Women who undergo female genital mutilation (FGM) are likely to have sexual dysfunction, experts report in a new Journal of Sexual Medicine study.

Those who have had more extensive FGM procedures tend to have more severe sexual problems, they added.

FGM involves the cutting or removal of female genitals for non-medical reasons. Despite being illegal in many countries, it is practiced in cultures around the world, most notably in parts of Africa, Asia, and the Middle East. (Note: FGM is also called female genital cutting or female circumcision.)

Many cultures consider FGM a traditional rite of passage for young girls – a way to maintain sexual purity and improve prospects for marriage. Many of the girls are younger than fifteen years old.

The type and extent of cutting varies from culture to culture. In some cases, the clitoris or labia (or both) are partially or completely removed. The vaginal opening might be covered or stitched shut. The genitals may be pricked, pierced, or cauterized.

The study authors noted a “significant lack in knowledge” about FGM and conducted a systematic review on the subject.

“In reality, health care providers are still often unaware of the many negative health consequences and remain inadequately trained to recognize and treat them properly,” they wrote.

The reviewers analyzed five studies published after 2000. All of the studies involved adult women who had undergone FGM and were experiencing sexual problems. All of the participants completed the Female Sexual Function Index (FSFI), a tool that assessed the women’s sexual arousal, lubrication, orgasm, desire, pain, and satisfaction during the previous four weeks. Higher scores on the FSFI indicate better sexual function.

The studies took place in Saudi Arabia and surrounding countries, as well as Sudan, Kenya, and Egypt. For four studies, the women’s average age ranged from 26 to 40; in the fifth study, about a quarter of the participants were aged 15 to 24 and the rest were aged 25 or older.

An analysis of FSFI scores showed that, in general, women who had undergone FGM had poorer sexual function than women who had not had FGM. This finding applied to total FSFI scores as well as the scores for individual domains. However, the affected domains were not the same for all studies.

How might FGM worsen women’s sexual function? The authors explained that “in women with FGM, parts of the erogenous genital zones and sexually responsive vascular tissue are excised.” Nerve endings can be damaged in the process, diminishing sexual response. Scarring can lead to pain.

Reconstructive surgery and counseling are options for addressing sexual problems in women after FGM, they said.

The authors encouraged further research on managing complications of FGM.

Resources

• International Society for Sexual Medicine - “What is female genital cutting?”
  https://www.issm.info/sexual-health-qa/what-is-female-genital-cutting/
  
  
• The Journal of Sexual Medicine - “Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis”
  Nzinga, Andy-Muller, MASt PMR, et al.
  (Full-text. Published: February 19, 2021)
  https://www.jsm.jsexmed.org/article/S1743-6095(21)00176-4/fulltext