Female Genital Mutilation Research Articles

Labiaplasty in Minors: Medicalizing Mutilation?

Labial hypertrophy, which lacks an accepted definition, is generally understood to refer to morphological and aesthetic characteristics of the labia believed to deviate from a perceived norm. Such ostensive deviation has the potential to affect many domains of a person's well-being, as does its surgical treatment, labiaplasty. Nearly 24,000 labiaplasty procedures were performed in the United States in 2022, representing a greater than three-fold increase since numbers were first reported in 2013. Nearly 20% of these procedures were performed on minors, and cases have been reported in children well before complete pubertal development or the age of personal consent. In this article, we explore the indications that are used to designate labiaplasty as "medically necessary" in minors, a status that, we argue, is required for such procedures to avoid fitting the definition of "medicalized FGM" (i.e., "female genital mutilation") according to the World Health Organization. As a part of this, we consider the particular ways in which outcomes are measured in this population. We shed light on persistent methodological shortcomings in the research on labiaplasty, discuss ethical and legal implications, and make recommendations to improve the relevance, reliability, and generalizability of future investigations into this increasingly common, controversial surgical procedure.

Utilizing Citizen Generated Data to enhance Women's Access to Sexual and Reproductive Health Services in Somalia: Insights, Barriers, and Pathways Forward

Purpose: This study was undertaken to capture citizen’s insights on practical steps that individuals, families, communities, and institutions could take to support the improvement of Sexual and Reproductive Health (SRH) services in Somalia. This includes raising awareness of issues affecting women's access to SRH, such as Gender-Based Violence (GBV) and Female Genital Mutilation (FGM). Methodology: This research employed a qualitative research design, utilizing semi-structured radio questions distributed through various channels such as radio promos, mini-dramas, interactive radio shows, and Short Messaging Service (SMS) on mobile phones. To enhance and validate the findings from the radio series, thirty Focus Group Discussions (FGD) involving 270 'hard-to-reach' participants were conducted across all Federal Member States (FMS) of Somalia, excluding Somaliland. Collaborating with 20 radio stations, a total of 4,268 participants from across Somalia were involved in this study. The qualitative data obtained was categorized into themes, and the subsequent information was analyzed using content analysis methodology for qualitative data, as well as descriptive statistics and inferential analysis through statistical package for social science (SPSS) version 25 and excel for quantitative data. The presentation of the data included the use of tables and figures. Findings: This study outlined key challenges in accessing quality SRH services for women in Somalia. Priorities included enhancing healthcare infrastructure and availability of SRH professionals, along with emphasizing health education on reproductive health and family planning. Food insecurity's impact, especially among displaced populations, was noted. GBV and FGM were highlighted, calling for comprehensive survivor care and male involvement in prevention. Collaboration between schools and the private sector was proposed for menstrual hygiene. Men's support for SRH access was deemed crucial. Addressing stigma around SRH access, GBV, and FGM was stressed, urging comprehensive awareness campaigns and improved healthcare provision for survivors. Unique Contribution to Theory, Practice and Policy: Addressing women's SRH in Somalia involves investing in healthcare infrastructure, expanding health education programs, ensuring access to nutritious food, and engaging men as allies in promoting women's SRH rights. Moreover, efforts to combat stigma, GBV, and FGM must be culturally sensitive and inclusive, involving religious and community leaders, and addressing underlying socio-economic factors contributing to these issues.

African Culture & the Girl-Child Education

This research article underscores the cultural factors that influence girl-child education among the Ilchamus community. Various literatures were reviewed and gaps were successfully identified. It embraces descriptive research design. It utilises purposive and snowballing techniques since the initial research that culminated into an article was basically a mixed research. The sample size of the study was 350 respondents. It establishes that; the practice of female genital mutilation (FGM), often linked with traditional rites of passage, is typically followed by early marriage, which disrupts girls’ education. Additionally, early marriage typically curtails educational opportunities for girls, as they are often expected to take on domestic responsibilities and childbearing, leaving little room for schooling. In this regard, it concludes that; cultural practices like FGM and early marriages are deeply rooted barriers to girl-child education in the Ilchamus community, while the role of parents’ education and cultural transitions reflect more nuanced influences on educational outcomes.

