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At least 200 million girls and women across the world have experienced female genital cutting (FGC). International migration has grown substantially in recent decades, leading to a need for health care providers in regions of the world that do not practice FGC to become knowledgeable and skilled in their care of women who have undergone the procedure. There are four commonly recognized types of FGC (Types I, II, III, and IV). To adhere to recommendations advanced by the World Health Organization (WHO) and numerous professional organizations, providers should discuss and offer deinfibulation to female patients who have undergone infibulation (Type III FGC), particularly before intercourse and childbirth. Infibulation involves narrowing the vaginal orifice through cutting and appositioning the labia minora and/or labia majora, and creating a covering seal over the vagina with appositioned tissue. The WHO has published a handbook for health care providers that includes guidance in counseling patients about deinfibulation and performing the procedure. Providers may benefit from additional guidance in how to discuss FGC and deinfibulation in a manner that is sensitive to each patient’s culture, community, and values. Little research is available to describe decision-making about deinfibulation among women. This article introduces a theoretically informed conceptual model to guide future research and clinical conversations about FGC and deinfibulation with women who have undergone FGC, as well as their partners and families. This conceptual model, based on the Theory of Planned Behavior, may facilitate conversations that lead to shared decision-making between providers and patients.

Background Female genital mutilation (FGM) is a traditional harmful practice that can cause severe physical and psychological damages to girls and women. Increasingly, trained health-care providers carry out the practice at the request of families. It is important to understand the motivations of providers in order to reduce the medicalization of FGM. This integrative review identifies, appraises and summarizes qualitative and quantitative literature exploring the factors that are associated with the medicalization of FGM and/or re-infibulation. Methods Literature searches were conducted in PubMed, CINAHL and grey literature databases. Hand searches of identified studies were also examined. The “CASP Qualitative Research Checklist” and the “STROBE Statement” were used to assess the methodological quality of the qualitative and quantitative studies respectively. A total of 354 articles were reviewed for inclusion. Results Fourteen (14) studies, conducted in countries where FGM is largely practiced as well as in countries hosting migrants from these regions, were included. The main findings about the motivations of health-care providers to practice FGM were: (1) the belief that performing FGM would be less harmful for girls or women than the procedure being performed by a traditional practitioner (the so-called “harm reduction” perspective); (2) the belief that the practice was justified for cultural reasons; (3) the financial gains of performing the procedure; (4) responding to requests of the community or feeling pressured by the community to perform FGM. The main reasons given by health-care providers for not performing FGM were that they (1) are concerned about the risks that FGM can cause for girls’ and women’s health; (2) are preoccupied by the legal sanctions that might result from performing FGM; and (3) consider FGM to be a “bad practice”. Conclusion The findings of this review can inform public health program planners, policy makers and researchers to adapt or create strategies to end medicalization of FGM in countries with high prevalence of this practice, as well as in countries hosting immigrants from these regions. Given the methodological limitations in the included studies, it is clear that more robust in-depth qualitative studies are needed, in order to better tackle the complexity of this phenomenon and contribute to eradicating FGM throughout the world.

Type III female genital mutilation/cutting (FGM/C), or infibulation, negatively impacts girls' and women's health and well-being. Some evidence suggests women who have experienced infibulation may have distinct menstrual health challenges. However, the intersection of infibulation and menstrual health is under-explored. The present study documented women's and providers' perspectives on menstrual health and infibulation among Somali communities in Wajir County, Kenya. We conducted a qualitative study including in-depth interviews (  = 23) with Somali women ages 18-45, and key informant interviews (  = 10) with healthcare providers. Interviews with women explored their reflections on and experiences of FGM/C, including infibulation, menstrual health, and perceived connections between the two. Interviews with healthcare providers explored their perspectives on women's healthcare needs in relation to menstrual health and infibulation. Thematic analysis identified three themes: (1) informal discussion among women shapes their menstruation and infibulation knowledge; (2) multiple factors that shape women's care-seeking for menstrual health concerns; and (3) healthcare providers lack the necessary preparation to address menstrual health concerns among women who have undergone infibulation. This study's findings provide insights into the intersections of menstrual health and infibulation within the broader educational, social and healthcare context of Somali communities in rural Kenya. While women learn, interpret, and describe infibulation as a source of acute menstrual health problems, including menstrual pain and irregular bleeding, clinical evidence on this relationship is needed. Findings illuminated multiple factors inhibiting Somali women's receipt of adequate care for menstrual health needs. Additional challenges included women's perceptions of healthcare quality, distrust of formal healthcare providers, and gendered family decision-making processes around healthcare. Healthcare providers' inadequate training and support hindered diagnosis and care for menstrual disorders for women who have and have not experienced infibulation, while confusion about Kenya's FGM/C ban further complicates provider engagement.

