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Effect of COVID-19 pandemic on female sexual function in women with female genital mutilation

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Abstract

We aimed to evaluate the impact of the COVID-19 pandemic on female sexual function in women with female genital mutilation (FGM) in Somalia. This cross-sectional study was conducted on women with FGM attending the gynaecologic outpatient clinic of our hospital, between March and June 2021, using a validated Female Sexual Function Index (FSFI) questionnaire with a physical examination based on FGM typing. Those women who refused to participate, those with mental illness, uncontrolled systemic disease, drug, alcohol, or khat addiction, pregnant, genital prolapse, gynaecological or urological cancer, previous pelvic surgery, premature ovarian failure, genital skin diseases, drug use that affects sexual function and those with or suspected of having COVID-19 infection were excluded. A total of 201 sexually active women enrolled, with a mean age of 29 (14–55) years. Comparison of FSFI scores and the COVID-19 pandemic, a statistically significant worsening in the mean FSFI scores and all its domains (p<.001, for each). All of the domains of the FSFI were determined higher before and during the pandemic except pain. There is a decline in female sexual functioning during the COVID-19 outbreak in women with FGM. FGM is a major public health concern necessitating urgent response in Somalia. • Impact statement • What is already known on this subject? As it stands, there is a body of research on sexual behaviour during COVID-19 pandemic, but a lack of conclusive evidence. However, our knowledge of the sexual function of women with FGM during the COVID-19 pandemic is largely based on very limited data. • What do the results of this study add? There is a decline in female sexual functioning during COVID-19 pandemic in women with female genital mutilation in Somalia. • What are the implications of these findings for clinical practice and/or further research? FGM is a major public health problem necessitating urgent response worldwide. There is an urgent need to implement FGM prevention programmes and raise public awareness in order to eradicate this harmful practice.

