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1.
Reprod Health ; 18(1): 52, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648528

RESUMO

INTRODUCTION: The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. METHODS: This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders. RESULTS: The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women. CONCLUSION: Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women's social networks for offsetting their extended family familial roles in sustaining FGM/C practices.


Assuntos
Circuncisão Feminina , Tomada de Decisões , Genitália Feminina/lesões , Adolescente , Adulto , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/psicologia , Circuncisão Feminina/estatística & dados numéricos , Cultura , Feminino , Grupos Focais , Genitália Feminina/patologia , Gana/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Casamento/psicologia , Casamento/estatística & dados numéricos , Pesquisa Qualitativa , Religião , Determinantes Sociais da Saúde , Fatores Socioeconômicos
2.
Acta Obstet Gynecol Scand ; 100(4): 587-595, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33719034

RESUMO

INTRODUCTION: The impact of female genital mutilation/cutting on obstetric outcomes in high-income countries is not clear. In general, women with female genital mutilation/cutting type 3 (infibulation) seem to be most at risk of adverse outcomes such as cesarean section. Deinfibulation is recommended to prevent obstetric complications. Whether the timing of this procedure affects the complication risk is not known. The aims of this study were, first, to examine the association between female genital mutilation/cutting and the risk of cesarean section in Norway, and, second, whether the timing of deinfibulation affected the cesarean section risk. MATERIAL AND METHODS: This was a historical cohort study of nulliparous Somali-born women who gave birth in Norway between 1990 and 2014. The Medical Birth Registry of Norway identified the women. Data were collected from medical records at 11 participating birth units. The exposures were female genital mutilation/cutting status and deinfibulation before pregnancy, during pregnancy, or no deinfibulation before labor onset. The main outcome was odds ratio (OR) of cesarean section. Type of cesarean section, primary indications, and neonatal outcomes were secondary outcomes. RESULTS: Women with female genital mutilation/cutting type 3 had lower risk of cesarean section compared with women with no female genital mutilation/cutting (OR 0.54, 95% CI 0.33-0.89 P = .02). Among the 1504 included women, the cesarean section rate was 28.0% and the proportion of emergency operations was 92.9%. Fetal distress was the primary indication in approximately 50% of cases, across the groups with different female genital mutilation/cutting status. Women who had no deinfibulation before labor onset had lower risk of cesarean section compared with those who underwent deinfibulation before or during pregnancy (OR 0.64, 95% CI 0.46-0.88 P = .01). CONCLUSIONS: High risk of cesarean section in Somali nulliparous women was not related to the type of female genital mutilation/cutting in the present study. Deinfibulation before labor did not protect against cesarean section. Our findings indicate that nulliparous Somali women are at high risk of intrapartum complications. Future research should focus on measures to reduce maternal morbidity and on how timing of deinfibulation affects the outcomes of vaginal births.


Assuntos
Cesárea , Circuncisão Feminina/efeitos adversos , Adulto , Feminino , Humanos , Noruega , Gravidez , Risco , Somália/etnologia
3.
Reprod Health ; 18(1): 51, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33639963

RESUMO

BACKGROUND: FGM/C is a cultural practice associated with adverse health outcomes that involves the partial or complete removal of the external female genitalia or injury to the genitalia. FGM/C is a form of violence against women and girls. There are no laws that specifically outlaw FGM/C in Sri Lanka and no national prevalence data. There is a lack of evidence about this practice to inform prevention efforts required to achieve the Sustainable Development Goal (SDG) target 5.3.2, which focuses on the elimination of all harmful practices, including FGM/C. METHODS: We undertook a qualitative interpretative study to explore the knowledge and perceptions of community members, religious leaders and professionals from the health, legal and community work sectors in five districts across Sri Lanka. We aimed to identify strategies to end this practice. RESULTS: Two-hundred-and twenty-one people participated in focus group discussions and key informant interviews. A template analysis identified five top-level themes: Providers, procedures and associated rituals; demand and decision-making; the role of religion; perceived benefits and adverse outcomes; ways forward for prevention. CONCLUSIONS: This study delivered detailed knowledge of FGM/C related beliefs, perceptions and practitioners and provided opportunities to develop an integrated programming strategy that incorporates interventions across three levels of prevention.


