Changes in Sexual Distress,Depression and Sexual Function after Clitoral Reconstruction in Women with Female Genital Mutilation/Cutting

Abstract

Background: Female genital mutilation/cutting (FGM/C) links health complications and psychological distress. However, there is scarce literature on how women with FGM/C respond to treatment interventions. Objective: In this study, we aimed to assess changes in depression symptomatology, sexual function, and distress following clitoral reconstructive surgery combined with a psychoeducational intervention. Methods: The reconstructive surgery consisted of recovering the remaining clitoris and placing it externally and as close to the vagina as possible. FGM/C patients (n?=?27) received psychological support and sexual counseling upon undergoing the surgical intervention and were further assessed at 6-month follow-up. Moreover, they completed the Beck Depression Inventory and the Female Sexual Distress Scale Revised at these two time points. Patients’ sexual dysfunction was assessed according to DSM-5 criteria. Results: Statistically significant clinical changes after FGM/C were reported. Overall, patients presented reduced depression and sexual distress levels, and decreased female sexual interest/arousal disorder prevalence. Results also revealed that sexual distress improvements were more significant in Type I FGM/C patients. Conclusions: Significant improvements in sexual distress, psychopathology, and sexual function were observed in our sample following reconstructive surgery, suggesting that combined interventions are effective for treatment.     

Social Isolation and Spousal Violence: Comparing Female Marriage Migrants With Local Women

This research examined the impact of network participation, social support, and social control on the violence victimization of female marriage migrants by a spouse. Data were from a household survey of 492 cross‐border and 379 local married couples in Hong Kong in 2007. The findings indicated that female marriage migrants were more vulnerable to spousal violence and more socially isolated, compared with local women. Husbands of marriage migrants were also more socially isolated compared with men who married locally. The network participation of both husband and wife was associated positively with spousal violence against women, whereas their perceived social control was associated negatively with violence. Female marriage migrants' greater vulnerability to spousal physical assault was a result of their younger age compared with local women, but their greater vulnerability to spousal psychological aggression and sexual coercion was related, in part, to their own and their husbands' network participation as well as their level of social control.     

The effect of urinary incontinence on sexual functioning in turkish women of reproductive and menopausal ages

Objectives: The primary objective was to investigate the effects of urinary incontinence (UI) on Turkish women's sexual functioning. Methods: We evaluated 396 women and divided them into 4 groups: reproductive-aged women without UI (Group A), reproductive-aged women with UI (Group B), menopausal-aged women without UI (Group C), and menopausal-aged women with UI (Group D). Results: The mean Female Sexual Function Index (FSFI) score was significantly higher and the Beck's Depression Inventory scores were significantly lower in Group A. FSFI scores showed a strong negative correlation with age and parity and a strong positive correlation with years of education. Conclusions: Our findings suggest that UI is an independent risk factor for female sexual problems.     

Female circumcision: the view from Sudan. Interview [with Ikhlas Nouh Osman

Female circumcision involves removing either all or part of the clitoris, labia minora, and/or labia majora. The practice is therefore increasingly being described as female genital mutilation. More than 90% of women in Sudan have undergone female genital mutilation. Pharonic circumcision is the most prevalent in Sudan. This form of mutilation involves the full removal of the clitoris and the labia. The two sides of the wound are then sewn together, leaving a small hole through which urine and menstrual blood may pass. Female genital mutilation occurs because women believe that the resultant narrow vaginal entrance will give pleasure to a future husband, due to tradition, uncircumcised women have great difficulty finding a spouse, and from the belief that the practice is mentioned in Islam. Koranic law is widely respected and followed in the Islamic areas of Sudan. Contrary to the belief of women that female circumcision keeps the vagina very clean, considerable health and psychological problems may result following the operation and throughout the woman's life. An activist against female genital mutilation describes her experience undergoing the operation, the trauma of first penile penetration with her husband, giving birth, and how women have their genital orifice restitched after delivery to the size before penetration. Nongovernmental organization efforts in Sudan against female circumcision are described.     

Labia Minora Elongation and its Implications on the Health of Women: A Systematic Review

ABSTRACT

Objectives: Labia minora elongation (LME) is a female genital modification practice categorized among the types included in the fourth group of female genital mutilation. In this article, we display the results of a systematic review of the evidence-based knowledge published on the health risks and benefits of LME as informed by African female respondents who are insiders of the practice. No other systematic review on this specific topic has been published before. Methods: A methodological bibliographic search was done in scientific databases by manual referencing and by contacting experts on this area of knowledge. Seventeen articles were eligible for this review, which corresponded to nine different studies. Eight of these studies were conducted in Eastern and Southern African countries and one was carried out in Italy. Results: This review concludes that pain at the beginning of the practice, nuisances related to the use of caustic herbs, and stigmatization in failing to comply with the practice are the principal health risks associated with LME. At the same time, there is evidence that labial elongation may benefit the sexual health and well-being of women. Conclusions: More research of a quantitative nature is necessary to determine the prevalence of LME across the practicing cultures and to determine its implications on the sexual and reproductive health of women who engage in this female genital modification.     

