Socio-demographic characteristics of respondents
The Respondents were 314 married women distributed as follows: cut before marriage 140 (44.6%), cut after marriage 29(9.2%) and uncut 145 (46.2%). The mean age of the Respondents was 30.59 ± 7.36 years ranging from 15 to 45 years. About three-quarters (76%) of the Respondents were 25 years and above. An analysis with chi-square test of independence was performed to examine the relation between social demographic factors and the cut status of the married women. Respondents who were uncut were more likely to be young (χ2 = 34.885, df = 2, p < 0.001), have fewer children (χ2 = 45.885, df = 2, p < 0.001), and of higher education (χ2 = 20.888, df = 2, p < 0.001) (Table 1). With regard to economic activity, over three-quarters (76.1%, n = 246) were farmers. Chi-square test of independence found no relationship between economic activity and the cutting status of the married women.
An independent t-test reveals a link between sexual functioning and three socio-demographic characteristics namely age, number of children and education. The data shows a significant association (p = 0.008) between age and sexual function with the younger women showing higher FSFI scores compared to older women (25.25 vs 23.67). In addition, there was a significant association (p = 0.035) between number of children and sexual functioning. The women with fewer children had higher FSFI scores compared to women with more children (24.84 vs 23.42). Similarly, there was a significant association (p = 0.038) between educational level and sexual functioning with post primary educated women having higher FSFI scores compared to those with primary education (25.64 vs 24.15). These findings are corroborated by data from FGDs and case narratives.
Women reported that children may lead to reduced sexual desire among married women. Indeed, there was concurrence that married women’s sexual desire changes as they get busy with additional domestic responsibility such as child rearing. “I think it's when the love is now going down, by this time there are children responsibilities, work, and life is generally harder”. (Young Women, FGD,, Mauche Shopping Centre).
Women’s sexual experiences are captured vividly in various case narratives. The excerpt below, from a middle-aged woman (35 yrs) and mother of 4 who was forced to cut 6 months after giving birth to her first baby, is a typical representation of experiences of cut women. It reveals bitterness and frustration in her sex life;
There was a lot of change because the body does not feel excited for sex even if you see a man you just see that you are not interested at all. Before I was cut, I used to have a lot of desire for sex such that we would even stop our meal halfway to go and I would tell my husband to go and have sex first. My husband told me that he used to enjoy sex more before I got cut than now when I am cut….I don’t feel like having sex at all, the body doesn’t want it and the mind is full of other things that are stressing me…. If it had been today I would refuse to get cut. Had I known better…. (35 years old woman, Case Narrative 1, Mauche Shopping Center)
Married cut women in this community clearly concurred that they encountered challenges in their experiences of sexuality after they got cut. They described the differences in their sexuality before and after being cut. The following narrative points to some of these sexual challenges that cut women have to contend with. This is reiterated by a participant in one FGD. “The ‘heat’ goes away [after being cut] so the wife is just forced by her husband [to have sex] when she is sleeping” (Participant 5, Cut participant, FGD with cut and uncut women, Mauche Shopping Center). Another FGD participant reiterated, “When you have been cut, your husband remains ‘hot’ and then he forces you to have sex [and] because you just don’t feel like, it [sex] is not sweet….” (Participant 1, FGD with cut and uncut women, Mauche Shopping Center).
In order to measure these experiences objectively, the sexual functioning of cut and uncut women in Mauche was assessed across the six domains of the FSFI tool namely: desire, arousal, lubrication, orgasm, satisfaction and pain. Overall the married uncut women had better sexual functioning scores (25.35) compared to cut before marriage (23.99) and cut after marriage (22.81), and the differences were statistically significant (p = 0.019). Further analysis with Bonferroni post hoc test revealed that women cut after marriage scored significantly (p = 0.056) lower than the uncut. However, in comparison to the cut before marriage there was no significant difference. Lubrication, orgasm and satisfaction were found to be statistically different across the three groups while desire, arousal and pain (reverse-scored) showed no statistical difference (Table 2). Lubrication scored significantly (p = 0.013) lower among women cut before marriage than the uncut. However, in comparison to cut after marriage there was no significant difference. Both orgasm (p = 0.041) and satisfaction (p = 0.043) scored significantly lower among women cut after marriage than the uncut and no significant difference with those cut before marriage.
A multivariate linear regression analysis was performed with female sexual function index scores as dependent and cutting status, age, number of children and level of education as predictor variables (Table 3). Tolerance values for the four predicator values were between 0.518 and 0.915 indicating there was no multicollinearity. The analysis revealed a significant model, accounting for 6.6% of the variance in sexual function, F(4, 309) = 5.437, p < 0.001, R
2 = 0.66. The analysis showed that age (β = −0.181, p = 0.018) and highest level of education (β = 0.162, p = 0.005) were independent predictors of FSFI total scores. The scores decreased by 0.13 for 1 year increase in age and increased by 1.577 for increase in level of education.
Reasons why women agreed to cut after marriage were explored and they include peer pressure on the husband and stigma associated to being different. One participant observed that “friends of the husband put a lot of pressure by refusing to eat her [his wife’s] food until she is cut” (Older women 42–50 years, FGD, Chief’s camp). Another added, “because the woman is called ‘ugali mbichi’ (partially cooked maize meal), she is seen as a child …”. Other reasons given for husbands forcing their wives to be cut include an attempt to reduce the women’s perceived ‘high’ sexual desire. This is captured in the following quote from a participant in one FGD, “some husbands feel like wives have too much ‘heat’, hence they want to reduce [it]” (Young Women,FGD, Mauche Shopping Centre). Stigma against women who are not cut was expressed as, “the state of being despised will be so much, you cannot be a community leader” (Participant 4), with another adding her view on how to deal with this stigma, “it is better you just accept to be cut” (Participant 3).
The socially moderated sexual behavior subdued women’s overt expressions of their sexuality as captured below:
A married woman is not expected to initiate sex even when she may desire lest this is misinterpreted for immorality…. (Participant 2, FGD of older women, Chief’s camp Mauche)
… you cannot tell your husband that you want sex, so you wait for him to ask. If you ask he will think you are ‘lustful’ and can be mistaken for being a prostitute. (Participant 1, FGD of older women Chief’s camp Mauche)
While the expected proper behavior may be culturally moderated, and even negatively affected by FGM/C, such moderation is not absolute as revealed in a view expressed by one of the participants from the older women’s FGD. This woman, although cut, mentions that she sometimes takes initiative to sexually arouse her husband although she associates it to trying to please him when he is stressed out. She stated; “When you are married you get to know your husband and when he is unhappy you can begin touching him in bed but you will not talk about it (sex) (Older women, FGD, Chief’s camp Mauche). This shows that as much as sexual experiences may be altered negatively by FGM/C, women reportedly experience sexual desire and enjoyment.