Assuntos
Circuncisão Feminina , Genitália Feminina/lesões , Medicina Preventiva , Adolescente , Adulto , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/psicologia , Circuncisão Feminina/estatística & dados numéricos , Feminino , Grupos Focais , Genitália Feminina/patologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Masculino , Motivação , Prevalência , Medicina Preventiva/métodos , Medicina Preventiva/normas , Pesquisa Qualitativa , Religião , Sri Lanka/epidemiologia , Adulto Jovem
4.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32719089

RESUMO

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.


Assuntos
Circuncisão Feminina , Criança , Maus-Tratos Infantis , Cicatriz/etiologia , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/classificação , Circuncisão Feminina/legislação & jurisprudência , Circuncisão Feminina/psicologia , Competência Clínica , Confidencialidade , Documentação , Feminino , Doenças Urogenitais Femininas/etiologia , Procedimentos Cirúrgicos em Ginecologia , Humanos , Infecções/etiologia , Infertilidade Feminina/etiologia , Consentimento Livre e Esclarecido , Classificação Internacional de Doenças , Notificação de Abuso , Anamnese , Saúde Mental , Dor/etiologia , Pediatras , Exame Físico , Prevalência , Refugiados/legislação & jurisprudência , Sexualidade
5.
Niger J Clin Pract ; 23(6): 883-886, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525127

RESUMO

A complicated case of female genital mutilation (FGM) type 2b done in late-pregnancy is presented and the interplay of Yoruba and Kwale culture, in this case, is discussed. A Yoruba who grew up among Kwales/Urhobos had FGM at 38 weeks and 4 days gestation (to assure vaginal delivery) and presented with vulvar hematoma, septicemia, obstructed labor, and a distressed fetus. 5 days after FGM procedure, she had an emergency cesarean section (EmCS), repair of FGM site and baby was admitted in special care. There was the obvious synergy of the Yoruba culture of FGM in infancy and Kwale/Urhobo culture of FGM in pregnancy. The patient and her fetus/baby almost became mortalities but for prompt intervention. The role of sociocultural factors in the practice of FGM is recommended to be further investigated as FGM even in educated women and at the dangerous stage of term pregnancy is still prevalent.


Assuntos
Cesárea , Circuncisão Feminina/efeitos adversos , Hematoma/cirurgia , Complicações do Trabalho de Parto/etiologia , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Drenagem , Tratamento de Emergência , Feminino , Gentamicinas/uso terapêutico , Hematoma/reabilitação , Humanos , Metronidazol/uso terapêutico , Gravidez , Resultado da Gravidez , Sepse/tratamento farmacológico , Sepse/microbiologia , Toxoide Tetânico , Resultado do Tratamento , Doenças da Vulva/tratamento farmacológico , Doenças da Vulva/etiologia , Adulto Jovem
6.
PLoS One ; 15(5): e0233344, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437387

RESUMO

Female genital mutilation is a harmful traditional practice that violates girls' right to health and overall well-being. Most research cites social acceptance, marriageability, community belonging, proof of virginity, curbing promiscuity, hygiene, and religion as motivations for the practice. It is generally assumed that individual attitudes of parents and other family members have an impact on decisions related to the cutting of girls, and that such attitudes are influenced by social norms. The aim of this study is to understand how parental attitudes towards the practice of female genital mutilation influence decision making related to the cutting of girls. Data from 15 Demographic and Health Surveys were analyzed to assess whether couples with at least one living daughter aged 0 to 14 years share the same opinions about the continuation of the practice, and to what extent couples' opinions are associated with the risk of daughters being cut. The analysis reveals that a significant percentage of couples hold discordant opinions on the continuation of the practice including in countries where the practice is very common. While a daughter's likelihood of being cut is much higher when both parents think the practice should continue, the analysis also shows that many cut girls have parents who oppose the practice. It further suggests that female genital mutilation is more prevalent among daughters whose mothers want the practice to continue and whose fathers are opposed or undecided, compared to daughters with fathers who are the sole parent supporting its continuation. Understanding the extent to which parental opinions influence decisions and which girls are most likely to be cut is essential for developing appropriate interventions aimed at promoting the abandonment of the practice.


