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Female Genital mutilation (FGM) has been associated with numerous negative health effects like sexual dysfunction, chronic pain, infections, infertility, and an increased risk of maternal mortality. To date, no recognized studies in sub-Saharan Africa (SSA) have combined machine learning (ML) models with nationally representative Demographic and Health Survey (DHS) data to classify FGM. Therefore, this study aims to identify the most effective ML model for classifying FGM in SSA. ML offers the significant advantage of handling extremely large and complex datasets with numerous variables and interactions, providing more accurate classifications than conventional statistical methods. This study used secondary data from the DHS collected between 2015 and 2023 in 11 SSA countries. The DHS employs a cross-sectional study design. A total of 62,249 women who had at least one daughter were included in the analysis. Seven classification algorithms, including Logistic Regression, Decision Tree, Random Forest (RF), Support Vector Machine (SVM), K-Nearest Neighbors (KNN), XGBoost (XGB), and Naive Bayes (NB), were used to classify FGM. The RF classifier yielded the highest performance, achieving 0.85 accuracy, 0.83 precision, 0.88 recall, 0.85 F1 score, and 0.93 AUC. Random Forest (Brier score = 0.1319) and Decision Tree (0.1328) showed best calibration. The SHAP plots provide a comprehensive interpretation of the features influencing the model’s classification of whether a mother reports that at least one daughter has undergone FGM. The bar plot shows the global importance of each feature, with opinion on FGM (+ 0.14), country of residence (+ 0.13), respondent’s circumcision status (+ 0.11), and religious justification for FGM (+ 0.07) contributing the most on average to the classification of FGM. This study applied seven machine ML techniques to classify FGM in SSA, with the Random Forest classifier demonstrating the best performance. SHAP interpretability findings indicated that maternal opinion on FGM, country of residence, religious justifications for FGM, and the respondent’s circumcision status contributed most, on average, to the classification of FGM. These results suggest that education and advocacy efforts aimed at mothers particularly those who have had FGM themselves or who believe that the practice is justified by religion should be given top priority in interventions. Implementing community engagement initiatives that challenge accepted conventions and ideas around FGM may be particularly beneficial, especially when these practices are rooted in religious or cultural justifications.

Female Genital Mutilation (FGM) is one of those traditional practices whose origin can be traced back to antiquity. The worst types of FGM are practiced in Sudan, Egypt and Nigeria. The international movement against FGM gained momentum in the past two decades, and attempts were made to increase public awareness of the procedure and its complications. In addition, laws were passed in Egypt to criminally charge practitioners who perform FGM. The aim of this study was to describe frequency, prevalence, complications of FGM and awareness of the women at the clinic visit about the latest update (2016) of the Egyptian law that criminalizes it. This was a cross sectional study of women in their childbearing years (18–45) who attended the Gynecology and Obstetrics outpatient clinics at Fayoum University hospitals between January 1st and December 31st, 2018. After giving their consent, one hundred women attending the clinic received a medical examination and structured interview related to their views and plans regarding FGM of female children. Sixty two percent of women participants reported that they had been circumcised. In 88% of cases, the participant's mother was the person who made the decision to have their daughter circumcised. The most common type of circumcision reported was type II, in 86% of cases. Regarding intent to have a female child circumcised, 32% reported that they would have their own daughter circumcised. Despite Egyptian law that criminalizes FGM, the know potential for serious complications of the procedure, including death, and the efforts of governmental, non-governmental, and international organizations to combat the use of FGM, one third of the women interviewed still planned to have their daughter circumcised.

ObjectiveTo describe the presentation and management of children referred with suspected female genital mutilation (FGM) to a UK safeguarding clinic.Design and settingCase series of all children under 18 years of age referred with suspected FGM between June 2006 and May 2014.Main outcome measuresThese include indication for referral, demographic data, circumstances of FGM, medical symptoms, type of FGM, investigations and short-term outcome.ResultsOf the 47 girls referred, 27 (57%) had confirmed FGM. According to the WHO classification of genital findings, FGM type 1 was found in 2 girls, type 2 in 8 girls and type 4 in 11 girls. No type 3 FGM was seen. The circumstances of FGM were known in 17 cases, of which 12 (71%) were performed by a health professional or in a medical setting (medicalisation). Ten cases were potentially illegal, yet despite police involvement there have been no prosecutions.ConclusionsThis study is an important snapshot of FGM within the UK paediatric population. The most frequent genital finding was type 4 FGM with no tissue damage or minimal scarring. FGM was performed at a young age, with 15% reported under the age of 1 year. The study also demonstrated significant medicalisation of FGM, which matches recent trends in international data. Type 4 FGM performed in infancy is easily missed on examination and so vigilance in assessing children with suspected FGM is essential.

Abstract Objective To assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification. Design Cross sectional study. Settings One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4. Participants 255 girls aged 4-9 and 282 women aged 17-35. Main outcome measures The women's reports of FGMthe actual anatomical extent of the mutilation, and the corresponding types according to the WHO classification. Results All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM were found to have it. Many said to have undergone “sunna circumcision” (excision of prepuce and part or all of clitoris, equivalent to WHO type I) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type III varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types II and III. Conclusion The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct and interpretation of epidemiological and clinical studies. WHO should revise its classification.

