Painful gynecologic and obstetric complications of female genital mutilation/cutting: A systematic review and meta-analysis
Jacob Michael Lurie aff001; Alessandra Weidman aff002; Samantha Huynh aff002; Diana Delgado aff003; Imaani Easthausen aff004; Gunisha Kaur aff002
Působiště autorů: Icahn School of Medicine at Mount Sinai, New York, New York, United States of America aff001; Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America aff002; Information, Education, and Clinical Services, Weill Cornell Medicine, New York, New York, United States of America aff003; Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States of America aff004
Vyšlo v časopise: Painful gynecologic and obstetric complications of female genital mutilation/cutting: A systematic review and meta-analysis. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003088
Kategorie: Research Article
The health complications experienced by women having undergone female genital mutilation/cutting (FGM/C) are a source of growing concern to healthcare workers globally as forced displacement and migration from countries with high rates of this practice increases. In this systematic review and meta-analysis, we investigate the association between FGM/C and painful gynecologic and obstetric complications in women affected by the practice.
Methods and findings
We performed a comprehensive literature search from inception to December 19, 2019 of Ovid MEDLINE, Ovid EMBASE, The Cochrane Library (Wiley), and POPLINE (prior to its retirement) for studies mentioning FGM/C. Two reviewers independently screened studies reporting prevalences of painful gynecologic and obstetric sequelae resulting from FGM/C. Random effects models were used to estimate pooled odds ratios (ORs) for outcomes obtained from cross-sectional, cohort, and case–control designs. Subgroup analysis was performed to assess and control for effect differences introduced by study design. Validated appraisal tools were utilized to assess quality and risk of bias. Our study was registered with PROSPERO. Two reviewers independently screened 6,666 abstracts. Of 559 full-text studies assessed for eligibility, 116 met eligibility criteria, which included studies describing the incidence or prevalence of painful sequelae associated with FGM/C. Pooled analyses after adjustment for study design found that FGM/C was associated with dyspareunia (6,283 FGM/C and 3,382 non-FGM/C participants; pooled OR: 2.47; 95% confidence interval [CI]: 1.45–4.21; I2: 79%; p-value < 0.01), perineal tears (4,898 FGM/C and 4,229 non-FGM/C participants; pooled OR: 2.63; 95% CI: 1.35–5.11; I2: 67%; p-value = 0.01), dysuria (3,686 FGM/C and 3,482 non-FGM/C participants; pooled OR: 1.43; 95% CI: 1.17–1.75; I2: 0%; p-value = 0.01), episiotomy (29,341 FGM/C and 39,260 non-FGM/C participants; pooled OR: 1.89; 95% CI: 1.26–2.82; I2: 96%; p-value < 0.01), and prolonged labor (7,516 FGM/C and 8,060 non-FGM/C participants; pooled OR: 2.04; 95% CI: 1.27–3.28; I2: 90%; p-value < 0.01). There was insufficient evidence to conclude that there was an association between FGM/C and dysmenorrhea (7,349 FGM/C and 4,411 non-FGM/C participants; pooled OR: 1.66; 95% CI: 0.97–2.84; I2: 86%; p-value = 0.06), urinary tract infection (4,493 FGM/C and 3,776 non-FGM/C participants; pooled OR: 2.11; 95% CI: 0.80–5.54; I2: 90%; p-value = 0.10), instrumental delivery (5,176 FGM/C and 31,923 non-FGM/C participants; pooled OR: 1.18; 95% CI: 0.78–1.79; I2: 63%; p-value = 0.40), or cesarean delivery (34,693 FGM/C and 46,013 non-FGM/C participants; pooled OR: 1.51; 95% CI: 0.99–2.30; I2: 96%; p-value = 0.05). Studies generally met quality assurance criteria. Limitations of this study include the largely suboptimal quality of studies.
In this study, we observed that specific painful outcomes are significantly more common in participants with FGM/C. Women who underwent FGM/C were around twice as likely as non-FGM/C women to experience dyspareunia, perineal tears, prolonged labor, and episiotomy. These data indicate that providers must familiarize themselves with the unique health consequences of FGM/C, including accurate diagnosis, pain management, and obstetric planning.