Assuntos
Circuncisão Feminina/psicologia , Relações Pai-Filho , Relações Mãe-Filho , Núcleo Familiar/psicologia , Adolescente , Criança , Pré-Escolar , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/estatística & dados numéricos , Pai/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mães/psicologia , Normas Sociais , Inquéritos e Questionários
7.
PLoS One ; 15(5): e0233440, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421757

RESUMO

BACKGROUND: Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. METHODS: We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. FINDINGS: We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants' intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. CONCLUSION: The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.


Assuntos
Circuncisão Feminina/métodos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Serviços de Saúde , Comportamento Sexual , Adulto , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/etnologia , Emigração e Imigração , Feminino , Humanos , Intenção , Entrevista Psicológica , Noruega/epidemiologia , Aconselhamento Sexual , Somália/etnologia , Sudão/etnologia
8.
BMC Womens Health ; 20(1): 100, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393248

RESUMO

BACKGROUND: Female genital mutilation (FGM) has been a longstanding tradition in Egypt and until recently the practice was quasi-universal. Nevertheless, there are indications that the practice has been losing support and that fewer girls are getting cut. This study analyzes the prevalence of FGM in different birth cohorts, to test whether the prevalence declined over time. The study also examines whether such a decline is occurring in all segments of society or whether it is limited mostly to certain more modernized segments of society. METHODS: This study pooled data from the 2005, 2008 and 2014 waves of the Egypt Demographic and Health Surveys (EDHS). The women participating in the EDHS provided data on 62,507 girls born to them between 1987 and 2014, including whether they were cut and at what age. Kaplan-Meier and Weibull proportional hazard survival analyses were used to examine trends in the prevalence and hazards of FGM across birth cohorts. Controls for region, religion and socioeconomic status of the parents were included in the Weibull regression. RESULTS: The results show a steady decline in FGM across the birth cohorts studied. The base hazard for the 2010 birth cohort is only 30% that of the 1987 one. Further analyses show that the decline in FGM occurred in all segments of Egyptian society in a fairly similar manner although differences by region, religion and socioeconomic status persisted. CONCLUSIONS: This study confirms that FGM is declining in Egypt. The proportion of girls getting cut has declined rapidly over the past few decades. This decline is not limited to the more modernized segments of society, but has spread to the more traditional segments as well. The latter increases prospects for the eventual eradication of the practice.


Assuntos
Atitude Frente a Saúde/etnologia , Circuncisão Feminina/etnologia , Circuncisão Feminina/tendências , Empoderamento , Saúde da Mulher/etnologia , Circuncisão Feminina/efeitos adversos , Estudos de Coortes , Egito/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde/etnologia , Inquéritos Epidemiológicos , Humanos , Prevalência , Religião , Saúde Reprodutiva
9.
PLoS Med ; 17(3): e1003088, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32231359

