ArticlePDF AvailableLiterature Review

Female Genital Mutilations: Genito-Urinary Complications and Ethical-Legal Aspects

Authors:

Abstract and Figures

Many women in the world are still undergoing female genital mutilations (FGMs) even if in almost all the countries, the practice of FGM is illegal. The increase of immigration, particularly from African Countries, to Europe, and Italy too, led to consider this phenomenon with particular attention and skill. All the operators in health services need to know the different types of FGMs and the related complications and the psychological and sexual sequels. Urological complications, in particular, are not rare and the changing anatomy of the external genital apparatus can also make the catheter insertion sometimes difficult. This review analyzes the epidemiology of FGMs, the reasons why the practice is still made, the complications, the ethical, and the principal legal aspects of this practise that must be hopefully early banned.
Content may be subject to copyright.
U
ISSN 0391-5603
© 2015 Wichg Publishing
Urologia 2015; 82 (3): 151-159
REVIEW
Materials and Methods
A computerized search on PubMed was made includ-
ing the following key words: FGM, epidemiology, complica-
ons, urological complicaons, genito-urinary complicaons,
sexual complicaons, ethico-legal. Only English papers have
been considered and the search comprised only the arcles
from 1980 unl now. Cumulavely, 150 papers have been re-
viewed and considered pernent for the topic. Six works have
been consulted to treat specically urological complicaons.
Discussion
Epidemiology
FGMs are carried out today in 26 African countries and it
is esmated that at least 100 million women are mulated,
belonging to very dierent socioeconomic classes and ethnic
and cultural groups, including Chrisans, Muslims, Jews, and
followers of indigenous African religions (4).
In parcular, Nigeria has the highest absolute number of
residents who have undergone FGM (5), and in Sudan and in
Somalia, these pracces are developed with a rate of 98%, es-
pecially the ancient form of FGM, called “pharaonic,” because
of its Egypan origin (6).
The pracce is also found in some countries in the Middle
East and Asia, and among immigrant communies in a num-
ber of Western countries, such as Australia, Canada, France,
Norway, Sweden, Switzerland, and the United States. It is
however believed that the majority of girls do not undergo
the procedure in the Western countries where they live, but
they are sent to their country of origin, usually in Africa, dur-
ing summer holidays, in order to undergo the pracce (7-10).
In spite of the general opinion, the mothers are not adverse
DOI: 10.5301/uro.5000115


Marco Vella121121
1 Surgical Disciplines, Oncology and Denstry, University of Palermo, Palermo - Italy
2 Sciences for Health Promoon and Mother and Child “G. D'Alessandro”, University of Palermo, Palermo - Italy

Female genital mulaons (FGM) (also referred to as
“female genital cung” and “female genital mulaon/
cung” – FGM/C) concern all procedures involving paral
or total removal of the external female genitalia or other
damage to the female genital organs for nonmedical rea-
sons (1). FGMs are harmful pracces that constute a se-
rious threat to the health of women and girls, including
their psychological, sexual, reproducve, and genitourinary
health.
It is important to specify the correct term to be used
to dene these pracces. When FGM/C rst came to be
discussed beyond the sociees in which it was tradionally
exercised, it was generally referred to as “female circumci-
sion.” This term created confusion (2) because it caused an
erroneous parallelism with male pracce, that is, in many
cases, a not dangerous operaon made as a prevenve
measure of penile cancer, infanle urinary tract infecons
(UTIs), balanoposthis, phimosis, and HIV infecon (3). In
contrast, female genital cung is, not rarely, harmful to
the women. To emphasize the gravity of the FGM/C act, the
word “mulaon” was adopted in the 1990s (2).
ABSTRACT
Many women in the world are sll undergoing female genital mulaons (FGMs) even if in almost all the coun-
tries, the pracce of FGM is illegal. The increase of immigraon, parcularly from African Countries, to Europe,
and Italy too, led to consider this phenomenon with parcular aenon and skill. All the operators in health ser-
vices need to know the dierent types of FGMs and the related complicaons and the psychological and sexual
sequels. Urological complicaons, in parcular, are not rare and the changing anatomy of the external genital
apparatus can also make the catheter inseron somemes dicult. This review analyzes the epidemiology of
FGMs, the reasons why the pracce is sll made, the complicaons, the ethical, and the principal legal aspects of
this pracse that must be hopefully early banned.
Keywords: Female genital mulaon, Epidemiology, Genito-urinary, Sexual complicaons, Ethico-legal
Accepted: January 28, 2015
Published online: February 28, 2015
Corresponding author:
Marco Vella
University of Palermo
Via del Vespro 129
90127 Palermo, Italy
marco.vella@libero.it
FOR PERSONAL USE ONLY
Female genital mulaons
152
© 2015 Wichg Publishing
to FGMs. The reasons why women are favorable to submit
their daughters to these procedures are that they consider
FGM necessary to maintain proper hygiene, to increase ferl-
ity, and to ensure a woman’s chasty (11).
Classicaon
There are many kinds of FGM and the last classicaon
(2007) proposed by WHO (12) recognizes four types of these
pracces (Tab. I).
Type I FGM/C (Fig. 1) is the most common, followed by
type II (Fig. 2). Type III (Fig. 3) is the most common in Middle
East Africa.
Reasons
The most important reasons that encourage this custom
are fundamentally ethical. In many sociees, it is pracced as
a rite of passage to womanhood, with strong ancestral and
sociocultural roots. The perpetuaon of the ritual is support-
ed by preservaon of ethnic and gender identy, femininity,
female purity/virginity, and “family honor”; other reasons
are maintenance of cleanliness and health and assurance of
women’s marriage ability. The age for the pracce is variable.
In Gambia, it is between birth (7 days) up to preadolescence,
and usually before the rst menstruaon and marriage (13).
The importance of FGM consists in the fact that among
these communies, girls who undergo FGM/C, and their fam-
ily, are met with social approval, notably respectability, and
honor; on the contrary, in response to failure to conform to
FGM/C, social mechanisms include insulng an uncut girl’s
mother, alienang uncut girls, denying them social accep-
tance, and, above all, rejecng them as marriage partners.
These ndings show the role of FGM/C as a tool in social con-
trol. Refusing FGM/C would not only makes uncut girls and
their families “dierent but also isolate them from marriage
prospects in their community (14, 15).
Complicaons
The consequences of FGM are several and involving many
aspects of cut girl's life.
 Classicaon WHO 2007 (“hp://www.smw.ch/index.php?id = 752” \l “REF01”) 1
Type I: Type Ia:
Paral or total removal of the clitoris* and/
or the prepuce (clitoridectomy).