Review protocol registration
The review protocol registration in PROSPERO is CRD42018115848.
Cesarean section – Cross-sectional studies – Dysmenorrhoea – Metaanalysis – Obstetrics and gynecology – Physicians – Systematic reviews – Urinary tract infections
1. UNICEF. Female Genital Mutilation/Cutting: A Global Concern. UNICEF's Data Work on FGM/C: UNICEF; 2016 [cited 2019 Oct 15]. Available from: https://data.unicef.org/resources/female-genital-mutilationcutting-global-concern/.
2. Shell-Duncan B, Naik R, Feldman-Jacobs C. A state-of-the-art synthesis on female genital mutilation/cutting: What do we know now? New York: Population Council; 2016.
3. WHO. WHO guidelines on the management of health complications from female genital mutilation. Geneva, Switzerland: WHO; 2016.
4. Grun G. #endFGM: The scope of the problem in graphics and numbers. Germany: Deutsche Welle. 2015 [cited 2019 Oct 15]. Available from: https://www.dw.com/en/endfgm-the-scope-of-the-problem-in-graphics-and-numbers/a-18670295.
5. United Nations High Commissioner for Refugees. Too Much Pain—Female Genital Mutilation & Asylum in the European Union: A Statistical Update. Report from the UN High Commissioner for Refugees. Geneva, Switzerland: United Nations High Commissioner for Refugees; 2018. Available from: https://reliefweb.int/report/world/too-much-pain-female-genital-mutilation-and-asylum-european-union-statistical-update.
6. Khalife N. "They took me and told me nothing": female genital mutilation in Iraqi Kurdistan. New York: Human Rights Watch; 2010.
7. Okusanya BO, Oduwole O, Nwachuku N, Meremikwu MM. Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta‐analysis. International Journal of Gynecology & Obstetrics. 2017;136: 13–20.
8. Varol N, Dawson A, Turkmani S, Hall JJ, Nanayakkara S, Jenkins G, et al. Obstetric outcomes for women with female genital mutilation at an Australian hospital, 2006–2012: a descriptive study. BMC Pregnancy and Childbirth. 2016: 328.
9. Clarke E. Female genital mutilation: a urology focus. Br J Nurs. 2016;25(18): 1022–8. doi: 10.12968/bjon.2016.25.18.1022 27734741
10. Chalmers B, Hashi KO. 432 Somali women's birth experiences in Canada after earlier female genital mutilation. Birth. 2000;27(4): 227–34. doi: 10.1046/j.1523-536x.2000.00227.x 11251507
11. Teufel K, Dorfler DM. Female genital circumcision/mutilation: implications for female urogynaecological health. Int Urogynecol J. 2013;24(12): 2021–7. doi: 10.1007/s00192-013-2160-5 23857065
12. Meniru GI, Hecht BR, Hopkins MP. Female circumcision: at our doorsteps and beyond. Prim Care Update Ob Gyns. 2000;7(6): 231–7. doi: 10.1016/s1068-607x(00)00051-2 11077235
13. Reisel D, Creighton SM. Long term health consequences of Female Genital Mutilation (FGM). Maturitas. 2015;80(1): 48–51. doi: 10.1016/j.maturitas.2014.10.009 25466303
14. Berg RC, Underland V, Odgaard-Jensen J, Fretheim A, Vist GE. Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open. 2014;4(11): e006316. doi: 10.1136/bmjopen-2014-006316 25416059
15. Abdalla SM, Galea S. Is female genital mutilation/cutting associated with adverse mental health consequences? A systematic review of the evidence. BMJ Global Health. 2019;4(4): e001553. doi: 10.1136/bmjgh-2019-001553 31406589
16. Berg RC, Underland V. The obstetric consequences of female genital mutilation/cutting: a systematic review and meta-analysis. Obstetrics and Gynecology International. 2013: 1–15.
17. Moher D, Altman DG, Tetzlaff J. PRISMA (Preferred Reporting items for systematic reviews and Meta-Analyses). Guidelines for Reporting Health Research: A User’s Manual. 1996;1999: 250.