RESUMO

BACKGROUND: The health complications experienced by women having undergone female genital mutilation/cutting (FGM/C) are a source of growing concern to healthcare workers globally as forced displacement and migration from countries with high rates of this practice increases. In this systematic review and meta-analysis, we investigate the association between FGM/C and painful gynecologic and obstetric complications in women affected by the practice. METHODS AND FINDINGS: We performed a comprehensive literature search from inception to December 19, 2019 of Ovid MEDLINE, Ovid EMBASE, The Cochrane Library (Wiley), and POPLINE (prior to its retirement) for studies mentioning FGM/C. Two reviewers independently screened studies reporting prevalences of painful gynecologic and obstetric sequelae resulting from FGM/C. Random effects models were used to estimate pooled odds ratios (ORs) for outcomes obtained from cross-sectional, cohort, and case-control designs. Subgroup analysis was performed to assess and control for effect differences introduced by study design. Validated appraisal tools were utilized to assess quality and risk of bias. Our study was registered with PROSPERO. Two reviewers independently screened 6,666 abstracts. Of 559 full-text studies assessed for eligibility, 116 met eligibility criteria, which included studies describing the incidence or prevalence of painful sequelae associated with FGM/C. Pooled analyses after adjustment for study design found that FGM/C was associated with dyspareunia (6,283 FGM/C and 3,382 non-FGM/C participants; pooled OR: 2.47; 95% confidence interval [CI]: 1.45-4.21; I2: 79%; p-value < 0.01), perineal tears (4,898 FGM/C and 4,229 non-FGM/C participants; pooled OR: 2.63; 95% CI: 1.35-5.11; I2: 67%; p-value = 0.01), dysuria (3,686 FGM/C and 3,482 non-FGM/C participants; pooled OR: 1.43; 95% CI: 1.17-1.75; I2: 0%; p-value = 0.01), episiotomy (29,341 FGM/C and 39,260 non-FGM/C participants; pooled OR: 1.89; 95% CI: 1.26-2.82; I2: 96%; p-value < 0.01), and prolonged labor (7,516 FGM/C and 8,060 non-FGM/C participants; pooled OR: 2.04; 95% CI: 1.27-3.28; I2: 90%; p-value < 0.01). There was insufficient evidence to conclude that there was an association between FGM/C and dysmenorrhea (7,349 FGM/C and 4,411 non-FGM/C participants; pooled OR: 1.66; 95% CI: 0.97-2.84; I2: 86%; p-value = 0.06), urinary tract infection (4,493 FGM/C and 3,776 non-FGM/C participants; pooled OR: 2.11; 95% CI: 0.80-5.54; I2: 90%; p-value = 0.10), instrumental delivery (5,176 FGM/C and 31,923 non-FGM/C participants; pooled OR: 1.18; 95% CI: 0.78-1.79; I2: 63%; p-value = 0.40), or cesarean delivery (34,693 FGM/C and 46,013 non-FGM/C participants; pooled OR: 1.51; 95% CI: 0.99-2.30; I2: 96%; p-value = 0.05). Studies generally met quality assurance criteria. Limitations of this study include the largely suboptimal quality of studies. CONCLUSIONS: In this study, we observed that specific painful outcomes are significantly more common in participants with FGM/C. Women who underwent FGM/C were around twice as likely as non-FGM/C women to experience dyspareunia, perineal tears, prolonged labor, and episiotomy. These data indicate that providers must familiarize themselves with the unique health consequences of FGM/C, including accurate diagnosis, pain management, and obstetric planning. REVIEW PROTOCOL REGISTRATION: The review protocol registration in PROSPERO is CRD42018115848.


Assuntos
Circuncisão Feminina/efeitos adversos , Vasoplegia/epidemiologia , Feminino , Doenças Urogenitais Femininas/etiologia , Humanos , Complicações do Trabalho de Parto/etiologia , Gravidez
10.
PLoS One ; 15(3): e0229917, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142530

RESUMO

We tested a feminist social-ecological model to understand community influences on daughters' experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15-49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. However, an integrated multilevel-level framework is lacking. We theorized that a more favorable community-level gender system, including stronger gender norms opposing FGMC and expanded extra-familial opportunities for women in the village or neighborhood, would be associated with a daughter's lower risk of FGMC and would strengthen the negative association of a mother's opposition to FGMC with her daughter's risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women's opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems framework of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and structural opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters, may be needed for sustainable declines in the practice.