Removal of the clitoral hood or prepuce only
Type Ib:
Removal of the clitoris* with the prepuce
Type II:
Paral or total removal of the clitoris* and the
labia minora, with or without excision of the labia
majora (excision)
Type IIa:
Removal of the labia minora only
Type IIb:
Paral or total removal of the clitoris* and the labia minora
Type IIc:
Paral or total removal of the clitoris*, the labia minora and the
labia majora
Type III:
Narrowing of the vaginal orice with creaon of a covering seal
by cung and apposioning the labia minora and/or the labia
majora, with or without excision of the clitoris (inbulaon)
Type IIIa:
Removal and apposion of the labia minora
Type IIIb:
Removal and apposion of the labia majora
Type IV:
Unclassied
All other harmful procedures to the female genitalia for
nonmedical purposes, for example, pricking, piercing, incising,
scraping, and cauterisaon.
*Noce that when total removal of the clitoris is reported, it refers to the total removal of the
external part of the body of the clitoris
.
 Type I or clitoridectomy or “sunna” (excision of the prepuce
and/or the clitoris).
FOR PERSONAL USE ONLY
Vella et al 153
© 2015 Wichg Publishing
 Type II means the removal of the clitoris with paral or total excision of the labia minora.
 Type III or inbulaons or phara-
onic in which not only the clitoris but
also the labia minora and majora were
removed. The oricium vaginae is sewn
up, leaving only a small opening for urine
or menstruaon blood.
Physical complicaons
They can arise as early and late complicaons. The clitori-
dectomy can cause hemorrhage and pain, which can lead to
shock and death in the worst cases, or to anemia, infecons
on the wound (local), or also systemic, abscesses, ulcers, up
to sepcemia, tetanus, and gangrene (16).
The infecon is one of the most serious complicaons of
FGM. The pracce is indeed oen performed with no anaesthe-
sia or anbiocs and in the absence of asepc condions. The
consequence is an increase of infecons caused by Chlostridium
tetani, Staphylococcus aureus, and Pseudomonas pyocyanea.
Also, sexually transmied diseases are increased and it was
recently shown that dierent types of infecons, such as HIV,
Chlamydia trachomas, Neisseria gonorrhoeae, Treponema
pallidum, Candida albicans, Trichomonas vaginalis, and Herpes
Simplex Virus Type 2 (HSV-2), were higher in mulated women
than in uncut women. The univariate risk of infecon ranged
from 0.47 to 5.2 (17).
The long-term complicaons are more typical of inbu-
laon (FGM type 3) than of simple clitoridectomy, because
in this case, there is an interference with the urinaon and
menstrual blood drainage.
Formaon of dermoyd cysts in the line of the scars
(caused by keranizaon of epithelial cells and sebaceous
glands) and formaon of keloids (Fig. 4) are complica-
ons that generate fear and shame among the cut girls,
and also recurrent abscesses can aict women for many
years (16).
Another serious long-term problem for these women is
the correlaon between FGM and HIV transmission. In the
context of sexual assault in general, and FGM in parcular
indeed, the mucosal microenvironment will be profoundly
altered, and danger signals will aract and modify the phe-
notype of immune cells that are also target cells for the HIV,
likely inuencing HIV suscepbility (18).
Urological consequences
Voiding dicules, recurrent UTIs, and vesicovaginal stula
occur mostly in women with inbulaon (19) (Tab. II).
About voiding dicules, immediately aer the opera-
on, an acute urinary retenon is frequent, and oen paents
try to avoid the pain by not urinang. The reasons are “ght
circumcision” (the urine cannot pass the scar), obstrucon by
skin aps, or blood clots. Several works support these kind of
complicaons: in a review, published in 2004, it is esmated
that the prevalence of acute urinary retenon accounts for
12%, without a dierence between the dierent types of FGM.
Teufel and Dörer reported that three out of 16 women stat-
ed that they spent unl to 15 min for each urinaon. Agugua
and Egwuatu, analyzing the consultaons in a gynecological
hospital in Nigeria, demonstrated that 28.8% of the paents
suered from urological problems. Straining and retenon of
urine associated with metal obstrucon and urethral stricture
occurred in three pediatric paents, and in other two nonpe-
diatric paents, metal obstrucon led to poor urinary ow.
Urinary retenon occurs, as an early complicaon, in the
rst 3 days aer FGM and has been aributed to postopera-
ve pain, irritaon of the raw areas by urine, and obstruc-
on of the external urethral meatus by skin aps or blood
clots. Late urological complicaons of FGM are, on the other
FOR PERSONAL USE ONLY
Female genital mulaons
154
© 2015 Wichg Publishing
hand, the obstrucon of the urinary stream by the fused la-
bia, following type 3 FGM, and UTIs. During micturion, the
urinary ow rst press on the fused labia minora and then ex-
its through the clutched opening in the vulva causing urinary
splashing around the perineum and upper thighs (20-25).
A case of formaon of calculus in a 32-year-old inbulat-
ed Somalian woman with voiding dicules is also reported,
because urine was retained in the vulva, which led to the
formaon of a calcium oxalate calculus outside the urinary
tract (25). The best form of therapy in paents with voiding
dicules is debulaon. Aer the operaon, the sudden
increased ow of urine may be unusual for women usually
used to a very thin stream, so it is important to prepare the
paent for this.
About recurrent urinary tract infecons, as urine and
blood remain trapped in the sealed vulva, this creates an
environment that facilitates bacterial growth, leading to re-
current urinary infecons. Compared with the complicaon
“voiding dicules,reliable evidence is scarce. Paents of an
antenatal outpaent clinic in Melbourne were asked to ll in
a quesonnaire concerning the health consequences of FGC.
Fourteen out of 51 women (27.5%) reported “urinary tract
infecon, but just one woman (1.9%) reported “recurrent
urinary tract infecons.” A bacterial culture with anbiogram
in FGM women is highly recommended (20, 23, 26). The third
most important urological complicaons is constuted by
Vesicovaginal stula. The main cause is a prolonged labor in
which the weight of the baby’s head puts enormous pressure
on the pelvic outlet and the pelvic oor, leading to ischaemic
necrosis and formaon of a vesicovaginal stula (27).
Sexual complicaons
Type I and II FGM/C have a negave impact on women’s
sexual lives when compared with women who have not un-
dergone FGM/C. The principal problems are dyspareunia
(painful intercourse), bleeding during or aer intercourse,
partner’s dicult penetraon, higher rates of vulvar or vagi-
nal pain, and clitoral neuroma. In a work of Rigmor C. Berg, a
total of 15 studies were carried out, showing that compared
with women without FGM/C, women who had undergone to
FGM/C were more subjected to dyspareunia, no sexual de-
sire, and less sexual sasfacon (28).
In another study, the eect of FGM on sexual pleasure,
comparing a group of women aected by dierent types of
   Urogynecological complicaons of FGM: gynecological
keloyd.
