Maternal infibulation and obstetrical outcome in Djibouti.

J Matern Fetal Neonatal Med. 2014 Sep 19:1-23. [Epub ahead of print]

Maternal infibulation and obstetrical outcome in Djibouti.

Minsart AF, N’guyen TS, Hadji RA, Caillet M.

ABSTRACT

The objective of the present study was to assess the relation between female genital mutilation and obstetric outcome in an East African urban clinic with a standardized care, taking into account medical and socioeconomic status. Methods This was a cohort study conducted in Djibouti between October 1, 2012 and April 30, 2014. Overall 643 mothers were interviewed and clinically assessed for the presence of female genital mutilation. The prevalence of obstetric complications by infibulation status was included in a multivariate stepwise regression model. Results Overall, 29 of 643 women did not have any form of mutilation (4.5%), as opposed to 238 of 643 women with infibulation (37.0%), 369 with type 2 (57.4%), and 7 with type 1 mutilation (1.1%).Women with a severe type of mutilation were more likely to have socio-economic and medical risk factors. After adjustment, the only outcome that was significantly related with infibulation was the presence of meconium-stained amniotic fluid with an odds ratio of 1.58 (1.10-2.27), p-value=0.014. Conclusions Infibulation was not related with excess perinatal morbidity in this setting with a very high prevalence of female genital mutilation, but future research should concentrate on the relation between infibulation and meconium.

This article can be accessed in this LINK

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience

Midwifery. 2014 Sep 6. pii: S0266-6138(14)00222-8. doi: 10.1016/j.midw.2014.08.012. [Epub ahead of print]

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience.

Dawson A, Turkmani S, Fray S, Nanayakkara S, Varol N, Homer C.

ABSTRACT

OBJECTIVE: to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care.

DESIGN: an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014.

FINDINGS: 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial.

KEY CONCLUSIONS: professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice.

IMPLICATIONS FOR PRACTICE: improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation.

This article can be accessed in this LINK

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

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

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

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

ABSTRACT

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

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

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

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

This article can be accessed in this LINK

Female genital mutilation and obstetric outcomes: flawed systematic review and meta-analysis does not accurately reflect the available evidence.

Obstet Gynecol Int. 2014;2014:205230. doi: 10.1155/2014/205230. Epub 2014 Mar 20. FREE

Female genital mutilation and obstetric outcomes: flawed systematic review and meta-analysis does not accurately reflect the available evidence.

Meirik O, Banks E, Farley T, Akande O, Bathija H, Ali M.

EXTRACT

We commend Berg and Underland for taking on the momentous task of systematically reviewing and summarizing available data on the association between female genital mutilation (FGM) and obstetric outcomes [12]. FGM is an important health and human rights issue and reliable evidence on its effects on health is critical for advocacy to encourage its abandonment.

Despite the obvious hard work and adherence to a prespecified protocol, there are two major problems with this systematic review that undermine the validity of the conclusions reached.

This article can be accessed in this LINK

Missed opportunities for diagnosis of female genital mutilation.

Int J Gynaecol Obstet. 2014 Mar 5. pii: S0020-7292(14)00114-3. doi: 10.1016/j.ijgo.2013.11.016. [Epub ahead of print]

Missed opportunities for diagnosis of female genital mutilation.

Abdulcadir J, Dugerdil A, Boulvain M, Yaron M, Margairaz C, Irion O, Petignat P.

ABSTRACT

OBJECTIVE: To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

METHODS: In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification.

RESULTS: In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis.

CONCLUSION: Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.

This article can be accessed in this LINK.

Female genital mutilation, cutting, or circumcision.

Obstet Gynecol Int. 2013;2013:240421. doi: 10.1155/2013/240421. Epub 2013 Nov 27.FREE

Female genital mutilation, cutting, or circumcision.

Sundby J(1), Essén B(2), Johansen RE(3).

Author information: (1)Institute of Health and Society, University of Oslo, Norway. (2)Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Sweden. (3)Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Norway.