Analyzing effective interventions against female genital mutilation across different regions

Female Genital Mutilation (FGM) remains a critical human rights issue affecting millions of girls and women. FGM is deeply rooted in cultural and religious traditions, posing significant challenges to its elimination. The trauma inflicted by FGM extends beyond physical pain, leading to severe psychological and emotional consequences. Addressing this complex issue requires a comprehensive approach that integrates legal, educational, medical, and community-based interventions. The paper examines the dynamics of FGM across multiple countries, utilizing third-party data from the United Nations Population Fund. By presenting a comprehensive analysis of these strategies, this paper aims to contribute to the fight against FGM, offering insights and recommendations for policymakers, activists, and practitioners dedicated to ending this practice. The eradication of FGM requires sustained, multi-dimensional efforts to ensure the protection and empowerment of girls and women.

Disrupting harmful gender norms: Youth at the centre

Disrupting harmful gender norms: Youth at the centre Dr Claudia Mitchell, Director of the Participatory Cultures Lab, Department of Integrated Studies in Education (DISE). McGill University, tells us about the TRANSFORM project aimed at disrupting harmful gender norms and mobilizing for social change. Gender inequalities and discrimination persist glaringly around the globe. Gender-based violence stands out as one of the most widespread human rights violations. Forced and early marriage and female genital mutilation also continue to have an impact on the lives of young people. The United Nations has identified transforming harmful gender norms as a critical goal among its 17 Sustainable Development Goals for 2030.

Ending Female Genital Mutilation: A New Ruling in the Gambia Can Reignite Progress Towards SDG Target 5.3.

Ending Female Genital Mutilation: A New Ruling in the Gambia Can Reignite Progress Towards SDG Target 5.3.

Parental Experience on Female Circumcision in East Coast of Malaysia

INTRODUCTION: Female circumcision (FC) is a deep-rooted tradition in Malaysia, influenced by religious, cultural, and health beliefs. However, it has drawn criticism for its similarities to Female Genital Mutilation (FGM) in Africa, particularly during the 2018 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) by the United Nations Human Rights (UNHR). Amidst this backdrop, this study aimed to investigate parents' perspectives and experiences concerning female circumcision, as well as the factors driving its persistence. MATERIALS AND METHODS: This qualitative study used phenomenological approach and 20 in-depth interviews were conducted using a semi-structured questionnaire until data saturation were reached. We employed convenience and snowball sampling methods. The interviews were recorded, transcribed, and analyzed using NVivo 12 software. We used thematic analysis to identify key themes in the data. RESULTS: Three themes emerged from the interviews: (1) FC is a ‘fitrah’, (2) maintaining good health is the main influence; and (3) FC causing no harm. The main influences on this practice are religious, cultural, and health factors. Parents described the procedure as simple and harmless for the baby and themselves, both physically and emotionally. CONCLUSIONS: This research shown that FC in Malaysia is not solely religious but deeply embedded in culture. The blend of cultural and religious aspects makes it a crucial practice for some.

Case report: A Large Fibroepithelial Polyp of the Vulva

Fibroepithelial polyps are one of the most common benign masses of the vulva and are characterized by relatively small size, vague symptomatology, and morphological diversity. These lesions mainly affect women of reproductive age and are hormone dependent. They are usually found around the urogenital area. A biopsy and histological examination are necessary to exclude the possibility of malignant neoplasm. The pathophysiology of the disease appears to be associated with the coexistence of diabetes mellitus, chronic inflammation and chronic friction. Below we will describe the case of a 17-year-old Somali patient who had undergone female genital mutilation type IIb tyand who presented to the regular clinic with a reported unspecified vulvar mass with coexisting chronic lower limb lymphedema.