Urological complicaons related to female genital mulaons
 Reason 
Urinary retenon Pain, obstrucon by skin aps or blood clots,
ght circumcision
Paral or total debulaon, pain relief, temporary
catheterisaon
Straining Obstrucon by skin aps or blood clots,
ght circumcision
Paral or total debulaon
Slow urinary stream Tight circumcision Paral or total debulaon
Urinary tract infecon, fester, open wound Paral or total debulaon, anbiocs, pain relief
Calculus formaon outside the
urinary tract causing sharp pain
Retained urine that causes a calcium oxalate
calculus
Paral or total debulaon
Urinary tract infecon Tight circumcision, accumulaon of blood
and urine under the inbulaon scar
Anbiocs, paral or total debulaon
Urinary inconnence Tight circumcision (dribbling inconnence) Paral or total debulaon
Vesicovaginal stula aer prolonged delivery and
necrosis, perineal tears
Fistula repair
FOR PERSONAL USE ONLY
Vella et al 155
© 2015 Wichg Publishing
FGM/C with a group of uncut women, has been evaluated
(29). The results showed that sexual funcon in women with
FGM is adversely altered in dierent domains of arousal, or-
gasm, and sasfacon. However, other studies reported a
good sexual health in women with FGM and orgasm in almost
86% (30). In inbulated women, some erecle structures fun-
damental for orgasm have not been excised and cultural inu-
ence can change the percepon of pleasure, as well as social
acceptance so that FGM/C women can also have the possi-
bility of reaching an orgasm. In FGM women with sexual dys-
funcon, it was shown that debulaon can ameliorate sexual
health, and aer debulaon, 14 out of 15 inbulated women
reported orgasm. Therefore, FGM/C women with sexual dys-
funcons can and must be cured; they have the right to have
an appropriate sexual therapy (30).
FGM/C also has obstetric complicaons, including nega-
ve repercussions for delivery and the health of the new-
born. Complicaon rates increased dramacally in women
with type I or II FGM/C (39.0 and 65.9%, respecvely) com-
pared with women who had not undergone FGM/C (11.7%).
The obstetric complicaon most oen found in all three
groups was perineal tearing, but with a prevalence three
mes higher for women with type I FGM/C (27.8%) and ve
mes higher for women with type II FGM/C (48.8%) than
women who had not undergone FGM/C (9.6%). The higher
frequency of perineal tear among women with FGM/C is at-
tributed to loss of elascity of the perineal ssue because of
scar ssue and abnormal scarring (brosis and keloids). This
loss of elascity of the perineum is also thought to be related
to the much greater prevalence of episiotomy observed for
women with type I (20.0%) and type II (30.5%) FGM/C, in
comparison with women who had not undergone FGM/C
(3.2%). Finally, higher rates of fresh sllbirth were observed
for women with type I or II FGM/C, linked to a prolonged
second stage of labor, because of obstrucon and loss of s-
sue elascity (13).
Another study, published in 2004, compared women with
and without FGM in a Swedish hospital regarding prolonged
labor. The most frequent type of FGM in the study group was
inbulaon (type III) and debulaon was done rounely. The
study showed no elevated risk of prolonged labor for women,
but if an inbulated woman gives birth to a child without be-
ing debulated in advance, the fetal head may have many
dicules in passing the scar, leading to strong contracons
that may lead to risk of ischaemic necrosis of the vesicovagi-
nal ssue and fetal death. Another study was published by
the WHO in 2006, in which 28,393 parcipants were exam-
ined in 28 obstetric centres in Burkina Faso, Ghana, Kenya,
Nigeria, Senegal, and Sudan, and they stated the existence of
an increased risk of certain consequences such as cesarean
secon, postpartum bleeding, episiotomy, extended mater-
nal hospital stay, infant resuscitaon, and inpaent perinatal
deaths in FGM women, compared with non-FGM group (9,
16, 31).
Obviously, these important physical complicaons have a
very strong eect on psychology of involved women. Although
in those countries where the pracces are carried out, the psy-
chological concerns are covered by a necessity of acceptant of
social norms, for women who live in western countries, psy-
chological sequelae are very serious, as they have many dif-
cules to develop a sexual identy (16). The seriousness of
the psychological consequences has been demonstrated in
a study carried out among a group of Senegalese women in
Dakar that showed a signicantly higher prevalence of post-
traumac stress disorder (PTSD), memory problems, and other
psychiatric syndromes (32).
A parcular aspect that can be analyzed is that of male
complicaons and atudes with regard to FGM. In a study
conducted in a village in the Gezira Scheme along the Blue
Nile in Sudan, among married men of the youngest paren-
tal generaon and grandfathers, it was found that there are
many complicaons also for men, caused by FGM, such as
diculty in penetraon, wounds/infecons on the penis, and
psychological problems. This is also very interesng because
the acknowledged male complicaons may open new possi-
bilies to withdraw the pracce of FGM (33).
Clinical management
The clinical treatment of these women is a very impor-
tant argument because their genital’s anatomy is altered and
the knowledge among gynecologists, urologists, obstetrician,
and healthcare assistants is fundamental. A very simple op-
eraon, such as catheterizaon, indeed, can be complex and
can need a parcular treatment for a cut woman. Recently,
Abdulrahim A. Rouzi showed the technique used to realize
a catheterizaon in a pregnant young woman with a type III
FGM. The diculty of this operaon is due to the scar ssue
that covers the urethral meatus and part of the vaginal introi-
tus. The procedure consists in cleaning the genital area with
an ansepc soluon, inserng a lubricated sterile speculum
below the scar, pulling the speculum outward, and then li-
ing it in an upward direcon to expose the urethra for clean-
ing with ansepc soluon and inseron of a Foley catheter
under direct visualizaon (34). In another study (35), the
hospital records of all women from Sudan, Somalia, Ethiopia,
Egypt, Eritrea, and Chad were collected who were admied
to King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
from January 1, 2011 to January 1, 2012. About 162 women
with type III FGM had urinary catheterizaon and 112 (69.1%)
women had urinary catheterizaon by the standard proce-
dure and 50 (30.9%) by the retracon technique because of
failure of the standard procedure. No complicaons occurred
during inseron or while the catheter was in place. This dem-
onstrates that the retracon technique provides a safe and
eecve opon for urinary catheterizaon of women with
type III FGM (35).
However, if required by the woman, the best soluon
is treatment of deinbulaon (Fig. 5), especially when she
has to aend her rst sexual examinaon or her rst in-
tercourse. Aer deinbulaon, the edges can be secured
in two possible ways: a circular stching around labia ma-
jora (Fig. 6), leaving the vulva area open, permits free ow
of urine and menstrual blood, or a tradional ‘reinbula-
on’ (the edges are sewn back together to cover urethra
and vaginal introitus). However, the second opon is con-
sidered harmful and ethically uncorrected. Surgeons have
to exercise extreme cauon in removing a dermoid cyst
and incising an abscess in a scared and damaged area as a
mulated genital (16).
FOR PERSONAL USE ONLY
Female genital mulaons
156
© 2015 Wichg Publishing
An important aspect of FGM’s management is the recon-
strucve surgery. Fazari presented a case of a 24-year-old Su-
danese female, who had undergone ritual FGM type III and
who suered from a large, vulval mass for the last 6 years
and with apareunia. The mass was successfully removed and
remaining genital ssues were approximated and sutured.