EXTRACT

Female genital mutilation (FGM), female genital cutting, or female circumcision of women, the theme addressed in this special issue has many terms. The short form acronym FGM is understood by most, and it does contain the notion that we are talking about a traditional practice that is harmful. The practice affects women in diaspora as well as African countries, and men are involved as decision makers and attitude changers. Cutting is a neutral term, and circumcision is a more traditional terminology. Each term carries a certain value. But the practice is the same regardless of name.

In order to understand the tradition, assist women who have undergone it, and promote action against it, it is important to have solid knowledge. This knowledge is partly medical and partly social. Thus, research based on a multitude of methods is warranted. This special issue is indeed a combination of social science and medical research on different aspects of the practice, that is also a genital health hazard for women….

This article can be downloaded in this LINK

Overactive bladder after female genital mutilation/cutting (FGM/C) type III.

BMJ Case Rep. 2013 Oct 4;2013. pii: bcr2012008155. doi: 10.1136/bcr-2012-008155.

Overactive bladder after female genital mutilation/cutting (FGM/C) type III.

Abdulcadir J, Dällenbach P.

Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland.

ABSTRACT

A 27-year-old Somali woman with type III a-b female genital mutilation/cutting, consulted because of slow micturition, voiding efforts, urgency and urge incontinence (overactive bladder). She also referred primary dysmenorrhoea and superficial dyspareunia making complete sexual intercourses impossible. We treated her by defibulation and biofeedback re-educative therapy. We also offered a multidisciplinary counselling. At 5 months follow-up, urgency and urge incontinence had resolved and she became pregnant.

This article can be accessed in this LINK

Knowledge of health personnel about female genital mutilation

Acta méd. costarric vol.50 no.4 San José dic. 2008FREE

Knowledge of health personnel about female genital mutilation (Letter in Spanish)

Cambronero-Aguilar I, Campos-Cortés C, Chavarría-Bolaños R, Chavarría-Ulate D, Gamboa- Ramón K, Loría- Chavarría G, Sandí Grettchen F

ABSTRACT

Background and aim: Nowadays, the short and long-term consequences in psychological, sexual, social and medical areas of female genital mutilation are known. It is a common practice in non occidental countries. However because of globalization and migration it has been a problem in different countries. In this context it is very important that the medical and nursing professionals have knowledge about its medical complications and management. The present study was undertaken to determine the knowledge of medical doctors and nurses regarding female genital mutilation, its possible medical consequences and its clinical management. Materials and method: A survey was made to 70 medical doctors and 30 nurses, at 4 national hospitals of the Costa Rican social security system, between October and November 2006. Result: 81% know about female genital mutilation, however 63% do not know about its obstetric complications and 97% said they did not know the deinfibulation method, 60% of the medical doctors do not know how to manage a case. Discussion: The result is explained because this is not a common diagnosis in this country. Nevertheless, the documentation of a case in Costa Rica and the continued migration of these populations justify the need of more information and knowledge about management of these patients. It is relevant the role of continue medical education.

Increasing certified nurse-midwives’ confidence in managing the obstetric care of women with female genital mutilation/cutting.

J Midwifery Womens Health. 2013 Jul;58(4):451-6. doi: 10.1111/j.1542-2011.2012.00262.x.

Increasing certified nurse-midwives’ confidence in managing the obstetric care of women with female genital mutilation/cutting.

Jacoby SD, Smith A.

INTRODUCTION: In response to an increase in the number of women who immigrate to the United States from countries that practice female genital mutilation/cutting (FGM/C; infibulation), US clinicians can expand their knowledge and increase confidence in caring for women who have experienced infibulation. This article describes a comprehensive education program on FGM/C and the results of a pilot study that examined its effect on midwives’ confidence in caring for women with infibulation.

