roles of relevant stakeholders in advocacy work related to the practice. The data were analysed thematically and interpreted based on the grammar of legitimation and social norms theory. The findings reveal several themes, involving the perceived benefits of the practice; tradition and conformity to social norms; conflicting emotions related to religion; and implicit pressure and fear of negative sanctions in relation to the practice. The findings shed light on the concerns faced by Malay-Muslim women in their decision-making process in relation to the practice of female circumcision in Malaysia.

Cutting through complexity: An intersectional analysis of female genital cutting in Indonesia

Female genital cutting (FGC) in Indonesia is still prevalent, and it is increasingly prevalent in urban than in rural areas. This study analyzed the prevalence of FGC in Indonesia and the urbanization and medicalization of FGC practices. Specifically, it addresses the critical questions of how urbanization affects the prevalence of FGC, why the medicalization of FGC became prevalent in urban areas, and how it proceeded with the commercialized form of FGC. This study reviews the existing literature and analyses secondary data from government survey reports and policy documents to answer these questions. The results indicate that the high prevalence of FGC in Indonesia is caused by the complexity of the ambiguity of the government’s stance and policy towards FGC and the influence of the actors involved in FGC practices, such as the government, religious organizations, and medical professionals. Hence, legal measures and comprehensive and culturally sensitive strategies are needed to abandon FGC practices in Indonesia.

The Need for Standardized Nomenclature in Electronic Documentation of Female Genital Cutting in Health Records.

To evaluate the quality of Electronic Health Record (EHR) documentation practices of Female Genital Cutting (FGC) by medical providers. A retrospective chart review study of 99 patient encounter notes within the University of Minnesota health system (inclusive of 40 hospitals and clinics) was conducted. Extracted data included but was not limited to patient demographics, reason for patient visit, ICD code used in note, and provider description of FGC anatomy. Data was entered into REDCAP and categorized according to descriptive statistics. Out of 99 encounters, 45% used the unspecified code for FGC. The most common reason for patient visits was sexual pain, though many notes contained several reasons for the visit regarding reproductive, urological, or sexual concerns. 56% of visits discussed deinfibulation. 11 different terms for FGC were used, with "female circumcision" being the most common. 14 different terms for deinfibulation were found within 64 notes. 42% of encounters included a description of introitus size in the anatomical description, and only 38% of these provided a metric measurement. This study found significant variation in the quality of FGC documentation practices. Medical providers often used the unspecified FGC code, subjective and/or seemingly inaccurate descriptions of FGC/anatomy, and several different terms for both FGC and deinfibulation. Clearly, more education is needed in clinical training programs to (1) identify FGC type, (2) use the corresponding ICD code, and (3) use specific, objective descriptions (including presence/absence of structures and infibulation status).

Harmful Cultural Traditions: An Analysis of Female Circumcision Practice in Maldives

Harmful Cultural Traditions: An Analysis of Female Circumcision Practice in Maldives

The Role of Culture in The Continued Practice of Female Genital Mutilation: A Study of Attah Community, Imo State

Even though the practice of female genital mutilation is not meant to hurt women, it nonetheless endangers their health. This necessitates research into the amount of understanding and cultural complications that prevent its eradication in Africa and Nigeria, particularly in rural communities where the practice is very prevalent. This study, therefore, examined cultural factors that promote the continued practice of female genital mutilation in the Attah community, Imo State. Social convention theory was used as the study's theoretical framework. The survey research method was adopted for this study. Using the multi-stage sampling method, 674 copies of the questionnaire were distributed to the study respondents for the quantitative data. However, only 539 copies of the questionnaire were retrieved. This represents the sample size of this study. For the qualitative data in the study, twelve (12) in-depth interviews were conducted among village and religious leaders. Statistical Package for Social Science (SPSS) was used to process this study's quantitative data, while descriptive and inferential statistics were analyzed. For the study's qualitative data, analysis was done using the content analysis method based on the study objectives. It was found that males are more likely to make decisions that influence the continued practice of Female Genital Mutilation in the Attah community than females. The study also found that cultural expectations for womanhood rite of passage, marriage prospects, and the belief that women with FGM are more likely to be less promiscuous are major factors that influence the continued practice of FGM in the Attah community. Consequently, to end female genital mutilation in the Attah community, there is a need to address those religious and cultural beliefs that negatively affect the control of the practice.

Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis

BackgroundControversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide. MethodsWe searched PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. DerSimonian-Laird random effects meta-analysis including pooled effect estimates with corresponding 95 % confidence intervals was performed. Heterogeneity was assessed using the I2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method. Results14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I2 = 93 %), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I2 = 0 %), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I2 = 95 %). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I2 = 52 %). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I2 = 96 %), perineal tears (OR 4.24, CI 1.09 to 16.46, I2 = 66 %), prolonged second stage of labour (OR 5.19, 95 % CI 1.00 to 26.85, I2 = 66 %), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I2 = 0 %). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6–8), the level of evidence, according to the GRADE assessment, was low. ConclusionsThese results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae. Systematic Review registration: PROSPERO CRD42023421993.

Case Report: Clitoral Epidermoid Cyst Related to Female Genital Mutilation as a Long-term Complication

Case Report: Clitoral Epidermoid Cyst Related to Female Genital Mutilation as a Long-term Complication

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.

Contextual determinants of generational continuation of female genital mutilation among women of reproductive age in nigeria: analysis of the 2018 demographic and health survey

BackgroundFemale genital mutilation (FGM) has negative health implications and has long been recognised as violating sexual rights. Despite the huge efforts expended on eradicating FGM, generational continuation of the practice, i.e. the act of mutilated women also mutilating their daughters, persists in Nigeria. This study investigated the individual, household, and community factors associated with generational continuation of FGM among women in Nigeria.MethodsThe study analysed data from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 3835 women with FGM history and who had given birth to female children was analysed. Models were estimated using mixed-effects multilevel logistic regression with Stata 16.0.ResultsThe results showed that 40.0% of women continued FGM for their daughters. Regional prevalence of FGM continuation ranged from 14.9% in the South-South (the lowest) to 64.3% in the North-West (the highest). Women aged 15–24 years (uaOR = 0.40; 95% CI:0.28–0.57) and rich (uaOR = 0.44; 95% CI:0.35–0.56) had the least likelihood of generational continuation of FGM. In communities with low proportions of women unexposed to the media, the likelihood of FGM continuation was significantly higher (uaOR = 1.85; 95% CI:1.35–2.53). Generational continuation of FGM was significantly lower in communities with moderate proportions of uneducated mothers (aOR = 0.6; 95% CI:0.42–0.86).ConclusionFGM continuation was high in Nigeria, and it was most common among older and poor mothers and in communities with large proportions of uneducated women and those unexposed to the media. Existing National Policy and Plan on FGM elimination should be strengthened to target these characteristics.

Re-evaluating the Legal and Institutional Complications Affecting the Protection of Women's Rights in Cameroon: The Need to Remedying the Odds

Several complex legal and institutional issues beset preserving women’s rights in Cameroon. Women’s rights refer to a wide range of ideals and entitlements intended to guarantee gender equality and encourage women’s full involvement and empowerment in all spheres of society. These rights include freedom from violence, equality, education, health, and body autonomy, among other things. However, even with the modern conception and advancement of today's society, women continue to be treated inhumanely, uncaringly, and pitilessly, thereby affecting their status and rights acquired in today´s society, with the numerous legal instruments wavering from the Universal Declaration of Human Rights, the Convention on the Elimination of all Forms of Discrimination Against Women, the Maputo Protocol, the African Charter on the Welfare of the Child, and hosts of other condemning the illegal practices experienced by women on the international scene. The increase in violations continues to be rampant. With all the praiseworthy struggles instigated and affected by these instruments, the degree of violation of women's rights is increasing and increasing in Cameroon. Women continue to experience violations of their rights, especially those related to Female Genital Mutilation, Sexual Abuse, Rape, widow practices, and many other harmful practices. The query one would be posing here is in searching why Cameroon is considered a State of Law, devouring great efforts in certifying that women anguishing from the effect of violence should be protected, continue to experience an increase in cases of women's rights violations. In this vane, it will be sufficient for us to assess the various legal and institutional dispositions put in place by the State of Cameroon in handling cases of violence done against women. It is surprising that with all the laws initiated by the State of Cameroon from the Constitution, the Penal Code, the Labour Code, the Civil Status Registration Ordinance, and the Civil Code enacted to deal with cases of violence done on Women, there exists no concrete and concise law handling matters of violence against women. The situation of child marriage, Female Genital Mutilation, Breast Ironing, Widow Practices, and Property Discrimination continue to be a nightmare and a pandemic to eradicate in the country, irrespective of the efforts introduced by competent authorities. There is a need to redress the situation for a better protective climate for women and their societal statuses.