18. Mutilation FG. Report of a WHO Technical Working Group. Geneva: WHO; 1996.
19. Walker DG, Wilson RF, Sharma R, Bridges J, Niessen L, Bass EB, et al. Best Practices for Conducting Economic Evaluations in Health Care: A Systematic Review of Quality Assessment Tools. Methods Research Reports. Rockville, MD: Agency for Healthcare Research and Quality; 2012. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114545/.
20. Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta‐analysis, and clinical practice guideline: a systematic review. Journal of Evidence-Based Medicine. 2015;8(1): 2–10. doi: 10.1111/jebm.12141 25594108
21. Schwarzer G. meta: An R package for meta-analysis. R news. 2007;7(3): 40–5.
22. Chalmers B, Omer-Hashi K, Khosid H. Female Genital Mutilation and Obstetric Care: 1st ed. Bloomington, IN: Trafford Publishing; 2005.
23. Momoh C, Ladhani S, Lochrie D, Rymer J. Female genital mutilation: analysis of the first twelve months of a Southeast London specialist clinic. BJOG: An International Journal of Obstetrics and Gynaecology. 2001;108(2): 186–91.
24. Mukoro U. A survey on the psychosexual implications of female genital mutilation on Urhobo women of the Niger Delta communities of Nigeria. Journal of Human Ecology. 2004;16(2): 147–50.
25. Plo K, Asse K, Sei D, Yenan J. Female genital mutilation in infants and young girls: report of sixty cases observed at the general hospital of Abobo (Abidjan, Cote d'Ivoire, West Africa). International Journal of Pediatrics. 2014;2014: 837471. doi: 10.1155/2014/837471 24729789
26. Sayed G, Abd el-Aty M, Fadel K. The practice of female genital mutilation in upper Egypt. International Journal of Gynecology & Obstetrics. 1996;55(3): 285–91.
27. Abor P. Female genital mutilation: Psychological and reproductive health consequences. The case of Kayoro traditional area in Ghana. Gender and Behaviour. 2006;4(1): 659–84.
28. Bjälkander O, Bangura L, Leigh B, Berggren V, Bergstrom S, Almroth L. Health complications of female genital mutilation in Sierra Leone. International Journal of Women's Health. 2012;4: 321–31. doi: 10.2147/IJWH.S32670 22870046
29. Bogale D, Markos D, Kaso M. Prevalence of female genital mutilation and its effect on women's health in Bale zone, Ethiopia: a cross-sectional study. BMC Public Health. 2014;14(1): 1076.
30. Chu T, Akinsulure-Smith A. Health Outcomes and Attitudes Toward Female Genital Cutting in a Community-Based Sample of West African Immigrant Women from High-Prevalence Countries in New York City. Journal of Aggression, Maltreatment & Trauma. 2016;25(1): 63–83.
31. Dirie M, Lindmark G. The risk of medical complications after female circumcision. East African Medical Journal. 1992;69(9): 479–82. 1286628
32. Dirie M, Lindmark G. A hospital study of the complications of female circumcision. Tropical Doctor. 1991;21(4): 146–8. doi: 10.1177/004947559102100404 1746031
33. El Dareer A. Woman, why do you weep? Circumcision and its consequences. London, UK: Zed Press; 1982.
34. Gudu W, Abdulahi M. Labor, Delivery and Postpartum Complications in Nulliparous Women with Female Genital Mutilation Admitted to Karamara Hospital. Ethiopian Medical Journal. 2017;55(1): 11–17. 29148634
35. Kaplan A, Hechavarria S, Martin M, Bonhoure I. Health consequences of female genital mutilation/cutting in the Gambia, evidence into action. Reproductive Health. 2011;5: 323–31.
36. Knight R, Hotchin A, Bayly C, Grover S. Female genital mutilation—experience of The Royal Women's Hospital, Melbourne. Australian and New Zealand Journal of Obstetrics and Gynaecology. 1999;39(1): 50–54. doi: 10.1111/j.1479-828x.1999.tb03444.x 10099750
37. Nonterah E, Kanmiki E, Agorinya I, Sakeah E, Mariatu T, Juliana K, et al. Prevalence and adverse obstetric outcomes of female genital mutilation among women in rural Northern Ghana. European Journal of Public Health. 2019: ckz195. doi: 10.1093/eurpub/ckz195 31637426
38. Raouf S, Ball T, Hughes A, Holder R, Papaioannou S. Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation. International Journal of Gynecology & Obstetrics. 2011;113(2): 141–3.