METHODS: An education program was developed that included didactic information, case studies, a cultural roundtable, and a hands-on skills laboratory of deinfibulation and repair. Eleven certified nurse-midwives (CNMs) participated in this pilot study. Participants completed a measure-of-confidence survey tool before and after the education intervention.

RESULTS: Participants reported increased confidence in their ability to provide culturally competent care to immigrant women with infibulation when comparisons of preeducation and posteducation survey confidence logs were completed.

DISCUSSION: Following the education program and the knowledge gained from it, these midwives were more confident about their ability to perform anterior episiotomy and to deliver necessary care to women with FGM/C in a culturally competent context. This education program should be expanded as more women who have experienced infibulation immigrate to the United States.

This article can be accessed in this LINK.

Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden.

Midwifery. 2008 Jun;24(2):214-25. Epub 2007 Feb 21.

Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden.

Lundberg PC, Gerezgiher A.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. Pranee.Lundberga@pubcare.uu.se

OBJECTIVE: to explore Eritrean immigrant women’s experiences of female genital mutilation (FGM) during pregnancy, childbirth and the postpartum period.

DESIGN: qualitative study using an ethnographic approach. Data were collected via tape-recorded interviews.

SETTING: interviews in the Eritrean women’s homes located in and around Uppsala, Sweden.

PARTICIPANTS: 15 voluntary Eritrean immigrant women.

DATA COLLECTION AND ANALYSIS: Semi-structured interview and open-ended questions were used. The interviews were tape-recorded, transcribed verbatim and then analysed.

FINDINGS: six themes of experiences of FGM among Eritrean women during pregnancy and childbirth were identified. They are (1) fear and anxiety; (2) extreme pain and long-term complications; (3) health-care professionals’ knowledge of circumcision and health-care system; (4) support from family, relatives and friends; (5) de-infibulation; and (6) decision against female circumcision of daughters.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: the Eritrean women had experiences of FGM and had suffered from its complications during pregnancy, childbirth and the postpartum period. Midwives and obstetricians should have competence in managing women with FGM, and they need increased understanding of cultural epistemology in order to be able to provide quality care to these women. At antenatal centres, circumcised women should be advised to de-infibulate before pregnancy. Special courses about anatomical differences should be offered to these women and their husbands. It is also important to inform them about Swedish law, which prohibits all forms of FGM.

This article can be purchased in this LINK

[Maternal and foetal prognostic in excised women delivery]

J Gynecol Obstet Biol Reprod (Paris). 2007 Jun;36(4):393-8. Epub 2007 Apr 6.FREE

[Maternal and foetal prognostic in excised women delivery]. [Article in French]

Millogo-Traore F, Kaba ST, Thieba B, Akotionga M, Lankoande J. fmillogo_traore@caramail.com

ABSTRACT

INTRODUCTION: The female circumcision constitutes by their frequency and complications a real problem of public health.

MATERIAL AND METHOD: Our study aims at comparing the maternal land fetal complications of the spontaneous vaginal delivery in the excised women and non-excised. We led a comparative survey case witness implying 227 excised pregnant women at the maternity in CHU YO of Ouagadougou.

RESULTS: The prevalence of the excision from January 1st to July 31, 2006 was 72.86%. The distribution of female genital mutilations in this population is the following: type I=27.75%, type II=69.61%, type III=2.64%. The middle age was 25 years and 79.30% of women were aged less than 30 years. Islam appeared like a factor of exposure to the practice of the excision with 67.40% of women excised that practise it against 41.90% at the non-excised group (P<0,0001). The maternal complications were dominated by the duration of fetal expulsion prolonged and perineal tears. The duration of fetal expulsion was superior to 30 minutes for 34.56% of excised woman childbirths 9 times more frequently than women non-excised (P=0.001). The frequency of perineal tears was 10.13% in the group of women excised against 5.73% in the group of the non-excised (P=0.008). These perineal lesions were more frequent with the primiparae and women excised at the 2nd and 3rd degree. The neobirth asphyxia affected 4.4% of newborns from mother excised against 0.2% in the non-excised group (RR=5.18; P=0.006). In the group of excised them the rate of mortinatality was 22.03 for 1000 births, against 8.81 for 1000 births in the group of the non-excised (P=0.22).