Reconstrucve surgery for women who suer sexual conse-
quences from FGM resulted feasible, with a high degree of
acceptance and sasfacon. It restores some of women's
natural genital anatomy and oers the potenal for improved
female sexuality (36).
Also, other studies demonstrated that reconstrucve
surgery aer FGM is associated with reduced pain and re-
stored pleasure: in one of these, 866 paents with FGM aged
18 years or older who had consulted a urologist at Poissy-St
Germain Hospital, between 1998 and 2009 were evaluable
for cosmec results, pain, and orgasmic funcon. They were
treated for resecng skin covering the stump to reveal the
clitoris. The results of 1-year follow-up visited paents were
very encouraging: most paents reported an improvement,
or at least no worsening, in pain and clitoral pleasure and im-
proved sex life (37).
Legal and ethical aspects
It is known that the pracce of FGM is not supported by any
western countries neither in Africa. Near 1980, the host coun-
tries began to adopt an-FGM laws: the rst was in Sweden,
where in 1982, a law was passed that considered all the female
mulaon illegal and later in UK, Belgium, the Netherlands,
and then in almost all Europe Countries. In France, many cases
of FGM were brought as special forms of child's abuse. Also,
United States considered the pracces illegal and also banned
the reinbulaon (16). More recently in Italy, penal code (law
number 7 of 2006) took into account rules regarding FGM as
an illegal pracce for health professionals (38). Consequently,
consensus of female, for example, cannot authorize physician
to pracce femal genital mulaon, within art. 583 bis of the
criminal code. Worthy of knowing the arcle 5 of that Law indi-
cang the so-called “free green call” to declare observed cases
of FGM by HCPs or anyone.
Possibly, somemes special concerns are related to the
balance between respect of paent freedom, commitment to
condenality, and legal dues for health professionals, and
all must be resolved in the view of major paent benecence.
Although laws are not yet enough, they work in several
ways with prevenon strategies, such as educaonal inter-
venon approaches by creang enabling environments for
change. Indeed, ndings are in agreement with UNICEF, sug-
gesng that comprehensive social support mechanisms and
awareness-raising campaigns may be advantageous (7).
The abandonment process involves expanding a range
of successful projects by health organizaon, addressing the
human rights priories of communies, which involve a rou-
ne approach to potenal vicms, also in the view of po-
tenal child abuse and gender violence, and transmission of
infecous diseases (39-43). Internaonally, an African Coor-
dinang Centre for abandonment of FGM/C is born in Kenya
to share research, to promote solidarity and advocacy, and to
implement a coordinated and integrated response to aban-
don FGM/C.
An important role in these programs is covered by health-
care professionals (HCPs). They have the potenal to become
important agents for the prevenon of FGM/C, because they
are integrated and legimated in the community. The involve-
ment of HCPs is parcularly urgent in rural areas, where the
prevalence of FGM/C is higher than in urban areas, and the
quality health services are less controlled (44).
 Deinbulaon technique.
 Circular stching around labia majora, the less harmful tech -
nique used to reproduce the vaginal closure, leaving the vulva area
open, and perming free ow of urine and menstrual blood.
FOR PERSONAL USE ONLY
Vella et al 157
© 2015 Wichg Publishing
Today, there are several campaigns against FGM, as that
managed, in Italy, from Department of Equal Opportunity,
or campaigns sustained from OMS or Amnesty Internaonal
(“End FGM”). It has been instuted since 2010, by OMS, an
internaonal day for "Zero Tolerance against FGM" that is cel-
ebrated on 6th February.
Knowledge of the phenomenon and future prospecve
Considering the sll high degree of the event, it is very
important to analyze the level of knowledge of the phenom-
enon, and consequently, several studies have been carried
out administering quesonnaires among doctors, social assis-
tants, psychologists, nurses, health assistants, and educators.
In one of these studies [a mulcenter study on knowledge
and atude of nurses in northern Nigeria concerning FGM
(45)], determing the knowledge and atude of nurses in north-
ern Nigeria concerning FGM, it is demonstrated that the nurses
studied had a high level of awareness of FGM and a good gen-
eral knowledge of complicaons associated with FGM, but not
an adequate knowledge of parcular forms of FGM.
Again, the work of Johnson OE “Percepon and pracce
of female genital cung in a rural community in southern
Nigeria,carried out to determine the awareness and prac-
ce of FGC in a rural community in southern Nigeria, shows
that majority of parcipants (98.6%) were aware of the prac-
ce of FGC (46).
Even in a city as London, as demonstrated by a study of
Relph, the majority of respondents were aware of FGM/C,
but their ability to idenfy the condion and its associated
morbidity remain subopmal (47).
In a study, a group of selected male and female stu-
dents from several facules of the University of Cairo, was
interviewed. Cumulavely seventy-two percent of these
students supported the abolishment of female mulaon.
The percentages of women and medical students who were
against this custom were even higher than men and non-
medical students.
Although medical students were signicantly more knowl-
edgeable than nonmedical students, the fact that less than half
of them knew that hemorrhage and infecon could follow fe-
male cung, and the opposing opinions of the other 28% of
students, suggests that some acon is sll needed (11).
In order to increase the condence in the ability of health-
care providers to treat immigrant women with inbulaon, a
study tried to carry out, in U.S. clinics, an educaon program
that included didacc informaon, case studies, a cultural
roundtable, and a hands-on skills laboratory of deinbulaon
and repair. Parcipants completed a measure-of-condence
survey tool before and aer the educaon intervenon. The
parcipants reported increased condence in their ability
to provide culturally competent care to immigrant women
with inbulaon (48). This is a conrmaon that educaon-
al programs can be advantageous in order to improve the
situaon.
What is the situaon in Italy, one of the countries that is
most subjected to immigraon? In the study “Health care for
immigrant women in Italy: are we really ready? A survey on
knowledge about female genital mulaon” by Caroppo, it is
reported that among 41 operators working in CARA (Shelter
for Refugees and Asylum Seekers) in central and southern Italy,
interviewed through a quesonnaire, only 7.3% of respon-
dents stated that they know FGM well, although 4.9% did not
know it at all. About 70.7% declared to have never met or
assisted a woman with FGM; nevertheless, all respondents
worked with an asylum seeker from countries where FGMs
were performed (49).
Certainly, migraon uxes to Italy over the past decade
created a healthcare challenge: women with FGM have spe-
cic medical and psychological problems that doctors, nurses,
and social assistants without specic training are not usually
able to manage (50). This led to the conclusion that it is essen-
al to improve the knowledge not only of the existence of the
phenomenon but also of the specic techniques to be used for
this kind of paents.
However, as in other European countries, in Italian medi-
cal schools, FGMs are not included in pre-graduate curriculum
and recent studies enphasize that there is a lack of knowledge
on the subject among gynecologists, many of whom are not
familiar with the classicaon and management of FGM. For
the best of our knowledge, no studies were conducted among
urology specialist aimed to appreciate their competence and
atude in this eld of interest. In addion, considering the
possible consequences for overall psychophysical health, a
muldisciplinary approach is recommended in collaboraon
with pediatricians, who can play a central role in prevenon.