Cross-Cultural Adaptation of the Female Genital Self-Image Scale (FGSIS) in Iranian Female College Students

The aim of the present study was to investigate the psychometric properties of a translated and culturally adapted Iranian version of the Female Genital Self-Image Scale (FGSIS-I) in a sample of college women. Further, the relationship between women's self-image, body appreciation, sexual functioning, and gynecological exam behavior was explored. A sample of 1,877 female students from five different universities across Qazvin and Tehran completed the Female Sexual Function Index (FSFI), the Body Appreciation Scale (BAS), the Rosenberg Self-Esteem Scale (RSES), the FGSIS-I, and a gynecological exam behavior questionnaire. Good to excellent internal consistency reliability, test-retest reliability, and convergent and construct validity were found. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) both provided a two-factor structure for the FGSIS-I. The validity of the FGSIS-I in predicting gynecological exam behavior of college women was tested using structural equation modeling (SEM). The final model accounted for 33% of the variance in gynecological exam behavior (p < 0.01). In conclusion, the FGSIS-I was found to be a highly valid and reliable instrument to assess female genital self-image in Iranian women.     

eDiary and Female Sexual Distress Scale© in Evaluating Distress in Hypoactive Sexual Desire Disorder (HSDD)

Sex-related distress is integral to the diagnosis of hypoactive sexual desire disorder (HSDD). This article describes the results of three prospective, non-treatment validation studies (two North American and one European), each testing over 200 participants with HSDD, other types of female sexual dysfunction (FSD), or no FSD in which the 12-item Female Sexual Distress Scale^© (FSDS^©), the 13-item FSDS–Revised^©(FSDS–R^©), and a single question asked using a daily electronic diary (the eDiary For HSDD Trials^©; eDiary) were used to measure sex-related distress. FSDS results with 30- and seven-day recall were equivalent. The results observed with FSDS–R Item 13 (a single question assessing concern due to low sexual desire) were comparable to the FSDS. Mean eDiary monthly distress scores were closer to the minimum possible score (equivalent to “a little bit” of distress) and were about twice as variable as FSDS or FSDS–R Item 13 scores in participants with HSDD. All three measures confirmed that there is more distress in women with HSDD compared to women with no sexual dysfunction at all time points, demonstrating discriminant validity.     

Sexual Abuse in Cameroon: A Four-Year-Old Girl Victim of Rape in Buea Case Study

A young girl was brought to the emergency unit after suffering sexual abuse by an older male. Additional abuses against women and girls include physical beating, forced marriage, female genital mutilation, breast ironing, widow’s rites, psychological abuse, and discrimination in education, finance, employment, and legal access. Cameroon has adopted strategies aimed at eliminating violence against women, including ratification of international policies, penal codes, and support of local and international efforts that promote women; however, many of the laws remain in name only and are rarely enforced, given women’s lack of financial access to quality lawyers and an unsympathetic male-dominated police force. Underreporting and culturally accepted abuses remain a challenge, too, as the country seeks to understand the extent of abuses and how to effectively fight against them. A complete paradigm shift in cultural attitude toward the female gender is required for abuses to cease.     

Local Rites and Body Politics

The growing awareness of violence against women has resulted in endorsement of various international codes and conventions relating to physical, psychological and sexual violence. Female genital mutilation is one form of violence against women that has polarized people within and across national borders. Here, I explore its popular representation, consider how activism against genital mutilation has been confounded by sex and race and how activism to eradicate the practice is understood by immigrant women in Australia. In doing this, I draw on research conducted with women immigrants to Australia from north Africa (the Sahel areas) and the Middle East, from countries where female genital mutilation is most common. These women are often frustrated by what they see as contradictions in hospital policy and practice that arise in response to their requests to be reinfibulated after childbirth. I tease out the dilemmas that emerge when refusal is contrasted with other permissible practices of the body, such as hymen reconstruction, and given the commodification of bodies and related issues of age and agency, the individual and the community. The perceived discrepancies suggest to these African women that rights discourse is discriminatory, racist and informed by sensational portrayals of traditional practices. I question the ethics, values and rights that inform public discourse about sexual and reproductive rights, when women’s rights and values are so discrepant from our own ideals.     

