Female genital circumcision/mutilation: implications for female urogynaecological health

Abstract

"Female genital circumcision" or "female genital mutilation", as it is called more often, is an operation that is primarily carried out in Africa. Owing to migration, physicians are increasingly confronted with this issue in Western countries as well. A range of negative effects may result from this operation and this article aims to address consequences for female pelvic health. Special emphasis is placed on urogynaecological health consequences; in particular, on "voiding difficulties", "recurrent urinary tract infections" and "vesicovaginal fistula". All of these occur mostly in infibulated women, i.e. in women whose genitalia are sealed by the most severe form of circumcision. Some of the problems that may emerge as a result of the operation can be resolved by defibulation (i.e. surgical reopening of the sealed vulva). Female genital circumcision is a sensitive topic even in the area of research and reliable data are therefore scarce.

Research gaps in the care of women with female genital mutilation: an analysis

“…With respect to obstetric outcomes and postpartum perineal re‐education, 24 references were identified (Table ): 16 research studies; five clinical guidelines; one expert opinion; one policy statement; and one letter to the editor . On defibulation performed outside of pregnancy or labour, nine references were identified: four research articles; one guideline; three expert opinions; and one case report . On clitoral reconstruction, ten relevant references were identified: five research articles; and five expert opinions, guidelines, or commentaries .…”

“…This surgery is technically simple and can significantly improve infibulated women's health . Limited evidence (case reports) suggests that defibulation can effectively treat symptoms such as dysmenorrhea, dyspareunia, and urinary complications, including overactive bladder, by removing the obstacle of the bridge scar …”

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

“…Deep tissue cuts may also create keloids and hypertrophic scars [4]. Progressive scar shrinkage may result in urinary retention and slow urine streaming [5]. Vaginal obliteration after Type III has been reported before [6].…”

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

“…It can vastly improve mutilated women's health by the resolution of symptoms, such as repeated urinary or vaginal infections, prolonged micturition, dysmenorrhoea and superficial dyspareunia 7 19. It also facilitates subsequent delivery and gynaecological screenings.…”