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Background International studies have demonstrated increasing rates of sexual dysfunction amidst the coronavirus disease 2019 (COVID-19) pandemic; however, the impact of the pandemic on female sexual function in the United States is unknown. Aim To assess the impact of the COVID-19 pandemic on female sexual function and frequency in the United States. Methods A pre-pandemic survey containing the Female Sexual Function Index (FSFI) and demographic questions was completed by adult women in the United States from October 20, 2019 and March 1, 2020. The same women were sent a follow-up survey also containing the FSFI, as well as the Patient Health Questionnaire for Depression and Anxiety with 4 items (PHQ-4), and questions pertaining to mask wearing habits, job loss, and relationship changes. Risk for female sexual dysfunction (RFSD) was defined as FSFI<26.55. Main outcome measures Differences in pre-pandemic and intra-pandemic female sexual function, measured by the FSFI, and sexual frequency. Results Ninety-one women were included in this study. Overall FSFI significantly decreased during the pandemic (27.2 versus 28.8, p=0.002), with domain-specific decreases in arousal (4.41 versus 4.86, p=0.0002), lubrication (4.90 versus 5.22, p=0.004), and satisfaction (4.40 versus 4.70, p=0.04). There was no change in sexual frequency. Contingency table analysis of RFSD prior to and during the pandemic revealed significantly increased RFSD during the pandemic (p=0.002). Women who developed RFSD during the pandemic had higher PHQ-4 anxiety subscale scores (3.74 versus 2.53, p=0.01) and depression subscale scores (2.74 versus 1.43, p=0.001) than those who did not. Development of FSD was not associated with age, home region, relationship status, mask wearing habits, knowing someone who tested positive for COVID-19, relationship change, or job loss/reduction during the pandemic. Conclusion In this population of female cannabis users, risk for sexual dysfunction increased amidst the COVID-19 pandemic and is associated with depression and anxiety symptoms.
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Background Female genital mutilation (FGM) can leave a lasting mark on the lives and minds of those affected. Aim To assess the consequences of FGM on women’s sexual function in women who have undergone FGM compared to women who have not undergone FGM. Methods A systematic review and meta-analysis were conducted from 3 databases; inclusion and exclusion criterions were determined. Studies included adult women having undergone FGM and presenting sexual disorders assessed by the Female Sexual Function Index (FSFI). Results Of 129 studies, 5 that met the criteria were selected. The sexual function of mutilated women, based on the FSFI total score and its different domains, was compared to the sexual function of non-mutilated women. There was a significant decrease in the total FSFI scores of mutilated women compared to non-mutilated women. However, the results obtained for the different domains were not the same for all authors. The meta-analysis highlighted a high heterogeneity with inconsistency and true variance in effect size between-studies. Conclusion Analysis of studies showed that there is a significant decrease in the total FSFI score, indicating that FGM of any type may cause impaired sexual functioning. But a firm conclusion on this topic is not yet achievable because the results of this analysis do not allow to conclude a cause and effect relationship of FGM on sexual function. Nzinga A-M, De Andrade Castanheira S, Herklmann J, et al. Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis. J Sex Med 2021;XX:XXX–XXX.
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Article
Objectives: Female genital mutilation (FGM) is becoming more widely seen in the West, due to immigration and population movement. Health services are being confronted with the need to provide care for women with FGM. One of the more recent trends is the provision of clitoral reconstruction. It remains unclear, however, what constitutes good practice with regard to this type of surgery. Methods: Based on a keynote presentation about reconstructive clitoral surgery, we briefly discuss the possible consequences of FGM and the findings from recent publications on clitoral reconstruction. Recognising individual differences in women, we suggest a multidisciplinary counselling model to provide appropriate care for women requesting clitoral reconstruction. Results: The literature shows that FGM influences physical, mental and sexual health. Clitoral reconstructive surgery can lead to an increase in sexual satisfaction and orgasm in some, but not all, women. A multidisciplinary approach would enable a more satisfactory and individually tailored approach to care. The multidisciplinary team should consist of a midwife, a gynaecological surgeon, a psychologist-psychotherapist, a sexologist and a social worker. Comprehensive health counselling should be the common thread in this model of care. Our proposed care pathway starts with taking a thorough history, followed by medical, psychological and sexological consultations. Conclusions: Women with FGM requesting clitoral reconstruction might primarily be looking to improve their sexual life, to recover their identity and to reduce pain. Surgery may not always be the right answer. Thorough counselling that includes medical, psychological and sexual advice is therefore necessary as part of a multidisciplinary approach.
Article
Introduction: The existing literature is conflicting regarding effects of female genital cutting (FGC) on sexual functions. Several studies from Africa over the past 20 years have challenged the negative effect of genital cutting on sexual function as defined by performance on the following domains: desire, arousal, lubrication, orgasm, satisfaction, and sexual pain. Other studies however indicated that sexual function of genitally cut women is adversely altered. Aim: The aim of the study was to investigate the effects of FGC on the female sexual function of Egyptian women. Methods: This is a cross-sectional study conducted between February and May 2011 at the outpatient clinic of Cairo University Hospitals. The study included 650 Egyptian females between 16 and 55 years of age (333 genitally cut women and 317 uncut women). Participants were requested to complete the Arabic Female Sexual Function Index (ArFSFI) and were then subjected to clinical examination where the cutting status was confirmed. Main outcome measures: The total score of the ArFSFI and its individual domains. Results: The mean age of cutting was 8.59 (±1.07) years. Of the cut participants, 84.98% showed signs of type I genital cutting, while 15.02% showed signs of type II genital cutting. After adjusting for age, residential area, and education level, uncut participants had significantly higher ArFSFI total score (23.99±2.21) compared with cut participants (26.81±2.26). The desire, arousal, lubrication, orgasm, and satisfaction domains were significantly higher in the uncut participants (4.02±0.78, 4.86±0.72, 4.86±0.75, 4.86±0.68, 5.04±0.71, respectively) compared with those of the cut participants (3.37±0.89, 4.13±0.71, 4.16±0.84, 4.50±0.79, 4.69±0.92, respectively). No significant difference between the two groups was found regarding the sexual pain domain. Conclusion: In Egyptian women, FGC is associated with reduced scores of ArFSFI on all domain scores except the sexual pain domain.
Article
To evaluate the reproductive health of women in the aftermath of the 2008 Richter scale 8.0 Wenchuan earthquake in China. Gynecologists surveyed 170 women using a questionnaire inquiring about symptoms of reproductive tract infection, menstruation disorders, satisfaction with sexual life, and desire for fertility. The rates of symptoms of lower genital tract infection were higher after than before the earthquake (50.0% vs 26.5%), as were the rates for pelvic inflammatory disease (35.9% vs 19.4%) and menstruation disorders (51.8% vs 22.4%) (P<0.05 for all). At the same time, the women's satisfaction with their sexual life was markedly decreased; 89.4% of them said they would not pursue a plan to become pregnant; and 67.1% said they would request pregnancy termination if they became pregnant. The findings of this first population-based assessment of reproductive health following the massive Wenchuan earthquake may help in shaping public health measures benefiting women surviving large-sale disasters.
Article
To compare the sexual function of women with female genital mutilation (FGM) to women without FGM. A prospective case-control study. A tertiary referral university hospital. One hundred and thirty sexually active women with FGM and 130 sexually active women without FGM in Jeddah, Saudi Arabia. Women with and without FGM were asked to answer the Arabic-translated version of the female sexual function index (FSFI) questionnaire. The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score of the FSFI were calculated. The two groups were comparable in demographic characteristics. There were no statistically significant differences between the two groups in mean desire score (+/- standard deviation) or pain score. However, there were statistically significant differences between the two groups in their scores for arousal, lubrication, orgasm, and satisfaction as well as the overall score. Sexual function in women with FGM is adversely altered. This adds to the well-known health consequences of FGM. Efforts to document and explain these complications should be encouraged so that FGM can be abandoned.
Article
The practice of female "circumcision," or traditional fe male genital surgery, is simultaneously complex and controversial, Although some consider it a human rights infringement, others view it as an integral part of cultures in which it remained unchallenged for centuries, With more than 30.000 Africmls entering the United States in the last decade, American clinicians are challenged with meeting Africml women's health needs, as they are barraged with a debate about the ethics and politics of circumcision, There are significant medical sequelae and public health ramifications of female circumcision: therefore most U, S. physicians probably would agree that programs to abolish it should continue. However, although there is ample media and political attention to this volatile issue. there is a relative dearth of practical, clinical information available to providers who care for circumcised women and their families. As African communities and advocates grapple with how to stop this practice, circumcised women need clinicians familiar with these surgeries, who
Article
To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems. Randomly selected (264) newly married women were the subjects of this work. Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P<0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's dissatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P<0.001). Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth.
Psychological, social and sexual consequences of female genital mutilation/cutting (FGM/C): a systematic review of quantitative studies
  • R C Berg
  • E Denison
  • A Fretheim