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

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    WHO/UNICEF/UNFPA (2008) Female genital mutilation: a joint WHO/UNICEF/UNFPA statement. Geneva WHO

  2. 2.

    Dirie MA, Lindmark G (1992) The risk of medical complications after female circumcision. East Afr Med J 69:479–482

    PubMed  CAS  Google Scholar 

  3. 3.

    The American College of Obstetricians and Gynecologists (2008) Female Genital Cutting: Clinical Management of Circumcised Women. Washington DTACoOaG

  4. 4.

    Gruenbaum E (2001) The female circumcision controversy: an anthropological perspective. University of Pennsylvania Press, Philadelphia

    Google Scholar 

  5. 5.

    Kolucki B (2004) http://www.disabilityworld.org/01-03_04/women/fgm.shtml. KBFGMDWaDS

  6. 6.

    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

    PubMed  Article  Google Scholar 

  7. 7.

    Nour NM (2008) Female genital cutting: a persisting practice. Rev Obstet Gynecol 1:135–139

    PubMed  Google Scholar 

  8. 8.

    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

  9. 9.

    World Health Organisation (WHO) (1995) Female genital mutilation. Report of The WHO Technical Working Group, Geneva

    Google Scholar 

  10. 10.

    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

    PubMed  CAS  Google Scholar 

  11. 11.

    Kun KE (1997) Female genital mutilation: the potential for increased risk of HIV infection. Int J Gynaecol Obstet 59:153–155

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    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

  13. 13.

    Adetoro OO, Ebomoyi E (1986) Health implications of traditional female circumcision in pregnancy. Asia Oceania J Obstet Gynaecol 12:489–492

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Chalmers B, Hashi KO (2000) 432 Somali women’s birth experiences in Canada after earlier female genital mutilation. Birth 27:227–234

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    El Dareer A (1983) Complications of female circumcision in the Sudan. Trop Doct 13:131–133

    PubMed  Google Scholar 

  16. 16.

    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

    PubMed  CAS  Google Scholar 

  17. 17.

    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

    PubMed  Google Scholar 

  18. 18.

    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

    PubMed  CAS  Google Scholar 

  19. 19.

    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

    PubMed  Article  Google Scholar 

  20. 20.

    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

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    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

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    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

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Hassan A (1995) Sudanese women’s struggle to eliminate harmful practices. Plan Parent Chall 2:17–8, 21–2

    Google Scholar 

  24. 24.

    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

    PubMed  Article  Google Scholar 

  25. 25.

    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

    PubMed  Article  Google Scholar 

  26. 26.

    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

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    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

    PubMed  Google Scholar 

  28. 28.

    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

    PubMed  Article  Google Scholar 

  29. 29.

    Yount KM, Abraham BK (2007) Female genital cutting and HIV/AIDS among Kenyan women. Stud Fam Plann 38:73–88

    PubMed  Article  Google Scholar 

  30. 30.

    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

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    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

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Hamoudi A, Shier M (2010) Late complications of childhood female genital mutilation. J Obstet Gynaecol Can 32:587–589

    PubMed  Google Scholar 

  33. 33.

    Jaeger F, Caflisch M, Hohlfeld P (2009) Female genital mutilation and its prevention: a challenge for paediatricians. Eur J Pediatr 168:27–33

    PubMed  Article  Google Scholar 

  34. 34.

    Utz-Billing I, Kentenich H (2008) Female genital mutilation: an injury, physical and mental harm. J Psychosom Obstet Gynaecol 29:225–229

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    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

    PubMed  Article  Google Scholar 

  36. 36.

    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

    PubMed  Article  Google Scholar 

  37. 37.

    Momoh C (2004) Female genital mutilation. Curr Opin Obstet Gynecol 16:477–480

    PubMed  Article  Google Scholar 

  38. 38.

    Nour NM (2004) Female genital cutting: clinical and cultural guidelines. Obstet Gynecol Surv 59:272–279

    PubMed  Article  Google Scholar 

  39. 39.

    Obermeyer CM (2005) The consequences of female circumcision for health and sexuality: an update on the evidence. Cult Health Sex 7:443–461

    PubMed  Article  Google Scholar 

  40. 40.

    Egwuatu VE, Agugua NE (1981) Complications of female circumcision in Nigerian Igbos. Br J Obstet Gynaecol 88:1090–1093

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Iregbulem LM (1980) Post-circumcision vulval adhesions in Nigerians. Br J Plast Surg 33:83–86

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    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

    Google Scholar 

  43. 43.

    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

    PubMed  Article  Google Scholar 

  44. 44.

    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

    PubMed  Article  Google Scholar 

  45. 45.

    Behrendt A, Moritz S (2005) Posttraumatic stress disorder and memory problems after female genital mutilation. Am J Psychiatry 162:1000–1002

    PubMed  Article  Google Scholar 

  46. 46.

    Boyle EH (2002) Female genital cutting: cultural conflict in the global community. Johns Hopkins University Press, Baltimore

    Google Scholar 

  47. 47.

    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

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    FGM Joint Statement W, UNICEF and UNFPA, (1997, Page 4

  49. 49.

    Goodwin J-A, David J (2007) HtupofcidywsliscB, “Daily Mail, 2007-JAN-03. http://www.dailymail.co.uk/

  50. 50.

    Center for Reproductive Rights (2004) Legislation on Female Genital Mutilation in the United States CfRR. http://www.reproductiverights.org/

  51. 51.

    Megan C (2004) TiUSAoGM, Womensenews, 2004-FEB-19. http://www.womensenews.org/

  52. 52.

    US Department of State (2009) CRoHRPf-I, 25 February, sect. 5—attachment 1

Download references

Conflict of interest

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Christos Iavazzo.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

Keywords

  • Female circumcision
  • Mutilation
  • Genital cutting
  • Infection