CONCLUSION: The prevention of these complications with the excised woman rests on the episiotomy and the instrumental extraction in the FGM of type III.

This article can be accessed in this LINK

Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula.

Soc Sci Med. 2009 Mar;68(5):971-9. doi: 10.1016/j.socscimed.2008.12.006. Epub 2009 Jan 6.

Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula.

Peterman A, Johnson K.

University of North Carolina, Department of Public Policy, Chapel Hill, NC 27599-3435, USA. apeterma@email.unc.edu

ABSTRACT

Obstetric fistula, characterized by urinary or fecal incontinence via the vagina, has begun to receive attention on the international public health agenda, however less attention has been given to traumatic fistula. Field reports indicate that trauma contributes to the burden of vaginal fistula, especially in regions wrought by civil unrest, however evidence is largely anecdotal or facility-based. This paper specifically examines the co-occurrence of incontinence and two potential sources of trauma: sexual violence and female genital cutting using the most recent Demographic and Health Surveys in Malawi, Rwanda, Uganda and Ethiopia. Multivariate selection models are used to control for sampling differences by country. Results indicate that sexual violence is a significant determinant of incontinence in Rwanda and Malawi, however not in Uganda. Simulations predict that elimination of sexual violence would result in from a 7 to a 40% reduction of the total burden of incontinence. In contrast, no evidence is found that female genital cutting contributes to incontinence and this finding is robust for types of cutting and high risk samples. Results point to the importance of reinforcing prevention programs which seek to address prevention of sexual violence and for the integration of services to better serve women experiencing both sexual violence and incontinence.

This article can be purchased in this LINK.

Interventions for improving outcomes for pregnant women who have experienced genital cutting.

Cochrane Database Syst Rev. 2013 Feb 28;2:CD009872. doi: 10.1002/14651858.CD009872.pub2.

Interventions for improving outcomes for pregnant women who have experienced genital cutting.

Balogun OO, Hirayama F, Wariki WM, Koyanagi A, Mori R.

Department of Social and Preventive Epidemiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

BACKGROUND: Female genital cutting (FGC) refers to all procedures that involve the partial or total removal of the external female genitalia, or other injury to the female genital organs for cultural or other non-therapeutic reasons. There are no known medical benefits to FGC, and it can be potentially dangerous for the health and psychological well-being of women and girls who are subjected to the practice resulting in short- and long-term complications. Health problems of significance associated with FGC faced by most women are maternal and neonatal mortality and morbidity, the need for assisted delivery and psychological distress. Under good clinical guidelines for caring for women who have undergone genital cutting, interventions could provide holistic care that is culturally sensitive and non-judgemental to improve outcomes and overall quality of life of women. This review focuses on key interventions carried out to improve outcome and overall quality of life in pregnant women who have undergone FGC.

OBJECTIVES: To evaluate the impact of interventions to improve all outcomes in pregnant women or women planning a pregnancy who have undergone genital cutting. The comparison group consisted of those who have undergone FGC but have not received any intervention.

SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (31 December 2012) and organisations engaged in projects regarding FGC.

SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-randomised trials or quasi-RCTs with reported data comparing intervention outcomes among pregnant women or women planning a pregnancy who have undergone genital cutting compared with those who did not receive any intervention.

DATA COLLECTION AND ANALYSIS: We did not identify any RCTs, cluster-randomised trials or quasi-RCTs.

MAIN RESULTS: There are no included studies.

AUTHORS’ CONCLUSIONS: FGC research has focused mainly on observational studies to describe the social and cultural context of the practice, and we found no intervention trials conducted to improve outcomes for pregnant women presenting with complications of FGC. While RCTs will provide the most reliable evidence on the effectiveness of interventions, there remains the issue of what is considered ethically appropriate and the willingness of women to undergo randomisation on an issue that is enmeshed in cultural traditions and beliefs. Consequently, conducting such a study might be difficult.