Harmful Traditional Practices Affecting the Under-Five Years Children and Associated Factors in Sokoto, State, Nigeria

Introduction Harmful traditional practices violate and negatively affect the physical, psychological well-being and right of women and children. Nigeria has the third highest absolute number of women and girls who have undergone Female Genital Mutilation (FGM) worldwide. Aims To assess the harmful traditional practices on the under-five years children and associated factors in Sokoto, State, Nigeria. Methods A community based cross sectional study that was conducted in Sokoto State, Nigeria on 320 mothers of under-five year children from 1st January-31st March 2021. The study participants were selected using multi stage sampling method, after proportionate allocation of sample size, systematic random sampling method was used to get the study participants. A structured questionnaire was used to collect information on harmful traditional practices from the mothers of the eligible children. Data was analysed using SPSS version 22. Results The mean age of the children was 22.5 ± 17.7 months, there were 199(62.2%) males and 121(37.8%) females, and male to female ratio was 1.6:1. Eighty (25.0%) of the under five-year children were circumcised by traditional healers, 189(59.1%) had traditional uvulectomy, 86(28.9%) had female genital mutilation, while 11(3.4%) had scarification marks. The respondent’s educational status (p = 0.008) and (p = 0.001) were factors associated with the practice of FGM and circumcision respectively. Conclusion Harmful traditional practices are still prevalent in Sokoto. Government at all levels should embark on awareness creation programs on the dangers of these harmful traditional practices through mass media, schools, traditional leaders and religious places. Child protection laws should be implemented to curtail these harmful practices.

Experiences, health needs, and access to health services of university students with female circumcision: A qualitative study.

This study aimed to assess the female circumcision (FC) experiences, healthcare needs, and access to health services of foreign university students who are victims of female genital mutilation and studying in Turkey. This descriptive qualitative study was conducted in the Faculty of Health Science in a state university in Turkey from December 2021 to January 2022. Eight students who had been subjected to FC participated in this study. Data were collected by conducting in-depth, semistructured online interviews and using a pilot-tested interview guide. The data were analyzed using inductive thematic analysis. Four themes emerged: "reasons for performing FC, 'health effects of FC,' 'psychological problems linked to FC,' and 'FC survivors' access to health services.'" Students stated that they exposed to this practice because of limiting their womanhood, they experienced problems, such as pelvic pain, infection, loss of sexuality, fear of pregnancy and birth, and they had healthcare needs due to FC but face some barriers. FC negatively affects women's health and has specific healthcare needs. Studying in a different country can be turned into an opportunity to solve the health problems they experience. For this, the right approach with knowledgeable and culturally sensitive health professionals can change stereotypes towards practice.

Traditional female cervical cauterization and risk of preterm birth in Somalia: a single-center prospective observational study

Numerous traditional practices are both beneficial and harmful. Traditional harmful practices, such as female genital mutilation and traditional cervical cauterization, are carried out for a number of reasons but can have negative health and social effects. In addition to deeply held beliefs, a lack of knowledge and awareness of the consequences of these practices contributes to the persistence of these issues. The objective of this study is to examine whether traditional cervical cauterizations were associated with preterm births in Somalia. This prospective cohort study was conducted at our hospital over a one-year period. Seven hundred and two patients were included in this study; these patients were divided into two groups, cauterized and non-cauterized groups, and the two groups were compared on pregnancy outcomes. We examined whether traditional cervical cauterizations were associated with adverse pregnancy outcomes, including preterm births. According to the findings of this study, traditional cervical cauterization was prevalent among patients visiting MSTREH (n = 328, 46.7%). Infections of the uterine cervix and infertility were the two main indications for cauterization, 44.8%, and 34.8%, respectively.Being older, uneducated, and poverty were significantly associated with traditional cauterization (P < 0.001). There was a significant correlation between prior traditional cervical cauterization and the risk of preterm births. Women with prior cauterization were two and half times more likely to deliver a preterm fetus (OR: 2.64, 95% CI 2.15–3.33) compared to non-cauterized mothers. Our findings show that women who have previously undergone traditional cervical cauterization have a significantly higher risk of preterm birth and negative pregnancy outcomes than non-cauterized women. Health professionals, particularly those who are close to the community, are crucial in developing and putting into practice plans to end harmful traditions in Somalia.

