Advertisement

Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study

Published:March 04, 2017DOI:https://doi.org/10.1016/j.ajog.2017.02.044

      Background

      Female genital mutilation/cutting (FGM/C) is a cultural practice that involves several types of removal or other injury to the external female genitalia for nonmedical reasons. Although much international research has focused on the health consequences of the practice, little is known about sexual functioning among women with various types of FGM/C.

      Objective

      To assess the impact of FGM/C on the sexual functioning of Sudanese women.

      Study Design

      This is a cross-sectional study conducted at Doctor Erfan and Bagedo Hospital, Jeddah, Saudi Arabia. Eligible women completed a survey and a clinical examination, which documented and verified women’s type of FGM/C. The main outcome measure was female sexual function, as assessed by the Arabic Female Sexual Function Index.

      Results

      A total of 107 eligible women completed the survey and the gynecological examination, which revealed that 39% of the women had FGM/C Type I, 25% had Type II, and 36% had Type III. Reliability of self-report of the type of FGM/C was low, with underreporting of the extent of the procedure. The results showed that 92.5% of the women scored lower than the Arabic Female Sexual Function Index cut-off point for sexual dysfunction. The multivariable regression analyses showed that sexual dysfunction was significantly greater with more extensive type of FGM/C, across all sexual function domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and overall.

      Conclusion

      The study documents that a substantial proportion of women subjected to FGM/C experience sexual dysfunction. It shows that the anatomical extent of FGM/C is related to the severity of sexual dysfunction.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • World Health Organization
        Eliminating female genital mutilation: an interagency statement.
        World Health Organization, Geneva2008
        • United Nations International Children's Emergency Fund
        Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change.
        UNICEF, New York2013
        • United Nations International Children's Emergency Fund
        Female genital mutilation/cutting: what might the future hold?.
        UNICEF, New York2014
        • Goldberg H.
        • Stupp P.
        • Okoroh E.
        • Besera G.
        • Goodman D.
        • Danel I.
        Female genital mutilation/cutting in the United States: updated estimates of women and girls at risk, 2012.
        Public Health Rep. 2016; 131: 1-8
        • Berg R.C.
        • Underland V.
        • Odgaard-Jensen J.
        • Fretheim A.
        • Vist G.E.
        Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis.
        BMJ Open. 2014; 4: e006316
        • Berg R.C.
        • Odgaard-Jensen J.
        • Fretheim A.
        • Underland V.
        • Vist G.E.
        An updated systematic review and meta-analysis of the obstetric consequences of female genital mutilation/cutting (FGM/C).
        Obstet Gynecol Int. 2014; (Article ID 542859)
        • Berg R.C.
        • Denison E.
        Does female genital mutilation/cutting (FGM/C) affect women's sexual functioning? A systematic review of the sexual consequences of FGM/C.
        Sex Res Soc Pol. 2012; 9: 41-56
        • Sun X.
        • Li C.
        • Jin L.
        • Fan Y.
        • Wang D.
        Development and validation of Chinese version of female sexual function index in a Chinese population—a pilot study.
        J Sex Med. 2011; 8: 2246-2254
        • Wiegel M.
        • Meston C.
        • Rosen R.
        The female sexual function index (FSFI): cross validation and development of clinical cutoff scores.
        J Sex Marital Ther. 2005; 31: 1-20
        • Meston C.M.
        Validation of the female sexual function index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder.
        J Sex Marital Ther. 2003; 29: 39-46
        • Sidi H.
        • Abdullah N.
        • Puteh S.E.
        • Midin M.
        • Lin H.H.
        The female sexual function index (FSFI): validation of the Malay version.
        J Sex Med. 2007; 4: 1642-1654
        • Takahashi M.
        • Inokuchi T.
        • Watanabe C.
        • Saito T.
        • Kai L.
        The female sexual function index (FSFI): Development of a Japanese version.
        J Sex Med. 2011; 8: 2246-2254
        • Rosen R.
        • Brown C.
        • Heiman J.
        • et al.
        The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.
        J Sex Marital Ther. 2000; 26: 191-208
        • Anis T.H.
        • Gheit S.A.
        • Saied H.S.
        • Al Kherbash S.A.
        Arabic translation of female sexual function index and validation in an Egyptian population.
        J Sex Med. 2011; 8: 3370-3378
      1. Female sexual function index. Available at: http://www.fsfiquestionnaire.com. Accessed April 27, 2016.