This review can be accessed in this LINK

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

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

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

Iavazzo C, Sardi TA, Gkegkes ID.

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

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

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

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

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

This article can be purchased in this LINK.

Infibulated women have an increased risk of anal sphincter tears at delivery: a population-based Swedish register study of 250 000 births

Acta Obstet Gynecol Scand. 2013 Jan;92(1):101-8. doi: 10.1111/aogs.12010. Epub 2012 Nov 1.

Infibulated women have an increased risk of anal sphincter tears at delivery: a population-based Swedish register study of 250 000 births.

Berggren V, Gottvall K, Isman E, Bergström S, Ekéus C.

Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden.

ABSTRACT

OBJECTIVE: To investigate the risk for anal sphincter tears (AST) in infibulated women. DESIGN: Population-based cohort study. SETTING: Nationwide study in Sweden. POPULATION: The study population included 250 491 primiparous women with a vaginal singleton birth at 37-41 completed gestational weeks during 1999-2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalia group, n = 929, where over 95% are infibulated; the Eritrea-Ethiopia-Sudan group, n = 955, where the majority are infibulated, compared with other African countries, n = 1035, where few individuals are infibulated but had otherwise similar anthropometric characteristics. These women were compared with 247 572 Swedish-born women. METHODS: Register study with data from the National Medical Birth Registry. MAIN OUTCOME MEASURES: AST in non-instrumental and instrumental vaginal delivery. RESULTS: Compared with Swedish-born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95%CI 2.08-3.54), followed by women from Eritrea-Ethiopia-Sudan 1.80 (1.41-2.32) and other African countries 1.23 (0.89-1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. CONCLUSION: Delivering African women from countries where infibulation is common carries an increased risk of AST compared with Swedish-born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.

This article can be purchased in this LINK.

When cultures collide: female genital cutting and U.S. obstetric practice.

Obstet Gynecol. 2009 Apr;113(4):931-4. doi: 10.1097/AOG.0b013e3181998ed3.

When cultures collide: female genital cutting and U.S. obstetric practice.

Rosenberg LB, Gibson K, Shulman JF.

Mount Sinai School of Medicine, Department of Obstetrics, Gynecology & Reproductive Science, The Mount Sinai Medical Center, New York, New York, USA.

ABSTRACT

CASE: A 28-year-old primigravida at 41 weeks of gestation, previously unregistered, presented to a tertiary care Labor and Delivery unit reporting painful uterine contractions 7 minutes apart. The patient, a recent immigrant from a Northeastern African country, was accompanied by her extended family. She promptly disclosed that as a 10-year-old she underwent genital cutting in her country of origin.

Physical examination revealed the results of Type III female circumcision, or total removal of the clitoris and labia minora, and infibulation, or sewing together, of the labia majora. The prepuce and body of the clitoris were completely absent. In addition, the external urethral orifice was not visible due to extensive scar tissue overlying the infibulation. The scar tissue was pale gray, avascular, and extended almost the entire length of the labia majora, leaving a relatively small opening. As active labor continued, it became clear that the constricted opening would not allow for fetal descent. The obstetrician in attendance subsequently performed a midline episiotomy through the perineal body. A healthy male neonate was delivered. During the postpartum examination, the obstetrician identified extensive lacerations as well as an almost total separation of the previously fused labia majora.

The obstetrician explained the reasoning for midline episiotomy repair to the patient and her sister, who was continuously at the bedside. The obstetrician also informed the patient that the infibulation separated. As the obstetrician began repairing the internal lacerations, the patient insisted that the labia majora be sewed back together (reinfibulation). Although the obstetrician explained the risks of poor wound healing and infection from suturing a devascularized tissue plane, the sister emphasized the importance of infibulation in their culture and the need to have the circumcised anatomy restored. After careful consideration, the obstetrician performed a repair of the lacerated tissue, including a partial reinfibulation.