At present, the number of migrants is globally increasing. Although the foreigners in the Czech Republic are pleading asylum less than in other countries of the EU (foreigners in the Czech Republic make up less than 5% of the whole population), there were 2,015,467,562 legally registered foreigners at the end of the last year, which was 15,639 more than in 2014. Migration is also associated with the presented issue of female genital mutilation. This article informs of female genital mutilation (FGM). The research was carried out in 2016. The goal was to find the specifics of the care of women with genital mutilation during pregnancy, delivery and puerperium, from the perspective of midwives. The research used a qualitative method of in-depth interviews with midwives who had experience with nursing women with genital mutilation during pregnancy, delivery and puerperium. The data were analyzed using the method of open coding and then categorized. We found that the interviewed midwives had a negative approach to the practices of genital mutilation. The results showed that midwives met obstacles in nursing women with FGM. The complications during pregnancy, delivery and puerperium, which appear in women after the genital mutilation procedure, depend on the extent of the procedure and the later individual periods. Growing migration suggests the number of women with genital mutilation is increasing. For this reason, it is important that midwives are informed of this issue and that they have knowledge in nursing women with FGM during pregnancy, delivery and puerperium.

In communities where female circumcision is carried out, increasingly large segments of the population have been exposed to strong arguments against the practice. This study aimed to explore diverse discourses on female circumcision and the relationship between discourses and practice among informants who have been exposed both to local and global discourses on female circumcision. A qualitative study was carried out in 2009/10 in Hargeysa, Somaliland, employing interviews and informal discussion. The main categories of informants were nurses, nursing students, returned exile Somalis and development workers. The study findings suggest that substantial change has taken place about perceptions and practice related to female circumcision; the topic is today openly discussed, albeit more in the public than in the private arena. An important transformation moreover seems to be taking place primarily from the severe forms (pharaoni) to the less extensive forms (Sunna). Dans les communautés où l'excision est pratiquée, de grandes parties de la population ont été exposées ? de forts arguments contre la pratique. Cette étude vise ? explorer les diverses discours sur l'excision et la relation entre les discours et la pratique parmi les informateurs qui ont été exposés ? la fois ? des discours locaux et mondiaux sur l'excision. Une étude qualitative a été menée en 2009/10, ? Hargeisa, au Somaliland, en utilisant des entrevues et des discussions informelles. Les principales catégories d'informateurs étaient des infirmières, des étudiants en soins infirmiers, des Somaliens qui revenaient de l'exil et des agents de développement. Les résultats de l'étude suggèrent que les changements importants ont eu lieu sur les perceptions et les pratiques liées ? l'excision; le sujet est aujourd'hui ouvertement discuté, mais plus dans le domaine public que dans le domaine privé. Une transformation importante semble d'ailleurs avoir lieu principalement ? partir des formes sévères (pharaoni) jusqu'aux formes moins vastes (de sunna).

This paper explores the dynamics of change in meaning-making about female genital cutting among migrants from Somalia and Sudan residing in Norway. In both countries, female genital cutting is almost universal, and most women are subjected to the most extensive form - infibulation - which entails the physical closure of the vulva. This closure must later be re-opened, or defibulated, to enable sexual intercourse and childbirth. Defibulation can also ease other negative health consequences of the practice. In Norway, surgical defibulation is provided on demand by the public health services, also beyond the traditional contexts of marriage and childbirth. This study explores experiences and perceptions of premarital defibulation. It explores whether Somali and Sudanese men and women understand defibulation as a purely medical issue or whether their use of the services is also affected by the cultural meaning of infibulation. This study analyses data from in-depth interviews with 36 women and men of Somali and Sudanese origin as well as participant observation conducted in various settings during 2014-2015. It reports that although all of the informants displayed negative attitudes towards infibulation, cultural meanings associated with virginity and virtue constitute a significant barrier to the uptake of premarital defibulation.

Background Female genital mutilation comprises all procedures involving the partial or total removal of female external genitalia or other injury to the female external organs, whether for religious, cultural or other non-therapeutic reasons. The impact of female genital mutilation is diverse, including physical, social and psychological impact. We report a case of a 36-year-old woman with type three female genital mutilation who did not seek medical treatment due to lack of awareness that there was treatment for it, and use this case as an entry point to comprehensively review literature regarding long-term complications associated with female genital mutilation and its impact on women’s quality of life. Case presentation We present a case of a 36-year-old single nulligravida lady with type three female genital mutilation who had presented with difficulty with urination since childhood. She had difficulty with menstruation since her menarche, and she had never had sexual intercourse. She never sought treatment, but recently went to hospital after she heard of a young lady who had the same problem in her neighborhood who was treated surgically and got married. On external genitalia examination, there was no clitoris, no labia minora, and labia majora were fused to each other with a healed old scar between them. There was a 0.5 cm by 0.5 cm opening below the fused labia majora near to the anus through which urine was dribbling. De-infibulation was done. Six months after the procedure, she was married and at that moment she was pregnant. Conclusion The physical, sexual, obstetrics and psychosocial consequences of female genital mutilation are neglected issues. The improvement of women’s socio-cultural status in combination with planning programs to enhance their information and awareness as well as trying to change the cultural and religious leaders’ viewpoints regarding this procedure is essential to reducing female genital mutilation and its burden on women’s health.

