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Gynecological Consequences of Female Genital Mutilation/Cutting (FGM/C)

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Gynecological Consequences of Female Genital Mutilation/Cutting (FGM/C) Gynecological consequences of female genital mutilation/cutting (FGM/C) Report from Kunnskapssenteret (Norwegian Knowledge Centre for the Health Services) No 11–2014 Systematic review The traditional practice of female genital mutilation or cutting (FGM/C) covers a range of procedures (clitoridectomy, excision, infi bulation, and other) performed on the genitals of females of different ages. This systematic review aimed to summarize empirical quantitative research describing the gynecological conse- quences of FGM/C on girls and women. We included 136 primary studies, 42 of which compared groups of women who had been subjected to FGM/C with women who had no or different types of genital alterations. The main fi nding is that FGM/C has harmful consequences for a woman’s gynecological health. We found that: • Women with FGM/C seem to be more likely than women wit- hout FGM/C to experience urinary tract infection, bacterial vaginosis, and pain during intercourse. • There seems to be a trend for women with FGM/C to be more likely than women without FGM/C to experience: burning/painful urina- tion, problems with menstruation, vaginal discharge and vaginal itching. • There seems to be no clear trend for either a greater or lower risk of HIV and sexually transmitted infections among women who have undergone FGM/C. • (continued) Norwegian Knowledge Centre for the Health Services (Kunnskapssenteret) PO Box 7004, St. Olavs plass N-0130 Oslo (+47) 23 25 50 00 www.kunnskapssenteret.no Report: ISBN 978-82-8121-864-2 ISSN 1890-1298 no 11–2014 (continued from page one) There were insuffi cient data for us to conclude whether the risk of other gynecological complications (tissue damage, vaginal adhesions and ob- structions, cysts, infertility) is different among women with FGM/C compared to women without FGM/C, and whether various FGM/C types differentially affect the risk of other gynecological complications (except regarding urinary tract in- fection). This systematic review found that suffi cient evidence exist to conclude that women who have undergone FGM/C suffer a greater risk of gynecological complications than women who have not undergone the procedure. There were no indications of gynecological benefi ts of FGM/C. Rather, there is a real chance of under-reporting of many of the health issues covered in this systematic re- view. Title Gynecological consequences of female genital mutilation/cut- ting (FGM/C) Norwegian Gynekologiske konsekvenser av kvinnelig kjønnslemlestelse title Institution Norwegian Knowledge Centre for the Health Services (Nasjonalt kunnskapssenter for helsetjenesten) Magne Nylenna, Director Authors Berg, Rigmor C, Project leader, researcher, NOKC Underland, Vigdis, researcher, NOKC No. of pages 121 (157 including appendices) Client World Health Organization, NORAD Subject head- Circumcision, Female ing (MeSH) Citation Berg Rigmor C, Underland Vigdis. Gynecological conse- quences of female genital mutilation/cutting (FGM/C). Re- port from Kunnskapssenteret no. 11−2014. Oslo: Norwegian Knowledge Centre for the Health Services, 2014. Norwegian Knowledge Centre for the Health Services (NOKC) summarizes and disseminates evidence concerning the effect of treatments, methods, and interventions in health services, in addition to monitoring health service quality. Our goal is to support good decision making in order to provide patients in Norway with the best possible care. The Centre is organized under The Norwegian Directorate for Health, but is scientifically and professionally independent. The Centre has no authority to develop health policy or responsibility to im- plement policies. We would like to thank Tove Ringerike, Ingeborg B. Lidal, Owolabi Bjälkander and Marleen Temmerman for their ex- pertise in this project. Norwegian Knowledge Centre for the Health Services assumes final responsibility for the content of this report. Norwegian Knowledge Centre for the Health Services Oslo, May 2014 Title: Key messages Gynecological consequences of female genital mutilation/cutting (FGM/C) ------------------------------------------ Type of publication: Systematic review A review of a clearly formulated question that uses systematic The traditional practice of female genital mutilation or cutting and explicit methods to identify, select, and critically appraise rel- (FGM/C) covers a range of procedures (clitoridectomy, excision, in- evant research, and to collect fibulation, and other) performed on the genitals of females of differ- and analyse data from the stud- ent ages. This systematic review aimed to summarize empirical ies that are included in the re- quantitative