It is necessary to connue studying, educang, increasing
awareness, and teaching medical professionals to guarantee
opmum prevenon and care for women with FGM.
Conclusion
Despite of many eorts, FGM/Cs are no more obsolete
pracces. During the mes, a variety of sociocultural myths,
religious misbelievers, and hygienic and aesthec concerns
were behind the FGM/C. Overall, a large proporon of people
supported the connuaon of FGM/C in spite of adverse ef-
fect and sexual dysfuncon associated with FGM/C, for many
reasons, generally not acceptable under the human dignity
parameter. There is a common and general opinion in favor
of the need to improve the knowledge about the argument
for all health professionals, and to eliminate and overthrow
the phenomenon, which constutes an unacceptable cause
of physical and psychological damages for women who are
subjected to it.
Disclosures
Financial support: No nancial support was received for this sub-
mission.
Conict of interest: The authors have no conict of interest.
References
1. WHO. Eliminang female genital mulaon – an interagency
statement (OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UN-
FPA, UNHCR, UNICEF, UNIFEM, WHO). WHO; 2008.
2. Fried S, Mahmoud Warsame A, Berggren V, Isman E, Johans-
son A. Outpaents’ perspecves on problems and needs
related to female genital mulaon/cung: a qualitave
study from Somaliland. Obstet Gynecol Int. 2013; 2013:Ar-
cle ID 165893, 11 pages.
FOR PERSONAL USE ONLY
Female genital mulaons
158
© 2015 Wichg Publishing
3. Schoen EJ, Female circumcision. N Engl J Med. 1995;332(3):
188-189, author reply 189-190.
4. Toubia N. Female genital mulaon: a call for global acon.
New York: women, Ink; 1993.
5. Ashimi AO, Amole TG. Percepon and atude of preg-
nant women in a rural community north-west Nigeria
to female genital mulaon. Arch Gynecol Obstet. 2015
Mar;291(3):695-700.
6. Rushwan H. Eologic factors in pelvic inammatory disease
in Sudanese women. Am J Obstet Gynecol. 1980;138(7 Pt
2):877-879.
7. Berg RC, Denison E. A tradion in transion: factors perpet-
uang and hindering the connuance of female genital mu-
laon/cung (FGM/C) summarized in a systemac review.
Health Care Women Int. 2013;34(10):837-859.
8. United Naons Children's Fund (UNICEF) Female genital mu-
laon/female genital cung: a stascal exploraon. New
York, NY: Author; 2005a.
9. Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M; WHO
study group on female genital mulaon and obstetric out-
come. Female genital mulaon and obstetric outcome:
WHO collaborave prospecve study in six African coun-
tries. Lancet. 2006;367(9525):1835-1841.
10. Elgaali M, Strevens H, Mårdh PA. Female genital mulaon –
an exported medical hazard. Eur J Contracept Reprod Health
Care. 2005;10(2):93-97.
11. Allam MF, de Irala-Estévez J, Fernández-Crehuet Navajas
R, et al. Factors associated with the condoning of female
genital mulaon among university students. Public Health.
2001; 115(5):350-355.
12. WHO Technical Working Group. Female genital mulaon.
Geneva: WHO, 1996.
13. Kaplan A, Forbes M, Bonhoure I, et al. Female genital mula-
on/cung in The Gambia: long-term health consequences
and complicaons during delivery and for the newborn, In-
ternaonal. J Womens Health (Larchmt). 2013;5:323-331.
14. Vissandjée B, Kanébo M, Levine A, N’Dejuru R. The cultural
context of gender, identy: female genital, excision and in-
bulaon. Health Care Women Int. 2003;24(2):115-124.
15. Powell RA, Leye E, Jayakody A, Mwangi-Powell FN, Morison
L. Female genital mulaon, asylum seekers and refugees:
the need for an integrated European Union agenda. Health
Policy. 2004;70(2):151-162.
16. Toubia N. Female circumcision as a public health issue. N
Engl J Med. 1994;331:712–716.
17. Iavazzo C, Sardi TA, Gkegkes ID. Female genital mulaon
and infecons: a systemac review of the clinical evidence.
Arch Gynecol Obstet. 2013;287(6):1137-1149.
18. Ghosh M, Rodriguez-Garcia M, Wira CR. Immunobiology of
genital tract trauma: endocrine regulaon of hiv acquision
in women following sexual assault or genital tract mula-
on. Am J Reprod Immunol. 2013;69(Suppl 1):51-60.
19. Teufel K1, Dorer DM. Female genital circumcision/mula-
on: implicaons for female urogynaecological health. Int
Urogynecol J. 2013;24(12):2021-2027.
20. Dirie MA, Lindmark G. The risk of medical complicaons
aer female circumcision. East Afr Med J. 1992;69(9):479-
482.
21. Nour NM. Female genital cung: clinical and cultural guide-
lines. Obstet Gynecol Surv. 2004;59(4):272-279.
22. Teufel K. Gesundheitsfolgen von weiblicher Beschneidung:
Eine Pilotstudie in Österreich [Health eects of female
genital mulaon. A pilot study in Austria]. Diploma thesis,
Medical University of Vienna, 2012.
23. Agugua NEN, Egwuatu VE. Female circumcision: man-
agement of urinary complicaons. J Trop Pediatr.
1982;28(5):248-252.
24. Okwudili OA, Chukwudi OR. Urinary and genital tract ob-
strucon as a complicaon of female genital mulaon:
case report and literature review. J Surg Tech Case Rep.
2012;4(1):64-66.
25. Nour NM. Urinary calculus associated with female genital
cung. Obstet Gynecol. 2006;107(2 Pt 2)(Supplement):
521-523.
26. Knight R, Hotchin A, Bayley C, Grover S. Female genital mu-
laon: experience of The Royal Women’s Hospital, Mel-
bourne. Aust N Z J Obstet Gynaecol. 1999;39:50-54.
27. Browning A, Allsworth JE, Wall LL. The relaonship between
female genital cung and obstetric stulae. Obstet Gyne-
col. 2010;115(3):578-583.
28. Berg RC, Denison E. Does female genital mulaon/cung/
FGM/C) aect women’s sexual funconing? A systemac
review of the sexual consequences of FGM/C. Sex Res Soc
Policy. 2012;9(1):41-56.
29. Alsibiani SA, Rouzi AA. Sexual funcon in women with fe-
male genital mulaon. Ferl Steril. 2010;93(3):722-724.
30. Catania L, Abdulcadir O, Puppo V, Verde JB, Abdulcadir J,
Abdulcadir D. Pleasure and orgasm in women with female
genital mulaon/cung (FGM/C). J Sex Med. 2007;4(6):
1666-1678.
31. Essén B, Sjöberg NO, Gudmundsson S, Östergren PO,
Lindqvist PG. No associaon between female cir-
cumcision and prolonged labour: a case control
study of immigrant women giving birth in Sweden.