39. Rouzi A, Aljhadali E, Amarin Z, Abduljabbar H. The use of intrapartum defibulation in women with female genital mutilation. BJOG: An International Journal of Obstetrics & Gynaecology. 2001;108(9): 949–51.
40. Andro A, Cambois E, Lesclingand M. Long-term consequences of female genital mutilation in a European context: self perceived health of FGM women compared to non-FGM women. Social Science & Medicine. 2014;106: 177–84.
41. Dare F, Oboro V, Fadiora S, Orji E, Sule-Odu A, Olabode T. Female genital mutilation: an analysis of 522 cases in South-Western Nigeria. Journal of Obstetrics and Gynaecology. 2004;24(3): 281–3. doi: 10.1080/01443610410001660850 15203627
42. Almroth L, Bedri H, El Musharaf S, Satti A, Idris T, Hashim M, et al. Urogenital complications among girls with genital mutilation: a hospital-based study in Khartoum. African Journal of Reproductive Health. 2005;9(2): 118–24. 16485592
43. Nour N, Michels K, Bryant A. Defibulation to treat female genital cutting: effect on symptoms and sexual function. Obstetrics & Gynecology. 2006;108(1): 55–60.
44. Paliwal P, Ali S, Bradshaw S, Hughes A, Jolly K. Management of type III female genital mutilation in Birmingham, UK: a retrospective audit. Midwifery. 2014;30(3): 282–8. doi: 10.1016/j.midw.2013.04.008 23747293
45. el-Defrawi M, Lotfy G, Dandash K, Refaat A, Eyada M. Female genital mutilation and its psychosexual impact. Journal of Sex & Marital Therapy. 2001;27(5): 465–73.
46. Kaplan A, Forbes M, Bonhoure I, Utzet M, Martin M, Manneh M, et al. Female genital mutilation/cutting in The Gambia: long-term health consequences and complications during delivery and for the newborn. International Journal of Women's Health. 2013;5: 323–31. doi: 10.2147/IJWH.S42064 23843705
47. Zurynski Y, Phu A, Sureshkumar P, Cherian S, Deverell M, Elliott E. Female genital mutilation in children presenting to Australian paediatricians. Archives of Disease in Childhood. 2017;102(6): 509–15. doi: 10.1136/archdischild-2016-311540 28082321
48. Elneil S. Female sexual dysfunction in female genital mutilation. Trop Doct. 2016;46(1): 2–11. doi: 10.1177/0049475515621644 26759415
49. Fund UNCs Gupta GR. Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change. New York, NY: UNICEF; 2013. Available from: https://www.unicef.org/publications/index_69875.html.
50. Einstein G. From body to brain: considering the neurobiological effects of female genital cutting. Perspectives in Biology and Medicine. 2008;51(1): 84–97. doi: 10.1353/pbm.2008.0012 18192768
51. Shah G, Susan L, Furcroy J. Female circumcision: history, medical and psychological complications, and initiatives to eradicate this practice. The Canadian Journal of Urology. 2009;16(2): 4576–9. 19364430
52. Almroth L, Elmusharaf S, El Hadi N, Obeid A, El Sheikh MA, Elfadil SM, et al. Primary infertility after genital mutilation in girlhood in Sudan: a case-control study. The Lancet. 2005;366(9483): 385–91.
53. Agugua NE, Egwuatu VE. Female circumcision: management of urinary complications. J Trop Pediatr. 1982;28(5): 248–52. doi: 10.1093/tropej/28.5.248 7176009
54. MacLeod TL. Female genital mutilation. Journal of Obstetrics and Gynaecology Canada. 1995;17(4): 333–42.
55. Aziz F. Gynecologic and obstetric complications of female circumcision. International Journal of Gynecology & Obstetrics. 1980;17(6): 560–3.