New perspectives on fighting violence against women.

Gender-based violence (GBV) and, more specifically, violence against women (VAW) are commonly considered a consequence of a patriarchal structure-a social system granting the senior male absolute authority over the family and the community as a whole. Anthropologists have documented that human male dominance is rooted in evolution, with male violent behavior observed among the great apes. Given that evolution is a continuous process, human progress over millennia has modified pre-existing behavior, demonstrating that humans can move beyond ancestral ways of life over time. Precisely because of the imperative to change and improve, at the global international level as well as in individual countries, strong movements are in action to eliminate GBV/VAW. FIGO has been and continues to be at the forefront of the battle for equality, with initiatives that cover many aspects of this, including the imperative to involve men, who-in the majority of cases-are the perpetrators. Since men are often the root of the problem, they must also be at the forefront of the battle to eradicate it. GBV/VAW comprises many facets, including selective female abortion, infanticide, femicide, honor killing, female genital mutilation, and child marriage. These deeply rooted forms of violence continue to perpetuate gender inequalities, remain major obstacles to health and societal progress, and violate the most basic human rights.

Comparison of Menstrual Symptoms in University Students with and without Female Genital Mutilation/Cutting.

The aim of this study was to compare the menstrual symptoms and dysmenorrhea in university students who underwent Female genital mutilation/cutting (FGM/C), in Mogadishu, Somalia, and students who did not undergo FGM/C in Ankara, Türkiye. A comparative cross-sectional study design was used. Among the participants with FGM/C, 88.5% were Type 1 and the age at FGM/C was 8 years. The pain severity was 6.20±2.54 in women with FGM/C and was higher than that of those without FGM/C (5.97±2.32), but no significant difference was found. Among those who had FGM/C, 66% had a menstrual duration of 3-5 days, while 52.0.% of those who did not have FGM/C had a menstrual duration of 6-8 days (p<0.05). While 85.1% of those without FGM/C had a menstrual cycle of 21-35 days, 35% of those with FGM/C had a menstrual cycle of less than 20 days (p<0.05). It was found that 95% of those who have undergone female circumcision and 90.2% of those who have not had dysmenorrhea (p<0.05). Painkillers were always used by 28% of women with FGM/C and 26.3% of women without FGM/C (p<0.05). The total MSS score of those who have not had FGM/C was 3.34±0.72 and the score of those who have had FGM/C was 2.91±0.74 (p<0.05). The negative effects sub-dimension score was found to be higher in the non-FGM/C group with 3.20±0.75, while the coping methods sub-dimension score was higher in the FGM/C group with 2.91±1.13 (p<0.05). FGM/C is still common in Somalia. Our study results showed that having FGM/C may cause differences in dysmenorrhea and menstrual symptoms. Efforts to increase students' effective coping with menstrual symptoms and dysmenorrhea are thought to be useful.