Assuntos
Circuncisão Feminina/efeitos adversos , Demografia , Genitália Feminina/cirurgia , Núcleo Familiar/psicologia , Adolescente , Adulto , Circuncisão Feminina/ética , Circuncisão Feminina/psicologia , Egito/epidemiologia , Feminino , Feminismo , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Mães/psicologia , Religião , Fatores Socioeconômicos , Adulto Jovem
11.
BMC Health Serv Res ; 20(1): 200, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164693

RESUMO

BACKGROUND: Female genital mutilation/cutting (FGM/C) negatively impacts the wellbeing of girls and women throughout their lifecycle. In Somalia, FGM/C prevalence is nearly universal (98%) among females aged 15-49 years, with infibulation prevalence at 77%. Whilst there is need to engage healthcare workers in the prevention and management of FGM/C, minimal information exists indicating healthcare systems' capacity to fulfil this role. This study explored factors impacting the capacity of the Somaliland healthcare system to prevent the medicalization, and manage the complications of, FGM/C. METHODS: A cross-sectional qualitative study using semi-structured key informant interviews, conducted in the Somali language, was undertaken in the Maroodi Jeex and Awdal regions of Somaliland, in rural and urban Borama and Hargeisa districts in December 2016. A total of 20 interviews were conducted with healthcare workers comprised of medical doctors, nurses, midwives and system administrators. Transcribed and translated interview data were analysed using the template analysis approach. RESULTS: Healthcare workers reported understanding the adverse impact of FGM/C on the health of girls and women. However, they faced multiple contextual challenges in their preventative and management roles at the individual level, e.g., they lacked specific formal training on the prevention and management of FGM/C complications and its medicalization; institutional level, e.g., many facilities lacked funding and equipment for effective FGM/C management; and policy level, e.g., no national policies exist on the management of FGM/C complications and against its medicalization. CONCLUSION: Healthcare systems in urban and rural Somaliland have limited capacity to prevent, diagnose and manage FGM/C. There is a need to strengthen healthcare workers' skill deficits through training and address gaps in the health system by incorporating the care of girls and women with FGM-related complications into primary healthcare services through multi-sectoral collaboration and coordination, establishing clinical guidelines for FGM/C management, providing related equipment, and enacting policies to prevent the medicalization of the practice.


Assuntos
Circuncisão Feminina/efeitos adversos , Assistência à Saúde/organização & administração , Medicalização , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Circuncisão Feminina/estatística & dados numéricos , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Somália , Adulto Jovem
12.
J Sex Med ; 17(3): 531-542, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31932257

RESUMO

INTRODUCTION: Clitoral reconstruction (CR) is a controversial surgical procedure performed for women who have undergone medically unnecessary, often ritualistic genital cutting involving the clitoris. Such cutting is known by several terms; we will use female genital mutilation/cutting (FGM/C). Treatments offered to women affected by complications of FGM/C include defibulation (releasing the scar of infibulation to allow penetrative intercourse, urinary flow, physiological delivery, and menstruation) and CR to decrease pain, improve sexual response, and create a pre-FGM/C genital appearance. AIM: In this study, our aim is to summarize the medical literature regarding CR techniques and outcomes, and stimulate ethical discussion surrounding potential adverse impacts on women who undergo the procedure. METHODS: A broad literature review was carried out to search any previous peer-reviewed publications regarding the techniques and ethical considerations for CR. MAIN OUTCOME MEASURE: The main outcome measure includes benefits, risks, and ethical analysis of CR. RESULTS: While we discuss the limited evidence regarding the risks and efficacy of CR, we did not find any peer-reviewed reports focused on ethical implications to date. CLINICAL IMPLICATIONS: CR can be indicated as a treatment for pain and potential improvement of associated sexual dysfunction when these have not responded to more conservative measures. Women must be appropriately informed about the risks of CR and the lack of strong evidence regarding potential benefits. They must be educated about their genital anatomy and disabused of any myths surrounding female sexual function as well as assessed and treated in accordance with the current scientific evidence and best clinical practices. STRENGTH & LIMITATIONS: This is the first formal ethical discussion surrounding CR. This is not a systematic review, and the ethical discussion of CR has only just begun. CONCLUSION: We present a preliminary ethical analysis of the procedure and its potential impact on women with FGM/C. Sharif Mohamed F, Wild V, Earp BD, et al. Clitoral Reconstruction After Female Genital Mutilation/Cutting: A Review of Surgical Techniques and Ethical Debate. J Sex Med 2020;17:531-542.


