Stage II Primips > 90 mins
Study 3 and Study 4: see table
· 200 prostitutes examined
Study 4
· 300 husbands interviewed who had more than one wife each
Study 5
· 100 consecutive cases of puerperal sepsis admitted to isolation ward
Study 6
· 20 cases of VVF studied
Study 7
· Young mothers who had Type III but no
complications with good education at least to secondary school on views of daughters and FGM. N = 100
Study 2
Teenage girls
(daughters of adult women patients) all young, unmarried Interviewed for
Immediate complications Examined by inspection only for FGM type
Vulval complications already apparent
Study 3 and Study 4: see table
Adults FGM Type III 51/3013 (1.69%) FGM Type I 2//807 (0.25%) FGM Type 0 0/204 (0%) Teenagers FGM Type III 5/236 (2.12%) FGM Type I 0.227 (0%) FGM Type 0 (0%)
· Bartholin’s cysts and abscesses (often infected cysts)
Adults FGM III Cyst 4/3013 (0.13%) Abscesses 3/3013 (0.1%) FGM I Cyst 1/807 (0.12%) Abscesses 1/807 (0.12%) FGM 0 Cyst 1/204 (0.49%) Abscesses 1/204 1/204 (0.49%) Teenagers FGM III Cyst 0/236 (0%) Abscesses 0/236 (0%) FGM I Cyst Abscesses FGM 0 Cyst Abscesses
· Urinary infection and bacteruria in adults
Bacteruria: Type III FGM = 843/3013 (28%) Type I FGM = 64/807 ( 8%) Type 0 FGM = 16/204 ( 8%) Urinary infection Type III FGM = 482/3013 = (16%) Type I FGM = 30/807 = ( 4%) Type 0 FGM = 8/204 = ( 4%)
Probable changing FGM practice
Of girls with FGM I N 27 103/227 (45%) of their mothers had Type III. Of the daughters with FGM 51% of their mothers had Type I.
Mothers’ group is not a community based sample but those referred for problems, so a comparison with the daughters needs to be treated with caution.
Cases with puerperal sepsis have FGM
· Vesico Vaginal Fistula insignificant risk factor
Fetal distress
(no direct comparisons)
· haemorrhage from circumcision (not quantified)
Psychosexual
· 3% of FGM III group require deinfibulation for tight circumcision · Difficulty in penetration
1% of FGM group had inability to penetrate leading to infertility · Anogasmia
12 x more likely never to have had orgasm with FGM I than FGM O
· High Vaginal Swab Culture
(All groups had similar rates of positive culture for Diphtheroid bacilli (40%), staph-albus (20%) and haemolytic strep. (10%) Adults E. Coli FGM Type III 301/3013 (10%) FGM Type I 40/807 ( 5%) FGM Type 0 10/204 ( 5%) Monilia (candida) FGM Type III 452/3013 (15%) FGM Type I 81/807 (10%) FGM Type 0 20/204 (10%) Trichomonas FGM Type III 307/3013 (10%) FGM Type I 40/807 ( 5%) FGM Type 0 40/807 (5%) · Vaginal Calculi “rare” :
2/3013 cases (described in detail) both infibulated (FGM Type III)
0/807 in Type 1 FGM · Chronic pelvic infection
N = 436 non-tuberculosis chronic pelvic infection over 5 years
Adults
FGM III 393/3013 (13%) FGM I 31/807 (4%) FGM 0 12/204 (6%)
· Tight infibulation surgically treated = 105/3013 (often following re-tightening after childbirth with ever thicker scar tissue in multiparas).