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.

To estimate the cost to the health system of obstetric complications due to female genital mutilation (FGM) in six African countries. A multistate model depicted six cohorts of 100,000 15-year-old girls who survived until the age of 45 years. Cohort members were modelled to have various degrees of FGM, to undergo childbirth according to each country's mortality and fertility statistics, and to have medically attended deliveries at the frequency observed in the relevant country. The risk of obstetric complications was estimated based on a 2006 study of 28,393 women. The costs of each complication were estimated in purchasing power parity dollars (I$) for 2008 and discounted at 3%. The model also tracked life years lost owing to fatal obstetric haemorrhage. Multivariate sensitivity analysis was used to estimate the uncertainty around the findings. The annual costs of FGM-related obstetric complications in the six African countries studied amounted to I$ 3.7 million and ranged from 0.1 to 1% of government spending on health for women aged 15-45 years. In the current population of 2.8 million 15-year-old women in the six African countries, a loss of 130,000 life years is expected owing to FGM's association with obstetric haemorrhage. This is equivalent to losing half a month from each lifespan. Beyond the immense psychological trauma it entails, FGM imposes large financial costs and loss of life. The cost of government efforts to prevent FGM will be offset by savings from preventing obstetric complications.

Introduction and hypothesis Female genital mutilation (FGM) is a violation of human rights; yet, more than 100 million females are estimated to have undergone the procedure worldwide. There is an increased need for physician education in treating FGM. Female pelvic surgeons have a unique opportunity to treat this population of patients. Here, we depict the classification of FGM and a general approach to FGM reversal. We specifically address the procedure of type III FGM reversal, or defibulation. Methods In this video, we first highlight the importance of the problem of FGM. Next, we present the classification of FGM using an original, simple, schematic diagram highlighting they key anatomic structures involved in the four types of FGM. We then present a simple case of reversal of type III FGM, a procedure also known as defibulation. After depicting the surgical procedure, we discuss clinical results and summarize key principles of the defibulation procedure. Results Our patient was a 25-year-old woman who had undergone type III FGM as a child in Somalia. She desired restoration of vaginal function. We performed a reversal, and her postoperative course was uncomplicated. By 6 weeks postoperatively, she was able to engage in sexual intercourse without dyspareunia. Conclusion FGM is a problem at the doorsteps of female pelvic medicine and reconstructive surgery. Our video demonstrates a basic surgical approach that can be applied to simple cases of type III FGM presenting to the female pelvic surgeon.

To explore paediatric complications of female genital mutilation (FGM), 255 consecutive girls aged 4-9 years presenting to an emergency ward in Sudan were included in this clinical study. Full examination, including inspection of genitalia, was performed. Dipsticks for nitrite and leucocytes were used to diagnose suspected urinary tract infection (UTI). Girls with a form of FGM narrowing vulva had significantly more UTI than others, and among girls below the age of seven there was a significant association between FGM and UTI. Only 8% of girls diagnosed as having UTI reported urogenital symptoms. In spite of the fact that 73% of the girls subjected to FGM were reported to have been bedridden for one week or more after the operation, only 10% stated immediate complications. We conclude that FGM contributes significantly to morbidity among girls, a large share of which does not come to medical attention. (Afr J Reprod Health 2005; 9[2]: 118-124) Afin d'explorer les complications de la mutilation génitale féminine (MGF), nous avons inclu dans cette étude clinique les filles consécutives âgées de 4 à 9 ans qui viennent au service des urgences au Soudan. On a fait passer un examen compréhensif y compris l'inspection des organes génitaux. Le diagnositic de la suspicion de l'infection urinaire (IU) a été fait à l'aide de la jauge pour les nitrites et les leucocytes. Les filles qui avaient une sorte de vulve qui a été pincé par la MGF avaient beaucoup plus de IU que les autres. Parmi les filles âgées de moins de sept ans, il y avait un lien important entre MGF et IU. Il n'y avait que 8% des filles qui avaient les symptômes de l'infection urogénitale. Malgré le fait que 73% des filles qui avaient la MGF ont été alitées pendant une semaine ou plus après l'opération chirurgicale, seules 10% avaient affirmé des complications immédiates. Nous concluons que la MGF contribue de manière importante à la morbidité chez les filles et qu'une grande majorité des cas ne viennent pas à l'hôpital. (Rev Afr Santé Reprod 2005; 9[2]: 118-124)

EDITOR-Conroy's editorial and the study by Elmusharaf et al contribute to a literature that has often tended to be long on polemic and short on data. 1 2 Conroy's recognition that our conceptions of what constitutes female genital mutilation need further thought is long overdue.

Female genital mutilation is a deeply rooted cultural tradition observed primarily in Africa and among certain communities in the Middle East and Asia. It has considerable health consequences. Women from the practising communities are increasingly seen within healthcare settings but few healthcare professionals are trained to treat their specific healthcare needs.