Abstract
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.
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References
WHO/UNICEF/UNFPA (2008) Female genital mutilation: a joint WHO/UNICEF/UNFPA statement. Geneva WHO
Dirie MA, Lindmark G (1992) The risk of medical complications after female circumcision. East Afr Med J 69:479–482
The American College of Obstetricians and Gynecologists (2008) Female Genital Cutting: Clinical Management of Circumcised Women. Washington DTACoOaG
Gruenbaum E (2001) The female circumcision controversy: an anthropological perspective. University of Pennsylvania Press, Philadelphia
Kolucki B (2004) http://www.disabilityworld.org/01-03_04/women/fgm.shtml. KBFGMDWaDS
Mitike G, Deressa W (2009) Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study. BMC Public Health 9:264
Nour NM (2008) Female genital cutting: a persisting practice. Rev Obstet Gynecol 1:135–139
Yoder PS, Abderrahim N, Zhuzhuni A (2004) Female genital cutting in the demographic and health surveys: a critical and comparative analysis. ORC Macro, Macro International, Inc., Calverton
World Health Organisation (WHO) (1995) Female genital mutilation. Report of The WHO Technical Working Group, Geneva
Davis G, Ellis J, Hibbert M, Perez RP, Zimbelman E (1999) Female circumcision: the prevalence and nature of the ritual in Eritrea. Mil Med 164:11–16
Kun KE (1997) Female genital mutilation: the potential for increased risk of HIV infection. Int J Gynaecol Obstet 59:153–155
Dean A, Sullivan Κ, Soe Μ (2008) OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 2.2.1. Updated 2008/04/06 [cited 2008/09/18]. http://www.OpenEpi.com
Adetoro OO, Ebomoyi E (1986) Health implications of traditional female circumcision in pregnancy. Asia Oceania J Obstet Gynaecol 12:489–492
Chalmers B, Hashi KO (2000) 432 Somali women’s birth experiences in Canada after earlier female genital mutilation. Birth 27:227–234
El Dareer A (1983) Complications of female circumcision in the Sudan. Trop Doct 13:131–133
Momoh C, Ladhani S, Lochrie DP, Rymer J (2001) Female genital mutilation: analysis of the first twelve months of a Southeast London specialist clinic. BJOG 108:186–191
Osifo DO, Evbuomwan I (2009) Female genital mutilation among Edo people: the complications and pattern of presentation at a pediatric surgery unit, Benin City. Afr J Reprod Health 13:17–25
Shandall AA (1967) Circumcision and infibulation of females: a general consideration of the problem and a clinical study of the complications in Sudanese women. Sudan Med J 5:178–212
Almroth L, Bedri H, El Musharaf S et al (2005) Urogenital complications among girls with genital mutilation: a hospital-based study in Khartoum. Afr J Reprod Health 9:118–124
el-Defrawi MH, Lotfy G, Dandash KF, Refaat AH, Eyada M (2001) Female genital mutilation and its psychosexual impact. J Sex Marital Ther 27:465–473
Knight R, Hotchin A, Bayly C, Grover S (1999) Female genital mutilation—experience of The Royal Women’s Hospital, Melbourne. Aust N Z J Obstet Gynaecol 39:50–54
Arbesman M, Kahler L, Buck GM (1993) Assessment of the impact of female circumcision on the gynecological, genitourinary and obstetrical health problems of women from Somalia: literature review and case series. Women Health 20:27–42
Hassan A (1995) Sudanese women’s struggle to eliminate harmful practices. Plan Parent Chall 2:17–8, 21–2
Klouman E, Manongi R, Klepp KI (2005) Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections. Trop Med Int Health 10:105–115
Msuya SE, Mbizvo E, Hussain A, Sundby J, Sam NE, Stray-Pedersen B (2002) Female genital cutting in Kilimanjaro, Tanzania: changing attitudes? Trop Med Int Health 7:159–165
Okonofu FE, Larsen U, Oronsaye F, Snow RC, Slanger TE (2002) The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria. BJOG 109:1089–1096