Eur J Obstet Gynecol Reprod Biol. 2005;121(2):
182-185.
32. Behrendt A, Moritz S. Posraumac stress disorder and
memory problems aer female genital mulaon. Am J Psy-
chiatry. 2005;162(5):1000-1002.
33. Almroth L, Almroth-Berggren V, Hassanein OM, et al. Male
complicaons of female genital mulaon. Soc Sci Med.
2001; 53(11):1455-1460.
34. Rouzi AA, Rouzi MB. Urinary catheterizaon and female gen-
ital mulaon. CMAJ. 2013;185(3):235.
35. Rouzi AA, Sahly N, Bahkali N, Abduljabbar H. Retracon tech-
nique for urinary catheterizaon of women with female geni-
tal mulaon. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):
296-298.
36. Fazari AB, Berg RC, Mohammed WA, Gailii EB, Elmusharaf K.
Reconstrucve surgery for female genital mulaon starts
sexual funconing in Sudanese woman: a case report. J Sex
Med. 2013;10(11):2861-2865.
37. Foldès P, Cuzin B, Andro A. Reconstrucve surgery aer
female genital mulaon: a prospecve cohort study. Lan-
cet. 2012;380(9837):134-141.
38. Colombo C. “L’arcolo 583 bis c.p. un illecito compiuto in
nome della religione? Rivista di Criminologia, Vimologia
e Sicurezza, Vol. III - N. 2 - Maggio-Agosto 2009:60-67
39. Argo A, Averna L, Triolo V, Francomano A, Zerbo S. Validity
and credibility of a child’s tesmony of sexual abuse: a case
report. Euromediterranian Biomed J. 2012;7:97-100
40. Argo A, Cucinella G, Calagna G, et al. Daphne II - Ve.R.S.O
project: a new protocol for the management of sexual as-
sault vicms. Int J Gynaecol Obstet. 2012;24(4):141-153.
41. Argo A, Zerbo S, Triolo V, et al. Legal aspects of sexually
transmied diseases: abuse, partner nocaon and pros-
ecuon. G Ital Dermatol Venereol. 2012;147(4):357-371.
42. D’Amato S, Pompa MG. Aspects of the Italian legislaon re-
lated to HIV tesng. Ann I
st
Super Sanita. 2010;46(1):51-56.
43. Presleo T, Argo A, Triolo V, Zerbo S, Procaccain P. Informed
consent to perform the HIV diagnosc test: how to behave
when minors are involved. Infez Med. 2008;16(4):200-203.
FOR PERSONAL USE ONLY
Vella et al 159
© 2015 Wichg Publishing
44. Kaplan A, Hechavarría S, Bernal M, Bonhoure I. Knowledge,
atudes and pracces of female genital mulaon/cung
among health care professionals in The Gambia: a muleth-
nic study. BMC Public Health. 2013;13(1):851.
45. Ashimi A, Aliyu L, Shiu M, Amole T. A mulcentre study on
knowledge and atude of nurses in northern Nigeria con-
cerning female genital mulaon. Eur J Contracept Reprod
Health Care. 2014;19(2):134-140.
46. Johnson OE, Okon RD. Percepon and pracce of female
genital cung in a rural community in southern Nigeria. Afr
J Reprod Health. 2012;16(4):132-139.
47. Relph S, Inamdar R, Singh H, Yoong W. Female genital mu-
laon/cung: knowledge, atude and training of health
professionals in inner city London. Eur J Obstet Gynecol Re-
prod Biol. 2013;168(2):195-198.
48. Varol N, Fraser IS, Ng CHM, Jaldesa G, Hall J, Varol N1, Fraser
IS, Ng CH, Jadesa G, Hall J. Female genital mulaon/cung:
towards abandonment of a harmful cultural pracce. N Z J
Obstet Gynaecol.2014;54(5):400-405.
49. Caroppo E, Almadori A, Giannuzzi V, Brogna P, Dioda A, Bria
P. Health care for immigrant women in Italy: are we really
ready? A survey on knowledge about female genital mula-
on. Ann Ist Super Sanita. 2014;50(1):49-53.
50. Jacoby SD, Smith A. Increasing cered nurse-midwives’
condence in managing the obstetric care of women with
female genital mulaon/cung. J Midwifery Womens
Health. 2013; 58(4):451-456.
FOR PERSONAL USE ONLY
... The genitourinary complications of FGM were reviewed by Vella et al in 2015. 5 Some studies suggested that in women with the consequences of FGM, there is an important role for reconstructive surgery. 5 The aim is to restore normal anatomy and offer the potential for improved female sexuality. ...
... 5 Some studies suggested that in women with the consequences of FGM, there is an important role for reconstructive surgery. 5 The aim is to restore normal anatomy and offer the potential for improved female sexuality. 5 The same review demonstrated that reconstructive surgery after FGM is associated with reduced pain and restored pleasure. ...
... 5 The aim is to restore normal anatomy and offer the potential for improved female sexuality. 5 The same review demonstrated that reconstructive surgery after FGM is associated with reduced pain and restored pleasure. The 1-year follow-up data was encouraging, with most patients reporting an improvement, or at least no worsening, in pain and improved sex life. ...
Article
Vulval epidermal cysts are rare and infrequently described in literature. They present a difficult diagnostic dilemma and surgical challenges. They most commonly occur as a late complication of female genital mutilation (FGM) and manifest as a primary condition. We present a case of a large vulval epidermal inclusion cyst, lined by vulval squamous epithelium, in a woman with a background of FGM who was referred with suspected vulval cancer. We discuss the clinical presentation, MRI findings, surgical treatment and outcome.
... The latter include psychosocial disorders, trauma, PTSD, depression, anxiety, suicidal ideation, eating disorders, sexual disorders, drug/alcohol addiction, self-harm and somatisation. 8,11,13,26,60,66,[79][80][81][82][83][84][85][86][87] IPV victims often exhibit alexithymic traits that could be linked to the traumatic experience of suffering violence. 88,89 A deeper understanding of the mechanisms and risk factors of violence may help forensic specialists uncover early signs of IPV in victims. ...
Article
Full-text available
Intimate partner violence against women (IPVAW) is the most pervasive violation of women's rights worldwide, causing devastating lifelong damage. Victims can suffer physical, emotional or mental health problems, and experience detrimental effects in social, psychological and relational health with their families, especially children. Due to the complexity regarding violence against women in heterosexual couples, it is important to make a clear distinction between psychological and physical mistreatment, which also includes psychological violence. This differentiation is important in determining different emotional and psychological aspects of mistreatment in order to understand the reasons why some women stay in such relationships and to explain the personality profiles of victims and perpetrators. In this short narrative review, we have combined perspectives of depth psychology and attachment theory from studies on trauma, traumatic bonds and the perpetrator/victim complex in gender violence. We have also considered the growing literature on IPVAW as it relates to the medico-legal field. Our search strategy included intimate partner violence, attachment styles, risk factors and the victim/perpetrator relationship. Distinguishing the different types of IPVAW is a necessary step in understanding the complexity, causes, correlations and consequences of this issue. Above all, it enables the implementation of effective prevention and intervention strategies.