56. Sauer PJ, Neubauer D. Female genital mutilation: a hidden epidemic (statement from the European Academy of Paediatrics). Eur J Pediatr. 2014;173(2): 237–8. doi: 10.1007/s00431-013-2126-0 23982245
57. Aziem-Abdallah-Ali A, Mohammed AA, Mohammed Ali AK. Large inclusion cyst complicating female genital mutilation. Clin Pract. 2011;1(4): e121. doi: 10.4081/cp.2011.e121 24765362
58. Berg R, Underland V. Obstetric Consequences of Female Genital Mutilation/Cutting (FGM/C). Report from Kunnskapssenteret No. 6–2013. Oslo: Norwegian Knowledge Centre for Health Services; 2013.
59. Berg RC, Underland V. Gynecological consequences of female genital mutilation/cutting (FGM/C): Report from Kunnskapssenteret No. 11–2014: Oslo: Norwegian Knowledge Centre for Health Services; 2014.
60. Berg RC, Denison E. Does female genital mutilation/cutting (FGM/C) affect women’s sexual functioning? A systematic review of the sexual consequences of FGM/C. Sexuality Research and Social Policy. 2012;9(1): 41–56.
61. Lawani L, Onyebuchi A, Iyoke C, Okeke N. Female genital mutilation and efforts to achieve Millennium Development Goals 3, 4, and 5 in southeast Nigeria. International Journal of Gynecology & Obstetrics. 2014;125(2): 125–8.
62. Slanger T, Snow R, Okonofua F. The impact of female genital cutting on first delivery in southwest Nigeria. Studies in Family Planning. 2002;33(2): 173–84. doi: 10.1111/j.1728-4465.2002.00173.x 12132637
63. Larsen U, Okonofua F. Female circumcision and obstetric complications. International Journal of Gynecology & Obstetrics. 2002;77(3): 255–65.
64. Elnashar A, Abdelhady R. The impact of female genital cutting on health of newly married women. International Journal of Gynecology & Obstetrics. 2007;97(3): 238–44.
65. Frega A, Puzio G, Maniglio P, Catalano A, Milazzo G, Lombardi D, et al. Obstetric and neonatal outcomes of women with FGM I and II in San Camillo Hospital, Burkina Faso. Archives of Gynecology and Obstetrics. 2013;288(3): 513–9. doi: 10.1007/s00404-013-2779-y 23471548
66. Ndiaye P, Diongue M, Faye A, Ouedraogo D, Tal A. Female genital mutilation and complications in childbirth in the province of Gourma (Burkina Faso). Sante publique (Vandoeuvre-les-Nancy, France). 2010;22(5): 563–70.
67. Ali H, Arafa A, NAEFA A, Fahim A. Prevalence of Female Circumcision among Young Women in Beni-Suef, Egypt: A Cross-Sectional Study. Journal of Pediatric and Adolescent Gynecology. 2018;31(6): 571–4. doi: 10.1016/j.jpag.2018.07.010 30064003
68. Arafa A, Elbahrawe R, Shawky S, Abbas A. Epidemiological and gynecological correlates with female genital mutilation among Beni-Suef University students; cross sectional study. Middle East Fertility Society Journal. 2018;23(3): 184–8.
69. Purchase TC, Lamoudi M, Colman S, Allen S, Latthe P, Jolly K. A survey on knowledge of female genital mutilation guidelines. Acta Obstetricia et Gynecologica Scandinavica. 2013;92(7): 858–61. doi: 10.1111/aogs.12144 23581719
70. Vangen S, Johansen REB, Sundby J, Træen B, Stray-Pedersen B. Qualitative study of perinatal care experiences among Somali women and local health care professionals in Norway. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2004;112(1): 29–35.
71. Nour NM. Female Genital Cutting: Clinical and Cultural Guidelines. Obstetrical & Gynecological Survey. 2004;59(4): 272–9.
72. Denison E, Berg RC, Lewin S, Fretheim A. Effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting. Report from Norwegian Knowledge Centre for the Health Services. No. 25–2009. Oslo: Norwegian Knowledge Centre for Health Services; 2009.
73. Berg RC, Denison E. Effectiveness of interventions designed to prevent female genital mutilation/cutting: a systematic review. Studies in Family Planning. 2012;43(2): 135–46. doi: 10.1111/j.1728-4465.2012.00311.x 23175952
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