        • Vital M.
        • de Visme S.
        • Hanf M.
        • Philippe H.-J.
        • Winer N.
        • Wylomanski S.
        Using the female sexual functioning index (FSFI) to evaluate sexual function in women with genital mutilation undergoing surgical reconstruction: a pilot prospective study.
        Eur J Obstet Gynecol Reprod Biol. 2016 Jul; 202: 71-74
        • Alsibiani S.A.
        • Rouzi A.A.
        Sexual function in women with female genital mutilation.
        Fertil Steril. 2010; 93: 722-724
        • Anis T.H.
        • Gheit S.A.
        • Awad H.H.
        • Saied H.S.
        Effects of female genital cutting on the sexual function of Egyptian women. A cross-sectional study.
        J Sex Med. 2012; 9: 2682-2692
        • Ibrahim Z.A.
        • Ahmed M.R.
        • Ahmed W.A.S.
        Prevalence and risk factors for female sexual dysfunction among Egyptian women.
        Arch Gynecol Obstet. 2013; 287: 1173-1180
        • Mohammed G.F.
        • Hassan M.M.
        • Eyada M.M.
        Female genital mutilation/cutting: will it continue?.
        J Sex Med. 2014; 11: 2756-2763
        • Mahmoud M.I.H.
        Effect of female genital mutilation on female sexual function, Alexandria, Egypt.
        Alexandria J Med. 2016; 52: 55-59
        • Elmusharaf S.
        • Elhadi N.
        • Almroth L.
        Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study.
        BMJ. 2006; 333: 124-127
        • Elnashar A.
        • El-Dien Ibrahim M.
        • El-desoky M.
        • Ali O.
        • El-Sayd Mohammed Hassan M.
        Female sexual dysfunction in Lower Egypt.
        BJOG. 2007; 114: 201-206
        • Hassanin I.M.
        • Helmy Y.A.
        • Fathalla M.M.
        • Shahin A.Y.
        Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt.
        Int J Gynecol Obstet. 2010; 108: 219-223
        • Thabet S.M.
        • Thabet A.S.
        Defective sexuality and female circumcision: the cause and the possible management.
        J Obstet Gynecol Res. 2003; 29: 12-19
        • Satti A.
        • Elmusharaf S.
        • Hibba B.
        • et al.
        Prevalence and determinants of the practice of genital mutilation of girls in Khartoum, Sudan.
        Ann Trop Paediatr. 2006; 26: 303-310
        • Bjälkander O.
        • Donald S.
        • Grant D.S.
        • Berggren V.
        • Bathija H.
        • Almroth L.
        Female genital mutilation in Sierra Leone: forms, reliability of reported status, and accuracy of related demographic and health survey questions.
        Obstet Gynecol Int. 2013; 2013: 680926
        • Raina R.
        • Pahlajani G.
        • Khan S.
        • Gupta S.
        • Agarwal A.
        • Zippe C.
        Female sexual dysfunction: classification, pathophysiology, and management.
        Fertil Steril. 2007; 88: 1273-1284
        • World Health Organization
        WHO guidelines on the management of health complications from female genital mutilation.
        WHO, Geneva2016
        • Foldès P.
        • Cuzin B.
        • Andro A.
        Reconstructive surgery after female genital mutilation: a prospective cohort study.
        Lancet. 2012; 380: 134-141
        • ACOG Committee Opinion. Female genital mutilation. Number 151–January 1995. Committee on Gynecologic Practice. Committee on International Affairs
        American College of Obstetricians and Gynecologists.
        Int J Gynaecol Obstet. 1995 May; 49: 209

      Linked Article

      • Reply
        American Journal of Obstetrics & GynecologyVol. 218Issue 1
        • Preview
          We thank Ms Sakyi-Agyekum for her close review of our article.1 The points she raises emphasize the difficulty in assessing sexual functioning in women with female genital mutilation/cutting (FGM/C), and we encourage other researchers to investigate this issue, taking, for example, physiological and cultural covariates into consideration.
        • Full-Text
        • PDF
      • Effective evidence-based medicine: considering factors not included in research studies
        American Journal of Obstetrics & GynecologyVol. 218Issue 1
        • Preview
          Rouzi et al1 recently published a cross-sectional study showing a direct correlation between the severities of mutilation and subsequent sexual dysfunction. The horrific practice of female genital mutilation/cutting has been carried out for thousands of years in different societies.
        • Full-Text
        • PDF