Assuntos
Circuncisão Feminina/efeitos adversos , Clitóris/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Clitóris/fisiopatologia , Feminino , Humanos , Dor/etiologia , Disfunções Sexuais Fisiológicas/etiologia
13.
J Matern Fetal Neonatal Med ; 33(5): 880-882, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30025487

RESUMO

Background: Authors have reported that evidence on health harms of female genital mutilation is poor.Aim: Meta-analyzing prospective studies on adverse obstetric outcomes according to the severity of female genital mutilation.Method: Prospective studies were already acknowledged in previous meta-analyses and used for calculations. The proportions of type III female genital mutilation were extracted by full-texts, along with the proportions of adverse obstetric outcomes. Assuming random models, the proportions were encoded for meta-analysis and weighted for the inverse of the variance. Nonparametric correlations among weighted proportions of type III female genital mutilation and weighted proportions of obstetric outcomes were built. Analyzable obstetric outcome were: cesarean section, instrumental delivery, episiotomy, post-partum hemorrhage, low Apgar score - need of resuscitation.Results: Meta-analyzable series are few and heterogeneous. There is a trend of direct correlation among the proportion of type III female genital mutilations in the series and the proportion of cesarean section, instrumental deliveries, post-partum hemorrhage and low Apgar scores at birth or need of neonatal resuscitation. The significance was reached for the post-partum hemorrhage and for the fetal adverse outcome.Conclusion: It should be retained that type III female genital mutilation is likely to be a serious concern for birth.


Assuntos
Circuncisão Feminina/efeitos adversos , Complicações do Trabalho de Parto/etiologia , Feminino , Humanos , Gravidez
14.
Women Birth ; 33(4): e326-e331, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31420205

RESUMO

BACKGROUND: Pregnant women affected by female genital mutilation/cutting are at risk of adverse maternal outcomes compared to unaffected women, and sometimes require procedures to facilitate giving birth that midwives and doctors do not routinely perform. These women require culturally sensitive care. Current health professional literature provides evidence that midwives and doctors need further knowledge and training in this area. AIMS: This audit aimed to describe the demographic characteristics of pregnant women with female genital mutilation/cutting giving birth at two Perth maternity units, in addition to assessing health provider compliance with the local female genital mutilation/cutting Clinical Guideline. MATERIALS AND METHODS: The clinical database used by public maternity units in Western Australia was used to identify affected women who gave birth during 2014 at King Edward Memorial Hospital or Osborne Park Hospital. Demographic characteristics and information about antenatal care and maternal outcomes were collected. RESULTS: 53 women fulfilled the audit criteria. Prevalence of pregnant women with female genital mutilation/cutting varied from 0.33% to 2.18% between the two units. Compliance with the Female Genital Mutilation/Cutting Clinical Guideline was generally suboptimal. While no woman was deinfibulated antenatally, 26% of women required intrapartum deinfibulation to give birth. CONCLUSIONS: Women with female genital mutilation/cutting make up more than 2% of the antenatal population in some Perth metropolitan maternity units. Health care provider knowledge of, and compliance with, the Female Genital Mutilation/Cutting Clinical Guideline was poor in the two units studied. It appears that healthcare professionals need more education and training to provide affected women with the best care.


