A case-control study on the association between female genital mutilation and sexually transmitted infections in Sudan.

OBJECTIVE: To assess whether the extent of female genital mutilation (FGM) influences the risk of acquiring sexually transmitted infections (STIs). DESIGN: Hospital-based case-control study. SETTING: Two obstetric/gynaecological outpatient clinics in Khartoum, Sudan, 2003-2004. POPULATION: A total of 222 women aged 17-35 years coming to antenatal and gynaecological clinics. METHODS: Women recruited for the study were divided into cases with seropositivity for Neisseria gonorrhoeae (gonococcal antibody test), Chlamydia trachomatis (enzyme immunoassay) or Treponema pallidum (Treponema pallidum haemagglutination assay) (n= 26) and controls without antibodies to these species (n= 196). Socio-demographic data were obtained and physical examination including genital examination was performed in order to classify the form of FGM. Cases and controls were compared using logistic regression to adjust for covariates. MAIN OUTCOME MEASURES: Extent of FGM and seropositivity for C. trachomatis, N. gonorrhoeae or T. pallidum. RESULTS: Of the cases, 85% had undergone the most severe form of FGM involving labia majora compared with 78% of controls (n.s.). Thus, there was no association between serological evidence of STIs and extent of FGM. The only factor that differed significantly between the groups was the education level, cases with STIs having significantly shorter education (P= 0.03) than controls. CONCLUSIONS: There is a little difference between cases and controls in regard to FGM. Having in mind the relatively small sample size, the results still indicate that FGM seems neither to be a risk factor for nor protective against acquiring STIs. This is important as argument against traditional beliefs that FGM protects against pre/extramarital sex.

Male complications of female genital mutilation.

Female genital mutilation (FGM) is known to cause a wide range of immediate and long-term complications for women subjected to the practice. Male complications due to FGM have, however, not been described before. The objectives of this study were to explore male complications and attitudes with regard to FGM. A village in the Gezira Scheme along the Blue Nile in Sudan constituted the basis of the study. Interviews were carried out according to a pre-tested questionnaire, using structured questions with open-answer possibilities. Married men of the youngest parental generation and grandfathers were randomly selected from up-to-date election lists. All respondents except one agreed to be interviewed. A total of 59 men were interviewed, 29 young men and 30 grandfathers. Male complications resulting from FGM, such as difficulty in penetration, wounds/infections on the penis and psychological problems were described by a majority of the men. Most men were also aware of the female complications. More young than old respondents would have accepted a woman without FGM to become their daughter-in-law (p < 0.03). A majority of the young men would have preferred to marry a woman without FGM. This proportion was significantly higher than among the grandfathers (p < 0.01). Female genital mutilation can no longer be considered to be only an issue for women. The acknowledged male complications and attitudes described may open new possibilities to counteract the practice of FGM.

A community based study on the change of practice of female genital mutilation in a Sudanese village.

OBJECTIVE: To investigate the practice of female genital mutilation (FGM), among young and old parents. METHODS: One hundred and twenty young parents and grandparents in a rural area in central Sudan were randomly selected for interviews carried out according to structured questionnaires with open answer possibilities. RESULTS: All female respondents had undergone FGM. Of the young respondents, 44% had decided not to let their daughters undergo FGM. Young fathers were more involved in the decision process than previously known, especially when decisions were taken not to perform FGM. Tradition and social pressure were the main motives for performing FGM. Sexuality was an important aspect, mentioned both as motives for and against FGM. Religious belief and education level significantly affected to what extent FGM was practiced. CONCLUSION: This is the first community based study of FGM indicating a significant shift in practice between generations, young parents starting to question the value of FGM.

[Need for more research on female circumcision. Lack of communication between women and men conserves the traditional practice]. / Behov av mer forskning om kvinnlig könsstympning. Brist på kommunikation mellan kvinnor och män bevarar traditionen.

Several studies in cultures in which FGM is widely performed have shown an emerging questioning of the value of performing the procedure, especially among the younger generations. Traditionally the practice has been said to be carried out by women in order to satisfy men. Recent research findings, however, indicate that men may have attitudes and preferences strikingly different from what has been ascribed to them in the literature. Thus men may play an important and positive role in future work to counteract the practice. Reinfibulation after delivery implies repeated genital mutilation. Despite this, reinfibulation has attracted little research, and not very much is known about the practice. There is a need for systematic research about the extent of complications of FGM, especially long-term effects including effects on pregnancy, delivery and the newborn child. Our experiences from research on FGM in Sudan indicate that research findings might be very useful in intervention programs.