INTERROGATING THE PERSISTENCE OF FEMALE GENITAL MUTILATION IN ILORIN, KWARA STATE, 2000-2020

Female genital mutilation is also known as female genital cutting and female circumcision which comprises all procedures involving a partial or total removal of the external female genitalia either for cultural or other non-therapeutic reasons. FGM is a sensitive topic and issue because it cuts across several cultures and needs to be addressed with great care, without affecting people’s feelings as it touches on other people’s cultures. The practice is, therefore, still deeply entrenched in the Nigerian society. Despite efforts to raise awareness of FGM’s medical complications through governmental and non-governmental organizations, the practice persists in some communities, and this makes one ponder on the factors that seem to preserve the practice. This paper using both primary and secondary sources of historical research methodology assesses the socio-cultural and religious factors that contributed to the continuous practice of female genital mutilation in Ilorin despite the international condemnation. In Nigeria, the South-south (77 percent) has the highest incidence of Female Genital Mutilation among adult women, followed by the South-east (68 percent), and the South-west (65 percent). However, it was only lightly practised in the North, surprisingly leaning toward a more extreme form. At the national level, 41 percent of adult women have had Female Genital Mutilation typically carried out by a traditional circumciser using a blade. There was a significant relationship between the persistence of the practice of FGM and social structures, cultural, and religious beliefs. The study shows that the continuous practice of female genital mutilation in Ilorin is not due to ignorance, but a longstanding tradition and religious belief.

Effect of Female Genital Mutilation on Sexual Function in Ibadan, Nigeria

Objective: Female genital mutilation, which harms women physically and psychologically, also causes serious problems in sexual life that continue throughout life. This study aimed to determine the impact of female genital mutilation on sexual outcomes in Ibadan, Nigeria. Method: This is a cross-sectional descriptive study. A self-administered questionnaire was used to obtain data from 161 women who agreed to participate in the study. After the data were collected, the sample group was divided into two groups those with female genital mutilation (84) and those without (77), and they were compared in terms of sexual outcomes. Results: Type I (77.3%) and type II (22.7%) mutilations were found in women with female genital mutilation. It was determined that women with FGM experienced statistically significantly more pain and bleeding during vaginal penetration than uncircumcised women. At the same time, the orgasm rate was found to be statistically significantly lower in this group. Conclusions: Our study revealed that female genital mutilation and enlargement of the incision area negatively affect sexual health.

Female genital mutilation/cutting among girls aged 0–14: evidence from the 2018 Mali Demographic and Health Survey data

BackgroundFemale genital mutilation/cutting (FGM/C) is considered a social norm in many African societies, with varying prevalence among countries. Mali is one of the eight countries with very high prevalence of FGM/C in Africa. This study assessed the individual and contextual factors associated with female FGM/C among girls aged 0–14 years in Mali.MethodsWe obtained data from the 2018 Mali Demographic and Health Survey. The prevalence of FGM/C in girls was presented using percentages while a multilevel binary logistic regression analysis was conducted to assess the predictors of FGM/C and the results were presented using adjusted odds ratios with associated 95% confidence intervals (CIs).ResultsThe results indicate that more than half (72.7%, 95% CI = 70.4–74.8) of women in Mali with daughters had at least one daughter who has gone through circumcision. The likelihood of circumcision of girls increased with age, with women aged 45–49 having the highest odds compared to those aged 15–19 (aOR = 17.68, CI = 7.91–31.79). A higher likelihood of FGM/C in daughters was observed among women who never read newspaper/magazine (aOR = 2.22, 95% CI = 1.27–3.89), compared to those who read newspaper/magazine at least once a week. Compared to women who are not circumcised, those who had been circumcised were more likely to have their daughters circumcised (aOR = 53.98, 95% CI = 24.91–117.00).ConclusionThe study revealed the age of mothers, frequency of reading newspaper/magazine, and circumcision status of mothers, as factors associated with circumcision of girls aged 0–14 in Mali. It is, therefore, imperative for existing interventions and new ones to focus on these factors in order to reduce FGM/C in Mali. This will help Mali to contribute to the global efforts of eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030.