Assuntos
Circuncisão Feminina/efeitos adversos , Assistência à Saúde Culturalmente Competente , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Adulto , Austrália , Circuncisão Feminina/estatística & dados numéricos , Feminino , Humanos , Auditoria Médica , Parto , Gravidez , Complicações na Gravidez/prevenção & controle , Prevalência , Competência Profissional , Estudos Retrospectivos
15.
Med Sante Trop ; 29(3): 310-316, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573528

RESUMO

To study the sexual dysfunctions of women living with a partnerin relationship in the city of Ouagadougou. This was a descriptive, and analytical cross-sectional study collectedwith prospective data collection over the a period of seven (07-) months period from March 1st through November 30th, 2016,. by interviewing It consisted of collecting from 633 women living with a partner in relationship in Ouagadougou data aboutn their sex livfes. The data werehas been processed and analyzed with epi-info software, in version 3.5.3. Statistical tests (Chi-square and, Fisher's exact tests) were used to assess the association between the different variables at athe 5% significance level of 5%. The study participation rate was 90.8%. In our study, 84.5% (n=or 486) women reported having at least one sexual dysfunction in their lifetime. Of those surveyed, 84.5% (486/575) had anorgasmia, 64.3% (370/575) had dyspareunia, 35.8% (206/575) had an problems of arousalexcitement disorder, and 35.1% had (202/575) frigidity. In addition,There were 116 of them (20.3%) hadwith lowdecreased libidosexual desire and 0.7% (4/575) with vaginismus. Female circumcision was the main factor associated with the sexual dysfunction of the respondents. Dyspareunia was 4.2 times more common in women with genital excisioned women than in uncircumcised women The sSexual dysfunction is frequent amongof a womean living within a partnercouple in the city of Ouagadougou is frequent. Because excision is one of the factors [[[The leading factor]]] found in the occurrence of sexual dysfunction in women, hence the need to proscribe this harmful practice must be proscribed in our societies.


Assuntos
Disfunções Sexuais Fisiológicas/epidemiologia , Adolescente , Adulto , Idoso , Burkina Faso/epidemiologia , Circuncisão Feminina/efeitos adversos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Autorrelato , Disfunções Sexuais Fisiológicas/etiologia , Parceiros Sexuais , Adulto Jovem
17.
Afr J AIDS Res ; 18(3): 181-191, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31502923

RESUMO

Apart from its known association with short- and long-term adverse physical, psychological, and sexual sequelae, female genital mutilation/cutting (FGM/C) could be associated with increased susceptibility to HIV. Some experts propose that FGM/C increases risk of genital trauma and bleeding. Given the known protective effect for men of male circumcision against HIV and that, in some communities, male circumcision and FGM/C are thought of as "equivalent" or parallel procedures, there is an obvious need to more accurately determine the effects of FGM/C on HIV infection risk in women. This article reviewed current evidence of associations between FGM/C and HIV, drawing on evidence from peer-reviewed as well as grey literature. All studies evaluated were observational. This review investigated associations between FGM/C and HIV, not a causal relationship, and observational studies therefore sufficed. The final review included 14 studies from several African countries. The strength of the evidence overall was determined to be of low to moderate quality by Department for International Development criteria: conceptual framing, openness and transparency, cogency, appropriateness and rigour, validity, reliability, and cultural sensitivity. Findings were inconsistent: four studies found no association between FGM/C and HIV, six found a negative association, two found a positive association, and two found an indirect association. Many of the studies had significant deficiencies including insufficient statistical power, inadequate adjustment for potential confounders, and measurement of FGM/C status by self-reporting alone. The available evidence did not conclusively demonstrate the anticipated association between FGM/C and HIV. This review revealed the need for stronger study designs and outlines some considerations for future research.


Assuntos
Circuncisão Feminina/efeitos adversos , Infecções por HIV/etiologia , Adulto , África , Circuncisão Masculina , Suscetibilidade a Doenças/virologia , Feminino , HIV , Humanos , Masculino , Estudos Observacionais como Assunto , Reprodutibilidade dos Testes , Comportamento Sexual
18.
BMJ Open ; 9(7): e025355, 2019 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-31362960