research describing the gynecological consequences of view. Statistical methods (meta- analysis) may or may not be FGM/C on girls and women. used to analyse and summarise the results of the included stud- We included 136 primary studies, 42 of which compared groups of ies. ------------------------------------------ women who had been subjected to FGM/C with women who had no or different types of genital alterations. The main finding is that Doesn’t answer every- FGM/C has harmful consequences for a woman’s gynecological thing: health. We found that: -Excluded studies that fall outside of the inclusion Women with FGM/C seem to be more likely than women criteria without FGM/C to experience urinary tract infection, bacterial - No health economic vaginosis, and pain during intercourse. evaluation -No recommendations There seems to be a trend for women with FGM/C to be more ------------------------------------------ likely than women without FGM/C to experience: Publisher: burning/painful urination, problems with menstruation, Norwegian Knowledge Centre vaginal discharge and vaginal itching. for the Health Services (NOKC) There seems to be no clear trend for either a greater or lower ------------------------------------------ risk of HIV and sexually transmitted infections among women Updated: who have undergone FGM/C. Last search for studies: January, 2012. There were insufficient data for us to conclude whether the risk ------------------------------------------ of other gynecological complications (tissue damage, vaginal Peer review: adhesions and obstructions, cysts, infertility) is different Tove Ringerike, researcher, among women with FGM/C compared to women without NOKC (Norway) FGM/C, and whether various FGM/C types differentially affect Ingeborg B. Lidal, researcher, the risk of other gynecological complications (except regarding NOKC (Norway) urinary tract infection). Owolabi Bjälkander, PhD This systematic review found that sufficient evidence exist to con- Independent Researcher clude that women who have undergone FGM/C suffer a greater risk (Democratic Republic of Congo) of gynecological complications than women who have not under- gone the procedure. There were no indications of gynecological ben- Marleen Temmerman, director of the Dept of Reproductive efits of FGM/C. Rather, there is a real chance of under-reporting of Health and Research, WHO many of the health issues covered in this systematic review. 2 Key messages Executive summary Background The traditional practice of female genital mutilation or cutting (FGM/C) covers a range of procedures performed on the genitals of females of different ages. It is de- fined by the World Health Organization (WHO) as “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.” According to the WHO typology, there are three main types of FGM/C: type I (clitoridectomy), type II (excision), type III (infibula- tion or pharaonic circumcision), and type IV which is used to describe all other harmful procedures to the female genitalia for non-medical purposes. According to a recent UNICEF report, there are over 125 million girls and women alive today who have undergone FGM/C in the 29 countries where the practice is concentrated. These are a swathe of 27 African countries stretching from the Atlantic Coast to the Horn of Africa, and Iraq and Yemen in the Middle East. In most countries for which reliable data are available, clitoridectomy and excision are most commonly prac- ticed. Since FGM/C involves the cutting, or other alteration, of sensitive genital tis- sue, it is reasonable to assume that it is an act that is prejudicial to girls’ and women’s health in the short-term and long-term. Thus, the question addressed in the present systematic review is whether women who have been subjected to FGM/C are more likely than women who have not been subjected to FGM/C to experience long-term gynecological health complications. Objective This systematic review summarizes empirical quantitative research describing the gynecological consequences of FGM/C on girls and women (excluding obstetric con- sequences and sexual functioning, which are covered in separate reports). The over- all aim of this systematic review is to support well-informed decisions in health pro- motion and health care that improve quality of services related to the consequences of FGM/C. The key research question was: What are the gynecological consequences of FGM/C? 3 Executive summary Method This systematic review was conducted in accordance with the guidelines in the NOKC Handbook for Summarizing Evidence and the Cochrane Handbook for Sys- tematic Reviews of Interventions. The main literature search strategy was systematic searches for literature in 15 international electronic literature databases. Studies eli- gible for inclusion were systematic reviews,
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