This article can be purchased in this LINK.

Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes

Stud Fam Plann. Sept 1999 30(3): 219–230

Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes

Jones H, Diop N, Askew I, Kaboré I

ABSTRACT

Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety-three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.

This article can be purchased in this LINK

The Impact of Female Genital Cutting on First Delivery in Southwest Nigeria

Stud Fam Plann. 2002 June 33(2):173–184

The Impact of Female Genital Cutting on First Delivery in Southwest Nigeria

Slanger TE, Snow RC, Okonofua FE

ABSTRACT

To date, data linking obstetric morbidity to female genital cutting in populations with less severe types of cutting have been limited to case reports and speculation. In this cross-sectional study, 1,107 women at three hospitals in Edo State, Nigeria, reported on their first-delivery experiences. Fifty-six percent of the sample had undergone genital cutting. Although univariate analyses suggest that genital cutting is associated with delivery complications and procedures, multivariate analyses controlling for sociodemographic factors and delivery setting show no difference between cut and noncut women’s likelihood of reporting first-delivery complications or procedures. Whereas a clinical association between genital cutting and obstetric morbidity may occur in populations that have undergone more severe forms of cutting, in this setting, apparent associations between cutting and obstetric morbidity appear to reflect confounding by social class and by the conditions under which delivery takes place.

This article can be purchased in this LINK

The issue of reinfibulation.

Int J Gynaecol Obstet. 2010 May;109(2):93-6. doi: 10.1016/j.ijgo.2010.01.001. Epub 2010 Feb 6.

The issue of reinfibulation.

Serour GI.

Department of Obstetrics and Gynecology, International Islamic Center for Population Studies and Research, Al Azhar University, Cairo, Egypt. giserour1@link.net

ABSTRACT

Reinfibulation is resuturing after delivery or gynecological procedures of the incised scar tissue resulting from infibulation. Despite the global fight against female genital mutilation/cutting (FGM/C), reinfibulation of previously mutilated or circumcised women is still performed in various countries around the world. A good estimate of the prevalence of reinfibulation is difficult to obtain, but it can be inferred that 6.5-10.4million women are likely to have been reinfibulated worldwide. Women who undergo reinfibulation have little influence on the decision-making and are usually persuaded by the midwife or birth attendant to undergo the procedure immediately following labor or gynecological operation. Although medicalization of reinfibulation may reduce its immediate risks, it has no effect on the incidence of long-term risks. Reinfibulation is performed mainly for the financial benefit of the operator, and cultural values that have been perpetuated for generations. Reinfibulation has no benefits and is associated with complications for the woman and the unborn child. Its medicalization violates the medical code of ethics and should be abandoned. International and national efforts should be combined to eradicate this practice.

This article can be purchased in this LINK

The relationship between female genital cutting and obstetric fistulae.

Obstet Gynecol. 2010 Mar;115(3):578-83. doi: 10.1097/AOG.0b013e3181d012cd.

The relationship between female genital cutting and obstetric fistulae.

Browning A, Allsworth JE, Wall LL.

Barhirdar Hamlin Fistula Centre, Barhirdar, Ethiopia.

OBJECTIVE: To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor.

METHODS: A comparison was made between 255 fistula patients who had undergone type I or type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age; parity; length of labor; labor outcome (stillbirth or not); type of fistula; site, size, and scarring of fistula; outcomes of surgery (fistula closed; persistent incontinence with closed fistula; urinary retention with overflow; site, size, and scarring of any rectovaginal fistula; and operation outcomes), and specific methods used during the operation (use of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure.

RESULTS: The only statistically significant differences between the two groups (P=.05) were a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, a slightly higher use of a pubococcygeal sling at the time of fistula repair, and a slightly longer length of labor (by 0.3 day) in women who had undergone genital cutting.

CONCLUSION: Type I and type II female genital cutting are not independent causative factors in the development of obstetric fistulae from obstructed labor.

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