RESUMO

OBJECTIVES: Literature on associations between female genital mutilation/cutting (FGM/C) and fistula points to a common belief that FGM/C predisposes women to developing fistula. This study explores this association using nationally representative survey data. DESIGN: A secondary statistical analysis of cross-sectional data from Demographic and Health Surveys was conducted to explore the association between FGM/C and fistula. SETTING: Sub-Saharan Africa. PARTICIPANTS: Women aged 15-49 years in Burkina Faso (n=17 087), Chad (n=17 719), Côte d'Ivoire (n=10 060), Ethiopia (n=14 070), Guinea (n=9142), Kenya (n=31 079), Mali (n=10 424), Nigeria (n=33 385), Senegal (n=15 688) and Sierra Leone (n=16 658). MAIN OUTCOME MEASURES: Fistula symptoms. RESULTS: Multivariate logit modelling using pooled data from 10 countries showed that the odds of reporting fistula symptoms were 1.5 times (CI 1.06 to 2.21) higher for women whose genitals were cut and sewn closed than those who had undergone other types of FGM/C. Women who attended antenatal care (ANC) (adjusted odds ratio (AOR) 0.51, CI 0.36 to 0.71) and those who lived in urban areas (AOR 0.62, CI 0.44 to 0.89) were less likely to report fistula symptoms than those who did not attend ANC or lived in rural areas. CONCLUSIONS: Severe forms of FGM/C (infibulation) may predispose women to fistula. Contextual and socioeconomic factors may increase the likelihood of fistula. Multisectoral interventions that concurrently address harmful traditional practices such as FGM/C and other contextual factors that drive the occurrence of fistula are warranted. Promotion of ANC utilisation could be a starting point in the prevention of fistulas.


Assuntos
Circuncisão Feminina/efeitos adversos , Fístula Retovaginal/etiologia , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fístula Retovaginal/epidemiologia , Fatores de Risco , Inquéritos e Questionários
19.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266286

RESUMO

Clitoromegaly due to non-hormonal causes is rare. In this case, we aimed to present an epidermal cyst that caused clitoromegaly after traditional female circumcision. A 22-year-old African female was referred to our clinic with enlarged clitoris. There is a mobile, soft, nonfluctuant mass with a size of 6 cm originating from the clitoral region at physical examination. Under spinal anesthesia the clitoral mass was excised totally and labioplasty was performed. Histopathologic examination was reported as epidermal cyst. Epidermal cyst should be considered after hormonal reasons are excluded in patients with clitoromegaly who have a history of trauma.


Assuntos
Circuncisão Feminina/efeitos adversos , Clitóris/patologia , Cisto Epidérmico/diagnóstico , Clitóris/cirurgia , Diagnóstico Diferencial , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Adulto Jovem
20.
Public Health Nurs ; 36(5): 615-622, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31240736

RESUMO

OBJECTIVE: This study investigated the level of knowledge, perception, and subjective norm as correlates for risk reduction in female genital mutilation (FGM) in Osun State, Nigeria. DESIGN AND MEASUREMENT: Data were collected from 376 respondents who were conveniently selected from 4 wards in Ede South LGA with structured questionnaire (75% reliability) and focus group discussion (FGD) guide. Data were analyzed using appropriate statistical tools and hypotheses set at p ≤ 0.05. RESULTS: Participants mean age was 38.5 ± 1.29, 79.3% were women, 82.9% were Muslims, and only 34.6% had up to secondary education. Over 38% had at least one of their daughters circumcised, and 54.8% were not aware of the health risks associated with FGM. Majority knew that FGM is prohibited in Nigeria yet 31.9% supported the practice. There were significant correlations (at p < 0.05) between knowledge level (R = 0.348), perception (R = 0.432), subjective norm (R = -0.475), and intention to discontinue FGM. However, these factors are still relatively low. Also, FGDs showed that majority of the respondents were not aware of any health risks associated with FGM but only supported the discontinuation because of public perception in Nigeria. CONCLUSION: The study recommended aggressive public health education drive and awareness campaign focusing on the negative health implications of FGM.


Assuntos
Circuncisão Feminina/efeitos adversos , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adulto , Feminino , Grupos Focais , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Nigéria , Núcleo Familiar , Reprodutibilidade dos Testes , Comportamento de Redução do Risco , Inquéritos e Questionários
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