EU approach towards violence against women and domestic violence – new EU Directive

European Union (EU) approach towards violence against women and domestic violence is analyzed through interconnection with principles of gender equality and nondiscrimination. The combination of gender-based discrimination and gender inequality with other forms of discrimination (economic, political, etc.) very often result in specific forms of violence against women. EU acceded the Istanbul Convention on preventing and combating violence against women and domestic violence of the Council of Europe in June 2023, which was spiritus movens for the adoption of the new EU Directive in this field. Achievements and shortcomings of this Directive are presented, as well as its significance within existing relevant EU primary and secondary legislation. New legislation criminalizes the following offences across the EU: female genital mutilation, forced marriage, non-consensual sharing of intimate images, cyber stalking, cyber harassment and cyber incitement to hatred or violence. However, criminalization of rape is lacking due to the absence of agreement of the constitutional element of sexual consent. Instead, prevention of rape and raising awareness of the importance of central role of consent are included. Taking into account the problem of secondary victimization, the Directive regulates rules on the measures of assistance and protection to victims that are to be secured by Member States, who are obliged to implement Directive in three years period. Directive gains special significance when taking into account relevant official data on violence against women in the EU. This Directive is to be considered the step forward in the direction of realization of gender equality de facto.

Ultrasound-guided staging and reversal of female genital mutilation.

FGM/C is common, effecting over 200 million women worldwide and has substantial associated morbidity. We seek improving the reversal procedure using ultrasound imaging. The use of peri- and intraoperative ultrasound imaging for reconstructive surgery following FGM/C for staging and surgical planning, with focus on the clitoral structures and blood flow. This is a case series of patients with FGM/C who were evaluated and underwent reconstructive surgical management at a single institution between 2018 and 2022. Ultrasound examination with Doppler imaging was performed. The electronic medical record was queried for data regarding patient characteristics, examination and ultrasound findings, and surgical and postoperative course. Seven patients are described in this case series who sustained the FGM/C with classifications ranging from Ia to IIIb. The primary complaints were dyspareunia or apareunia. Six of seven (86%) reported anorgasmia. Four of seven (57%) had prior vaginal deliveries, and one of seven (14%) was delivered only by cesarean sections, two of seven (29%) have not been able to have intercourse. Ultrasound examination was utilized to facilitate recognition of the anatomic structures during the reconstruction, and Doppler was used to evaluate the clitoral blood flow. Doppler was useful to delineate clitoral tissues from a closely involved periclitoral inclusion cyst, aiding in surgical excision while minimizing clitoral vascular or nerve injury. Postoperative anatomical restoration, sexual function, and alleviation of dyspareunia were excellent. None of the patients reported decreased sexual pleasure postoperatively. Ultrasound imaging with Doppler can be utilized to facilitate personalized approaches to optimize both anatomical and functional results in cases of genital reconstruction.

Tradition of Tetesan in Central Java

One of the traditions in Java in the life cycle is the tradition of dripping or female circumcision, especially at the age of 8-12 years. The various meanings of this dripping tradition are, for example, a sign of maturity, avoiding bad things and getting good fortune. At present, the dripping tradition has been abandoned by many Javanese people. Moreover, there is some information that drops are not good for health. However, this tradition must be maintained and preserved. The purpose of this study is to find out an overview of the dripping tradition in Central Java, especially Central Java and Yogyakarta. Moreover, there are differences in the implementation of the drip for ordinary people and the Yogyakarta Palace. The research method used is the historical method. As expressed by Kuntowijoyo in his book Introduction to History which states that the historical research method has five stages, namely topic selection, heuristics (source gathering), source criticism (verification, interpretation, and historical writing (historiography). The results of this study are how practice is the tradition of dripping in Central Java, namely Central Java and Yogyakarta, especially for ordinary people and the Yogyakarta Palace. The procedures for ordinary people are relatively ordinary while at the Yogyakarta Palace it is classified as complex because there are rules. And also, this drip is included in the oral tradition because it is tied to beliefs, meanings, symbols, norms, and customs that describe the meaning of this dripping tradition.

Climate change and sexual and reproductive health and rights research in low-income and middle-income countries: a scoping review

IntroductionThis study aimed to provide an overview of the research landscape and to identify research gaps linking climate change events and sexual and reproductive health and rights (SRHR) in low-income...