... and where violence is a form of culture, as in the case of mutilations, how should psychological data be interpreted? [33] According to some scholars, neuroscience is close to providing the definitive empirical demonstration that every human behavior is only the mechanistic outcome of a brain process; in this perspective, a free and conscious will would exist exclusively as a manifestation of neuronal connections. According to other researchers, although neuroscience is able to identify the subjects' predisposition to violent and antisocial behaviours in the light of psychological and social factors, we still have no tools or systems to help us ascertain whether this predisposition will actually become concrete. ...
... It is built into the system dealing with requests for asylum that the legal medicine institute of the University of Palermo guarantees irregular migrants the right to access a forensic clinical service available for all victims of violence, torture and female genital mutilation. 5 From May 2018 to March 2020, about 118 asylum seekers who alleged that they were victims of torture were medically evaluated, and each of them was provided with medico-legal certification which is taken into account when they request a grant of political asylum from Italian territorial Commissions. ...
Article
Full-text available
The Covid-19 pandemic is a global health emergency that requires immediate, effective action by governments to protect the health and basic human rights of everyone’s life. Refugees and migrants are potentially at increased risk because they typically live in overcrowded conditions often without access to basic sanitation. Since the beginning of the official lockdown for Covid-19, the medico-legal assessment of physical violence related to obtaining status or other forms of human protection has been frozen.
... As defined by World Health Organization gender violence is 'the greatest public health issue and violation of human rights in the world; it is a violation of a person's physical and mental integrity (WHO 2014). SA is a traumatic life event in which the negative outcomes increase with increasing severity of abuse including physical maltreatment (McCauley et al. 1997) such us lacerations, fractures, genital mutilation, sexually transmitted diseases (Lacey 1990), gynecologic disorders (Walling et al. 1994;Golding et al. 1998) unwanted or pathological pregnancies (Murphy et al. 2001), depression (Wise et al. 2001), eating disorders (Goodwin et al. 2003), self-destructive behaviours (Alix et al. 2017) genito-urinary and sexual disorders (Vella et al. 2015), post-traumatic stress disorders (Kendler et al. 2000;MacMillan et al. 2001;Sprinter et al. 2007;Jonas et al. 2011;Gauthier-Duchesne et al. 2017;Bottomley et al. 1999). Internationally, different approaches are taken to the collection of forensic evidence and to the clinical and psychological assessment of alleged victims Berry et al. 2014). ...
... As defined by World Health Organization gender violence is 'the greatest public health issue and violation of human rights in the world; it is a violation of a person's physical and mental integrity (WHO 2014). SA is a traumatic life event in which the negative outcomes increase with increasing severity of abuse including physical maltreatment (McCauley et al. 1997) such us lacerations, fractures, genital mutilation, sexually transmitted diseases (Lacey 1990), gynecologic disorders (Walling et al. 1994;Golding et al. 1998) unwanted or pathological pregnancies (Murphy et al. 2001), depression (Wise et al. 2001), eating disorders (Goodwin et al. 2003), self-destructive behaviours (Alix et al. 2017) genito-urinary and sexual disorders (Vella et al. 2015), post-traumatic stress disorders (Kendler et al. 2000;MacMillan et al. 2001;Sprinter et al. 2007;Jonas et al. 2011;Gauthier-Duchesne et al. 2017;Bottomley et al. 1999). Internationally, different approaches are taken to the collection of forensic evidence and to the clinical and psychological assessment of alleged victims Berry et al. 2014). ...
Article
Full-text available
Background: Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged as confirmed by the literature. Italian law n.96, 1996, foreseeing norms regarding rape and sexual abuse, finally gave significant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II program to support victims of rape and abuse, and the Violence and Operative Healthcare Networks (Ve.R.S.O.) project started at the Policlinico “P. Giaccone” University Hospital of Palermo in 2006. Aim: data analysis emerging from 10 years experience of Daphne protocol utilization for the management of sexual assault victims. Methods: From October 2006 since December 2016 a total of 90 victims of sexual assault were retrospectively investigated. Patients are divided into groups in relation to: gender, age, place of SA, number and type of assailant, nature of sexual assault, presence/absence of physical or genital injuries. Results: Among victims 88 were females (97%) and 2 males (3%); 68 Italians (75.5%) and 22 foreigners (24.5%). At the time the events occurred, 42% (n = 38) of the victims were minors aged less than 16 years. In 11 cases, the age of the victim is not indicated. The assailant was an acquaintance of the victim in 65% of the cases (in 73% of these cases, the assailant was a family member). In 26 cases (28%) happened indoor, 44 cases happened outdoor and in 20 cases there were no data. Evidence of recent acute general body trauma (abrasions, bruises, lacerations) was found in 38 cases (42%); other types of injuries include: genital trauma (14 cases, 15%), genital and body traumas (49 cases, 54%) (tab. 1–2-). In 24 cases (26%) there were no injuries. Among genital trauma, we distinguished vulvo-vaginal lesions (68.5%) and anal lesions (31.5%). We have classified the minor victims using first Adam’s classification and based on Adam’s classification revised in 2015. Conclusion: Application of the Ve.R.S.O project protocol changed and greatly improved health management of victims of violence. By following these procedures, violence and abuse are analyzed from every point of view, also for an appropriate assessment of the medium and long term health consequences of sexual assault. Only in this way are citizens provided with a high level of protection against gender violence, psychological support and prevention from any form of violence which takes place in respect of such vulnerable people.
... consequently no far similarities must be drawn between two practices. Thus, the practices banned by the WHO, as female genital mutilations, even with patient consent, could not be considered lawful [43]. ...
Article
Violence against women breaches women’s human rights and is a global public health issue that can cause devastating life-long damage. This study considers the characters of victims, abusers and traumatic bonding in heterosexual couples from a medico-legal and psycological standpoint. After considering the devastating effects on women’s health, and with the objective of preventing future violence, it illustrates the weaknesses and strengths of new Italian guidelines related to violence against women in emergency departments including the use of “Brief Risk Assessment for IPV in the Emergency Department – DA5”.
Article
Female genital mutilation (FGM) is a collective term for the deliberate alteration, removal and cutting of the female genitalia. It has no known health benefits and can have negative physical and psychological consequences. The number of women and girls in the UK that are affected by FGM is unknown. Recent NHS data suggested that FGM has been evident (declared or observed) in women who have accessed health care; however, there are gaps in knowledge and a limited evidence base on the health consequences of FGM. This article explores the urological complications experienced by women who have undergone this practice, and the effects this can have on their health and wellbeing.