Background: Female genital mutilation (FGM), especially infibulation, is a significant public health issue that poses numerous health risks for young girls. Despite its severity, this phenomenon remains under-documented.Aim: This study aims to identify the factors associated with infibulation among girls who underwent FGM in Guinea.Setting: This study was conducted in Guinea.Method: A secondary analysis of data from the 2018 Demographic and Health Survey (DHS) in Guinea included 3950 women whose daughters had undergone female genital mutilation or excision (FGM/E). A multivariate logistic regression was performed to identify factors associated with infibulation using the Stata software version 17.Results: The overall prevalence of infibulation among girls who underwent female genital mutilation or cutting (FGM/C) in Guinea was 16%. This prevalence was higher at 17% (95% confidence interval [CI]: [0.1–0.2]) among girls aged 0 years to 4 years. Statistically significant individual and contextual factors included: maternal age (odds ratio [OR] = 1.4, 95% CI: [1.1–2.6]), maternal employment status (OR = 1.7, 95% CI: [1.3–2.2]), maternal religion (OR = 2.7, 95% CI: [1.2–5.8]), maternal infibulation status (OR = 22.1, 95% CI: [16.6–29.4]) and region of residence (OR = 2.8, 95% CI: [1.6–4.8]).Conclusion: This study highlights the need for educational, socio-economic and public health strategies to eradicate infibulation in Guinea and promote sustainable change.Contribution: This research revealed the influence of individual and contextual factors on infibulation and highlighted the emergency of targeted strategies, such as awareness raising, community dialogue and education about its risks.

Background Female Genital Mutilation/Cutting (FGM/C) concerns over 200 million women and girls worldwide and is associated with obstetric trauma and long-term urogynaecological and psychosexual complications that are often under-investigated and undertreated. The aim of this study was to assess the pelvic floor distress and the impact of pelvic floor and psychosexual symptoms among migrant women with different types of FGM/C. Methods This cross-sectional study was conducted between April 2016 and January 2019 at the Division of Gynaecology of the Geneva University Hospitals. The participants were interviewed on socio-demographic and background information, underwent a systematic gynaecological examination to assess the presence and type of FGM/C and eventual Pelvic Organ Prolapse (POP), and completed six validated questionnaires on pelvic floor and psychosexual symptoms (PFDI-20 and PFIQ7 on pelvic floor distress and impact, FISI and WCS on faecal incontinence and constipation, PISQ-IR and FGSIS on sexual function and genital self-image). The participants’ scores were compared with scores of uncut women available from the literature. The association between selected variables and higher scores for distress and impact of pelvic floor symptoms was assessed using univariate and multivariable linear regression models. Results 124 women with a mean age of 31.5 (± 7.5), mostly with a normal BMI, and with no significant POP were included. PFDI-20 and PFIQ-7 mean (± SD) scores were of 49.5 (± 52.0) and 40.7 (± 53.6) respectively. In comparison with the available literature, the participants’ scores were lower than those of uncut women with pelvic floor dysfunction but higher than those of uncut women without such disorders. Past violent events other than FGM/C and forced or arranged marriage, age at FGM/C of more than 10, a period of staying in Switzerland of less than 6 months, and nulliparity were significantly associated with higher scores for distress and impact of pelvic floor symptoms, independently of known risk factors such as age, weight, ongoing pregnancy and history of episiotomy. Conclusions Women with various types of FGM/C, without POP, can suffer from pelvic floor symptoms responsible for distress and impact on their daily life. Trial registration . The study protocol was approved by the Swiss Ethics Committee on research involving humans (protocol n°15-224).

Background The most pervasive form of female genital mutilation/cutting—infibulation—involves the almost complete closure of the vaginal orifice by cutting and closing the labia to create a skin seal. A small opening remains for the passage of urine and menstrual blood. This physical closure has to be re-opened—defibulated—later in life. When they marry, a partial opening is made to enable sexual intercourse. The husband commonly uses his penis to create this opening. In some settings, a circumciser or traditional midwife opens the infibulated scar with a knife or razor blade. Later, during childbirth, a further opening is necessary to make room for the child’s passage. In Norway, public health services provide surgical defibulation, which is less risky and painful than traditional forms of defibulation. This paper explores the perceptions and experiences of surgical defibulation among migrants in Norway and investigates whether surgical defibulation is an accepted medicalization of a traditional procedure or instead challenges the cultural underpinnings of infibulation. Methods Data derived from in-depth interviews with 36 women and men of Somali and Sudanese origin and with 30 service providers, as well as participant observations in various settings from 2014–15, were thematically analyzed. Results The study findings indicate that, despite negative attitudes towards infibulation, its cultural meaning in relation to virility and sexual pleasure constitutes a barrier to the acceptance of medicalized defibulation. Conclusions As sexual concerns regarding virility and male sexual pleasure constitute a barrier to the uptake of medicalized defibulation, health care providers need to address sexual concerns when discussing treatment for complications in infibulated women. Furthermore, campaigns and counselling against this practice also need to tackle these sexual concerns.