“This is the sphere where the
main morbid sequelae resided” None needed with FGM Type I · Penetration failure 110/3013 · Sexual Response
“Removal of clitoris interferes with sexual response”
Ø Never had orgasm:
FGM Type III 2520/3013 = (83.6%) FGM Type I 98/807 = (12.1%) FGM Type 0 14/204 = (6.86%) Ø Had orgasm in 50 - 75% of occasions
Type III 180/3013 = (5.97%) Type I 300/3013 = (37.17%) Type 0 61/204 = (29.9%)
Ø Had orgasm on less than 50% of occasions Type III 162/3013 = (5.3%)
Type I 139/807 = (17.2%) Type 0 29/204 = (14.2%)
Ø Had orgasm on more than 75% of occasions Type III 151/3013 = ( 5.01%)
Type I 270/807 = (33.46%) Type 0 100/208 = (49.2%)
FGM Type III 80/3013 women claimed not to know that women get satisfaction from intercourse and had no idea about orgasm.
Husband’s views: 300 men all with one wife with FGM
Type III and at least one wife with FGM Type 0 or I. 266/300 preferred sex with wives with FGM/0/I rather than FGM III “because they seem to share with them the desire, the act and the pleasure, unlike those with FGM III who always seem to be putting on an act and never seem to enjoy intercourse”.
Obstetric complications Injuries at anterior episiotomy
· Splitting of urethra leading to urethrovaginal fistula = 1/1245
Proper vaginal examination difficult in labour. 5/3013 (FGM Type III) had to have scar split for catheterisation and vaginal examination in labour. (All had become pregnant via pinhole introitus).
· Vesico-vaginal fistula
Stated by author: “FGM may add to the delay of the delivery of the head but the usual course of vesico- vaginal fistula is cephalo-pelvic disproportion” Of 20 cases VVF
FGM 0 = 9 FGM I = 4 FGM III = 7
Delay 2nd stage with FGM III
Perineal tears, or if early incision of scar, excessive blood loss, pain, inertia.
Puerperal sepsis
N = 100 admitted, 40 (40%) due to infected FGM scar FGM III 12% postpartum wound infection, sometimes very severe.
FGM I 5% infected episiotomy history including psychological trauma in spite of being brought up to look forward to day of FGM (Tahour) and imagine a day of pleasure and celebration in her honour
Infertility
Adults with Type III FGM 105/3013 = 3% deinfibulated due to tight circumcision.
32/105 had complained of primary infertility of 2-10 years 32/105 = 1%
23/32 conceived within six months of deinfibulation
Results of examination of 200 female prostitutes
170/200 Type III = 85% 22/200 Type I = 11% 8/200 Type O = 4%
Table 12
Summary of studies included in the review arranged alphabetically by author
Study Review categories, study population, country, study design, study size
Outcome measures, follow-up
Results Commentary and implications
SHAW E 1985 Female circumcision: perception of clients and caregivers Journal of American College Health 1985 33 (5) : 193-197 1. Descriptive study to identify, by informal interview. Specific needs and concerns of a group of 12 circumcised women who have used the western medical system while living in the United States. Women from Sudan, Egypt, Somalia
FGM type: not stated Age at FGM: childhood
2. Questionnaire based follow-up study sent to care providers of 95 student health centres with foreign students expected to number more than 500, to identify problems and concerns that student health providers
encountered while caring for circumcised women
1. N = 12
Recommendations/suggestions agreed upon by over 90% of respondents
Antenatal fears
Worried about painful pelvic examinations
12/12 100%
Obstetric
Fears expressed regarding · unnecessary damage and
additional cost of services needed · tearing of infibulation scars due to
anterior episiotomies that were not performed quickly enough · being resutured incorrectly post
partum
· post partum infection
suggested that these complications arise because of providers ignorance and mismanagement of deliveries in presence of FGM
Not extracted:
Health care provider study
Suggests women with FG resident in US have concerns re:
Gynaecological
Pelvic examination anticipated to be painful
Obstetric
Fear of delivery
Experience/fear of perineal tears
Fear of ignorance of health care provider re: FGM Experience/fear of improper suturing post partum Experience of post partum infection
Table 12
Summary of studies included in the review arranged alphabetically by author
Study Review categories, study population, country, study design, study size
Outcome measures, follow-up
Results Commentary and implications
SHEIK, H.A.