Brewer DD, Potterat JJ, Roberts JM Jr, Brody S (2007) Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania. Ann Epidemiol 17:217–226
Maslovskaya O, Brown JJ, Padmadas SS (2009) Disentangling the complex association between female genital cutting and HIV among Kenyan women. J Biosoc Sci 41:815–830
Yount KM, Abraham BK (2007) Female genital cutting and HIV/AIDS among Kenyan women. Stud Fam Plann 38:73–88
Elmusharaf S, Elkhidir I, Hoffmann S, Almroth L (2006) A case-control study on the association between female genital mutilation and sexually transmitted infections in Sudan. BJOG 113:469–474
Morison L, Scherf C, Ekpo G et al (2001) The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey. Trop Med Int Health 6:643–653
Hamoudi A, Shier M (2010) Late complications of childhood female genital mutilation. J Obstet Gynaecol Can 32:587–589
Jaeger F, Caflisch M, Hohlfeld P (2009) Female genital mutilation and its prevention: a challenge for paediatricians. Eur J Pediatr 168:27–33
Utz-Billing I, Kentenich H (2008) Female genital mutilation: an injury, physical and mental harm. J Psychosom Obstet Gynaecol 29:225–229
Leye EPR, Nienhuis G, Claeys P, Temmerman M (2006) Health care in Europe for women with genital mutilation. Health Care Women Int 27:362–378
Johansen RE (2006) Care for infibulated women giving birth in Norway: an anthropological analysis of health workers’ management of a medically and culturally unfamiliar issue. Med Anthropol Q 20:516–544
Momoh C (2004) Female genital mutilation. Curr Opin Obstet Gynecol 16:477–480
Nour NM (2004) Female genital cutting: clinical and cultural guidelines. Obstet Gynecol Surv 59:272–279
Obermeyer CM (2005) The consequences of female circumcision for health and sexuality: an update on the evidence. Cult Health Sex 7:443–461
Egwuatu VE, Agugua NE (1981) Complications of female circumcision in Nigerian Igbos. Br J Obstet Gynaecol 88:1090–1093
Iregbulem LM (1980) Post-circumcision vulval adhesions in Nigerians. Br J Plast Surg 33:83–86
European Study Group on Heterosexual Transmission of HIV (1992) Comparison of female to male and male to female transmission of HIV in 563 stable couples. BMJ 304:809–813
Merli C (2010) Male and female genital cutting among Southern Thailand’s Muslims: rituals, biomedical practice and local discourses. Cult Health Sex 12:725–738
Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M (2006) Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet 367:1835–1841
Behrendt A, Moritz S (2005) Posttraumatic stress disorder and memory problems after female genital mutilation. Am J Psychiatry 162:1000–1002
Boyle EH (2002) Female genital cutting: cultural conflict in the global community. Johns Hopkins University Press, Baltimore
Snow RC, Slanger TE, Okonofua FE, Oronsaye F, Wacker J (2002) Female genital cutting in southern urban and peri-urban Nigeria: self-reported validity, social determinants and secular decline. Trop Med Int Health 7:91–100
FGM Joint Statement W, UNICEF and UNFPA, (1997, Page 4
Goodwin J-A, David J (2007) HtupofcidywsliscB, “Daily Mail, 2007-JAN-03. http://www.dailymail.co.uk/
Center for Reproductive Rights (2004) Legislation on Female Genital Mutilation in the United States CfRR. http://www.reproductiverights.org/
Megan C (2004) TiUSAoGM, Womensenews, 2004-FEB-19. http://www.womensenews.org/
US Department of State (2009) CRoHRPf-I, 25 February, sect. 5—attachment 1
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Iavazzo, C., Sardi, T.A. & Gkegkes, I.D. Female genital mutilation and infections: a systematic review of the clinical evidence. Arch Gynecol Obstet 287, 1137–1149 (2013). https://doi.org/10.1007/s00404-012-2708-5
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DOI: https://doi.org/10.1007/s00404-012-2708-5