Incorrect and Sex-Inconsistent Mapping of Disorders: Identification of Sex Biases in the ICD-10, ICD-11 and SNOMED CT and How to Work Around Them.

In the international classifications ICD-10-WHO and ICD-11-WHO, many sex-specific diseases have incomplete coding. It is possible to further enhance semantic interoperability using SNOMED CT additionally to ICD. Part of the analysis of semantic interoperability of diagnoses in the ICD are Sexual Dysfunctions, Postpartum Depression, Sexual Assault, Premenstrual Tension Syndrome and Premenstrual Dysphoric Disorder, Female Genital Mutilation and Cutting, Gender Incongruence and Disorders of Breast. Labeling biases have been identified in all diagnoses, either in SNOMED CT or ICD. For mental disorders associated with pregnancy, gender incongruence and sexual violence the use of the GPS of SNOMED CT can help enhance semantic interoperability additionally to ICD.

Discerning Deinfibulation: Impact of Personal, Professional, and Familial Influences on Decision-Making.

The past decades have seen large numbers of Somali women migrate across the globe. It is critical for healthcare workers in host countries to understand healthcare needs of Somali women. The majority of Somali female migrants experience female genital cutting (FGC). The most common type in Somalia is Type 3 or infibulation, the narrowing of the vaginal introitus. Deinfibulation opens the introitus to reduce poor health outcomes and/or allow for vaginal births. In this study, we explored the perspectives of Somali women living in the United States about deinfibulation. We recruited 75 Somali women who had experienced FGC through community-based participatory research methods. Bilingual community researchers conducted qualitative interviews in Somali or English. University faculty and community-based researchers coded data together in a participatory-analysis process. We identified four themes. (1) Personal Views: participants reported positive attitudes toward deinfibulation and varied on the appropriateness of deinfibulation before marriage. (2) Benefits: identified benefits included alleviation of health problems; improved sexual health, in particular reduction or prevention of sexual pain; and reclamation of body and womanhood. (3) Barriers: these included associated stigma and lack of knowledge by providers. (4) Decision-Making: most reported that husbands, healthcare providers, and elder female community members may provide advice about if and/or when to seek deinfibulation, though some felt deinfibulation decisions are solely up to the impacted woman. An ecological framework is used to frame the findings and identify the importance of healthcare workers in assisting women who have been infibulated make decisions.

Rethinking and advancing the movement of resistance, activism, and advocacy in health in four central arenas of the Middle East Region

AbstractThe Middle East region has a long history of resistance, activism, and advocacy movements in health, most recently as part of the 2011 region‐wide Arab Spring. Despite this storied history, however, movements of resistance, activism, and advocacy in health in the region are rarely unpacked, examined, or documented. This historical and contextual analysis aims to examine the long‐standing confiscated health rights and subsequent experiences of resistance, activism, and advocacy in health in populations in Palestine, Lebanon, Egypt, and Iraq. Promoting a health equity and health rights‐based approach is key to achieving Universal Health Coverage and health‐related Sustainable Development Goals, particularly in contexts that experience fragile socioeconomic and humanitarian conditions and political instability such as many countries in the Middle East. Marginalized populations, including Palestinians living under Israeli occupation, Lebanese Lesbian, Gay, Bisexual, and Transgender+ (LGBT) communities, Egyptian women and girls affected by Female Genital Mutilation, and Iraqi refugees and Internally Displaced Persons, have been severely impacted by decades of oppression, conflict, and displacement. These populations have faced various forms of discrimination, neglect, and violence that have hindered their access to quality healthcare and basic health rights. Rather than relying on government efforts, local and international movements to advocate for and protect the health rights of these populations are key. Innovative approaches, strategic dialogue and collective actions are prerequisites for promoting resistance, activism, and advocacy in health in all country's systems structure. This analysis highlights the important of this social public health issue in the most turbulent region and provides evidence to guide all countries to realize equitable human rights for health for all populations.