Article
Full-text available
The allegation by a child victim of sexual abuse is, in many cases, the most important evidence of wrongdoing, especially in absence of medical or physical evidence or confes-sions of guilt. The Rorschach inkblot test is a projective personality assessment technique used to evaluate child witnesses. We report a case of three girls allegedly abused by the father, in which the psychometric evaluation with the Rorschach test did not give credibility to the testimony of the chil-dren. When interrogating a minor, it is very difficult to distinguish between a true and a lie. Indeed, many different elements can affect the dialogue, such as the child's age, the events being discussed, interrogation environment, factors linked to the interviewer, etc. Therefore, it is possible errors of evaluation, misunderstandings or confusion happen fre-quently. The aim of this case report is to highlight that employment of methodologies and criteria recognised by the scientific community could simplify the acquisition and assessment of information from a minor.
Article
Full-text available
Sexually transmitted diseases (STDs), with special emphasis to HIV infection, involve legal and ethical issues regarding informed consent to submit to a diagnostic, observance of professional secrecy in regard to partner(s) and community; legal troubles of particular difficulties are related to STD involving minors; lastly, physicians must be able to recognize the state of so called medical necessity. Knowledge and awareness of these related obligations are crucial to STD in medical practice; it is also important to allow for proper protection of victims of suspected sexual abuse under observation of healthcare. With regard to this aspect should be emphasized that violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. Italian legislation (Law n. 96/1996) against rapes finally gave significant relevance to sex crimes. When sexual abusers have to be evaluated some obstacles may arise for lack of appropriate interdisciplinary approach, with insurance of the collection of biological samples, also related to STD diagnosis and alerts of legal authorities. Personal preconceptions may interfere with investigation if the biological evidences in children are few. In this regard, rules of document "Carta di Noto" drafted in 1996 and reviewed in July 2002 include some specific indications aiming to grant the reliability of the results of technical investigations and authenticity of the statements of the alleged victims.
Article
Full-text available
Purpose: Nigeria has the highest absolute number of residents who have undergone female genital mutilation (FGM) and most are carried out during infancy; however most reports on FGM are from urban based facilities hence we sought to know the perception and attitude of pregnant women residing in a rural community in northern Nigeria to FGM. Methods: A descriptive cross sectional study utilized a pretested structured interviewer administered questionnaire to assess the types of FGM known, reasons for performing it and willingness to support or perform FGM among 323 pregnant women attending antenatal care in two different health facilities. Results: Of the 323 respondents, 256 (79.3%) were aware of the practice and the common varieties of FGM known to them were Gishiri cut in 137 (53.5%) and Angurya cut 113 (44.1). The notable reasons for carrying out FGM in the community were tradition 88 (34.4%), to ease difficulty in childbirth 69 (26.9%) and better marriage prospect in 55 (21.5%). Of the respondents that were aware of FGM; 100 (39.1%) have experienced it and 55 (21.5%) of those aware of it would subject their daughters to the procedure. There was statistically significant association between willingness to mutilate daughters by the respondents type of education (p = 0.014) and the type of facility they were receiving antenatal care (p = 0.001). Conclusion: FGM is prevalent in this community with Gishiri cut being the commonest variety. It is often associated with difficult childbirth and many women would subject their daughters to this practice. Female education and empowerment is crucial to discontinuation of this practice.
Article
Full-text available
INTRODUCTION Sexual assault (SA) is any form of sexual contact or behavior that occurs without the ex-plicit consent of the recipient of the unwanted sexual acts (1). It also includes all cases in which the individual, even if never physically touched, is exposed to an inappropriate sexu-al content or relationship with the abuser. SA is a worldwide problem that has not yet been sufficiently acknowledged or report-ed, as confirmed by analyses and studies car-ried out at different levels and in different contexts (2). In particular, sexual abuse in children is a problem of epidemic propor-tions, affecting children of all ages, socioeco-nomic levels, and cultural backgrounds: of the 3 million cases of maltreatment of chil-dren, approximately 20% are reported as sex-ual abuse (3). Data from National Institute of Statistics -Is-tituto Nazionale di Statistica (ISTAT) in 2006 state that in Italy, the number of female vic-Daphne II -Ve.R.S.O project: a new protocol for the management of sexual assault victims
Article
Full-text available
Background: Because of immigration, female genital mutilation (FGM) is an issue of increasing concern in western countries. Nevertheless operators without a specific training may ignore the health condition of women subjected to this practice and fail to provide them adequate assistance. The purpose of the study was to estimate the current knowledge about FGM among social and health care assistants working with asylum seeker. Material and methods: From October to December 2012, a questionnaire was used to interview 41 operators working in CARA (Shelter for Refugees and Asylum Seekers) in central and southern Italy. Results: Only 7.3% of respondents states to know well FGM, while 4.9% do not know it at all. 70.7% declare to have never met or assisted a woman with FGM, nevertheless all respondents work with asylum seeker from countries where FGM are performed. Conclusions: Migration fluxes to Italy over the past decade created a healthcare challenge: women with FGM have specific medical and psychological problems that doctors, nurses and social assistants without specific training are not usually able to manage.
Article
Female genital mutilation (FGM) is practiced in Egypt, despite its recent ban, generally in rural and uneducated communities, under unsanitary conditions and by non-medical personnel. Immediate and long-term complications are frequent. The aim of this study was to gain insight into what beliefs or knowledge are conducive to supporting FGM.One thousand and seventy university students in Cairo, Egypt were randomly selected. A 32-item questionnaire was used to interview students regarding their knowledge and attitudes toward FGM. Multivariable analyses were performed to find factors associated with being against the abolishment of FGM.The response rate was 95% (n=1020). Twenty-eight percent of the students support FGM. The most significant factors associated with the condoning of FGM were believing FGM has a religious basis (OR=2.53), disagreeing that FGM is a custom with no other basis (OR=2.59), not believing it is harmful (OR=4.11), and ignoring that it is usually followed by complications (OR=5.14).Even in an educated population, a considerable amount of ignorance concerning FGM exists. Widespread education about FGM is important to dispel the myths that surround its practice and to bring the practice to an end. Public Health (2001) 115, 350–355.
Article
Globally, the prevalence of, and support for, female genital mutilation/cutting (FGM/C) is declining. However, the entrenched sense of social obligation that propagates the continuation of this practice and the lack of open communication between men and women on this sensitive issue are two important barriers to abandonment. There is limited evidence on the role of men and their experiences in FGM/C. Marriageability of girls is considered to be one of the main driving forces for the continuation of this practice. In some countries, more men than women are advocating to end FGM/C. Moreover, men, as partners to women with FGM/C, also report physical and psychosexual problems. The abandonment process involves expanding a range of successful programs, addressing the human rights priorities of communities and providing power over their own development processes. Anecdotal evidence exists that FGM/C is practised amongst African migrant populations in Australia. The Australian Government supports a taskforce to improve community awareness and education, workforce training and evidence building. Internationally, an African Coordinating Centre for abandonment of FGM/C has been established in Kenya with a major global support group to share research, promote solidarity, advocacy and implement a coordinated and integrated response to abandon FGM/C.