(011) Exploring Pretending Orgasm and Sexual Satisfaction Among Egyptian Women: A Cross-Sectional Survey Study

Abstract Introduction Research on sexual satisfaction, especially orgasm, has focused on North American and Western contexts. Studies show women frequently pretend during PVI to end activity or avoid consequences. Reasons vary from emotional communication to mate deception, not always related to sexual dysfunctions. Sociosexuality may influence behaviors, with casual sex individuals less likely to fake orgasms for positive feedback. Limited research on non-Western societies, especially Egypt, prompted this study to explore prevalence and reasons for pretending orgasm among Egyptian women, investigating correlations with sexual orientation, sexual violence history, dysfunction, and family size. Objective 1. Prevalence of faking orgasm in Egyptian adults. 2. Reasons for faking orgasm in Egyptian women. 3. Correlations with sexual orientation, violence history, dysfunction, and family size. 4. Insights into sexual scripts in Egyptian society. Methods This cross-sectional survey investigates reasons for faking orgasm in Egyptian women. A convenience sample of women aged 18 and above was recruited through social media, community centers, and universities. Data collection occurred between [December 2020] and [February 2021], with participants providing informed consent for the online survey. The survey includes 51 questions on pretending orgasm and a structured interview for demographic information. Participants rated reasons on a Likert scale, and quantitative data will be analyzed using descriptive and inferential statistics to identify prevailing motives. Results In the survey of 626 Egyptian women: •38.6% (242 women) reported pretending orgasm during sexual encounters. •Common reasons for pretending included: wanting to end sexual activity (55.9%–350 women), avoiding negative consequences (66.6%–417 women), and pleasing their partner (55.9%–350 women). •Sociosexuality played a role, with 38.3% (240 women) of those interested in casual sex less likely to fake orgasms for positive feedback. •96.2% (602 women) identified as heterosexual, 1% (6 women) as homosexual, and 2.9% (18 women) as bisexual. •85.2% (534 women) were married, 6.4% (40 women) divorced, 2.6% (16 women) separated, and 5.7% (36 women) in a relationship. •91.8% (575 women) belonged to small families, and 8.2% (51 women) to big families. •14.1% (88 women) had multiple sexual partners, and 16.5% (103 women) suffered from psychological dysfunction. •43.2% (271 women) engaged in sexual relationships more than once a week, 26.9% (168 women) once a week, and 17.6% (110 women) once a month. •32.6% (204 women) were sexually satisfied, 9.6% (60 women) were not satisfied, and 7% (44 women) were neutral. •45.5% (285 women) had a history of sexual harassment, and 27.6% (173 women) had a history of Female Genital Mutilation (FMG). Conclusions The study reveals a prevalent practice of pretending orgasm among Egyptian women (38.6%). Reasons for pretending vary, with a significant percentage aiming to end sexual activity (55.9%), avoid negative consequences (66.6%), and please partners (55.9%). Sociosexuality plays a role, with 38.3% of those interested in casual sex less likely to fake orgasms for positive feedback. Findings emphasize open communication for sexual satisfaction and relationship well-being. Limitations include self-report bias and limited generalizability. Future research should explore diverse contexts and long-term effects on relationship satisfaction. Addressing complexities is vital for healthy relationships among Egyptian women. Disclosure No.

Understanding Acharya’s Concept on Norms Localization: A Lesson Learned from Localization of Transnational Norms on Banning Female Genital Mutilation (FGM) in Gorontalo, Indonesia

This paper is a critical review of Amitav Acharya's concept related to the process of global norm adaptation. Acharya wrote that norm internalization leads to three possible outcomes, i.e., the norms being accepted (norm displacement), adapted and modified (localization), or rejected (resistance rejection). This paper will analyze the localization of transnational norms to the domestic sphere, both the process, and its result. To understand Acharya's concept, the authors use a case study of global norm localization on anti Female Genital Mutilation (FGM) in Gorontalo, Indonesia. In Gorontalo, the global norm of FGM was initially accepted by the people and was implemented as government policies. However, later on there was rejection by the people which pressured for the modification of the regulation. According to Acharya, this was made possible by the role of key actor of norm adaptation, which are the local agents.This paper tries to answer the question "How is the process of localization of transnational norms in the case study of female genital mutilation in Gorontalo, Indonesia?" which then contributes to the identification of the different factors that facilitate local agents to successfully modify the transnational norms imposed to the local settings.&#x0D;

Healthcare professionals attitudes on “Female Genital Mutilation”: an observational study

Healthcare professionals attitudes on “Female Genital Mutilation”: an observational study

Maternal origin matters: Country of birth as a risk factor for obstetric anal sphincter injuries.

Obstetric anal sphincter injuries (OASIS) are severe complications to vaginal births with potential long-term consequences. Maternal origin has been proposed to affect the overall risk, but the association and underlying explanation are uncertain. The objective was to assess the association between maternal country of birth and OASIS. A Swedish nationwide cohort study including singleton term vaginal births during 2005-2016. Data were extracted from the Swedish Medical Birth Registry and Statistics Sweden. Modified Poisson regression analyses were performed to obtain crude and adjusted risk ratios (RRs). Adjustments were made in four cumulative steps. Sub-analyses were performed to investigate the risk of OASIS associated with female genital circumcision (FGC). In all, 988 804 births were included. The rate of OASIS in Swedish-born women was 3.5%. Women from East/Southeast Asia had an increased risk of OASIS (adjusted RR [aRR] 1.71, 95% confidence interval [CI] 1.60-1.83), as did women born in Sub-Saharan Africa (aRR 1.60, 95% CI 1.49-1.72). The risk remained significantly increased also after adjustment for maternal height. By contrast, women from South/Central America had a decreased risk of OASIS (aRR 0.65, 95% CI 0.56-0.76). FGC was associated with an increased risk of OASIS (aRR 3.05, 95% CI 2.60-3.58). Episiotomy appeared to have an overall protective effect (aRR 0.95, 95% CI 0.92-0.98), but not significantly more protective among women with female genital mutilation. Country of birth plays an important role in the risk of OASIS. Women from East/Southeast Asia and Sub-Saharan Africa are at significantly increased risk as compared with Swedish-born women, whereas women from South/Central America are at lower risk. FGC is also a significant risk factor for OASIS.

Challenges in cosmetic gynecology surgery: A case series

Background: Cosmetic and functional gynecology is a novel specialty that is rapidly gaining tractionacross the globe, particularly in Europe, Asia, and America. These intricate procedures enhance theesthetics and restore the physiological function of the genitalia. This relates very closely to womensexuality, dignity, self-esteem, and overall confidence. Self-esteem is often closely mirrored anddependent on a person’s perception of her genitalia, both functionally and more recently esthetically. Anincreasing number of gynecologists are gradually embracing this art of restoration as the demand rapidlyincreases among patients. The outcomes are sometimes not pleasing to the patients and may requirerevision.Case series: We present four case series of undesirable outcomes from labiaplasty andperineovaginoplasty. The surgical procedures had to be repeated in two instances because of spousaldemand or from the lady herself.Case 1: Reconstruction after Type IV female genital mutilation (FGM)A 46-year-old grand multipara with Type IV FGM presented with sexual dysfunction and psychosexualproblems arising from FGM. She requested reconstruction of the labia minora, restoration of the labiamajora, and perineovaginoplasty. Examination revealed partial clitoridectomy, a narrowed vaginalintroitus with the removal of the labia minora, and excision of the labia majora. The missing tissues madethe reconstruction technically difficult. Labia minora was reconstructed from the labia majora by thegrooving technique, and labia majora fat augmentation with perineoplasty was performed with goodoutcomes.Case 2: Perineoplasty revision.A 43-year-old, para 3+0, presented with complaints of lax vaginal muscles after her third delivery. All herdeliveries were normal, vertex. She sustained a second-degree perineal tear after her last delivery, whichwas repaired. She was started on Kegel’s exercises with no improvement. She had a perineoplasty donesuccessfully, but she healed with a small rent. A revision was performed with good results.Case 3: Perineoplasty revisionThe patient underwent vaginoperineoplasty, but the perineum healed with a little bump, which both thepatient and the spouse did not like. Revision of perineoplasty was performed with excellent outcomes.Case 4: Revision of an overly tight vagina after vaginoperineoplastyThe patient had previously undergone vaginoperineoplasty but felt it was not tight enough. However,three months after revision, the spouse complained of incomplete penetration, whereas the patientcomplained of pain at the fourchette. Another revision was performed to address their concerns withgood outcomes. Conclusion: Cosmetic gynecological procedures must achieve satisfactory outcomes and restore theclient’s genital esthetics and functionality. Although some procedures are technically challenging and mayrequire repeat procedures, patient satisfaction is key. Knowledge of pelvic anatomy and restoration techniques is a prerequisite for achieving acceptable outcomes. Counseling of the couple is an integralpart of cosmetic gynecology to manage expectations and rule out psychosocial causes.