Measurement of the sexual health and wellbeing of women who have undergone female genital mutilation/Cutting: A scoping review

Objective: We conducted a scoping review to identify and assess instruments used to measure sexual health and wellbeing in women who have undergone female genital mutilation/cutting (FGM/C). Method: We retrieved and assessed 10 validated instruments using an 18-item checklist derived from the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Results: All instruments were developed and initially validated among literate, predominantly Caucasian participants in North America and Europe. Only 1 validation study was conducted among women living with FGM/C. Conclusion: Most instruments only measured sexual functioning. Findings underscore the need to validate instruments appropriate for use among FGM/C survivors.     

eDiary and Female Sexual Distress Scale(©) in evaluating distress in hypoactive sexual desire disorder (HSDD)

Sex-related distress is integral to the diagnosis of hypoactive sexual desire disorder (HSDD). This article describes the results of three prospective, non-treatment validation studies (two North American and one European), each testing over 200 participants with HSDD, other types of female sexual dysfunction (FSD), or no FSD in which the 12-item Female Sexual Distress Scale(?) (FSDS(?)), the 13-item FSDS-Revised(?)(FSDS-R(?)), and a single question asked using a daily electronic diary (the eDiary For HSDD Trials(?); eDiary) were used to measure sex-related distress. FSDS results with 30- and seven-day recall were equivalent. The results observed with FSDS-R Item 13 (a single question assessing concern due to low sexual desire) were comparable to the FSDS. Mean eDiary monthly distress scores were closer to the minimum possible score (equivalent to "a little bit" of distress) and were about twice as variable as FSDS or FSDS-R Item 13 scores in participants with HSDD. All three measures confirmed that there is more distress in women with HSDD compared to women with no sexual dysfunction at all time points, demonstrating discriminant validity.     

Medical Complications of Female Genital Mutilation

Abstract

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation “surgery.”     

Influence of Female Genital Cutting on Sexual Experience in Southern Ethiopia

Female genital cutting (FGC) is a persistent social norm in the Liben district of southern Ethiopia. This study explores whether the sexual experiences of married men and women differ by women's FGC status. Qualitative in-depth interviews were conducted with 28 women with different types of FGC (or no FGC) and 21 husbands. Compared to others, women with more severe FGC reported traumatic sexual experiences and decreased sexual desire. Nonetheless, participants largely endorsed FGC for daughters, revealing pressure to maintain the practice. Opportunities for change exist, as women and men recognized the sexual pleasure and healthy birth experiences of uncut women.     

The Incidence of Sexual Dysfunction in Patients Attending Dutch General Practitioners

ABSTRACT

Data on patients with a sexual dysfunction were collected in 45 Dutch general practices between 2003 and 2008. The aim of the study was to determine the incidence of patients with a sexual dysfunction, associated health problems, and related interventions performed by their general practitioners (GPs). The study design was a dynamic cohort study comparing 6 years of data on patients with a sexual dysfunction. Participating GPs were asked to record weekly all consulting patients who presented with a sexual dysfunction. In an additional questionnaire, these problems and associated interventions were specified. Incidence of sexual dysfunctions varied between 132 per 100,000 per year for male patients and 60 per 100,000 per year for female patients. Men mainly consulted a GP for erectile dysfunction, and women mainly consulted a GP for hypoactive sexual desire disorder and dyspareunia. Sexual desire problems were more often associated with comorbid problems such as psychological and relationship problems and medication use than other sexual dysfunctions. Female patients showed more co-occurrence of sexual dysfunction and were more often referred to secondary care services than were male patients. During the period of 2003 to 2008, the help-seeking pattern of men and women consulting their GP for a sexual dysfunction appears to be stable. The presence of comorbid problems indicates that GPs are often dealing with complex multifactorial dynamics. Co-occurrence of sexual dysfunction among women probably resulted in a higher referral rate to secondary care services. Therefore, a gender-sensitive approach and an open mind to differences in sexual identity are needed for counseling in and treatment of sexual dysfunction.     

Engage In or Refrain From? A Qualitative Exploration of Premarital Sexual Relations Among Female College Students in Tehran

This study explored the factors that educated young Iranian women consider when they decide whether to have premarital sex. Using a purposive sampling method, 30 in-depth interviews were conducted with female college students in both government and private universities in Tehran in 2005–2006. The respondents included unmarried women who had experienced sexual relations, unmarried women who had abstained, and married women. Young women’s considerations for premarital sex included (1) marriage meaning and motivations; (2) compliance with family values and expectations; (3) perceived gender and social norms of premarital sex; (4) importance of religiosity; and (5) sexual knowledge and self-efficacy. Marriage meaning and motivation seem to be the central pillar in the complex decision to engage in or refrain from premarital sex among female college students. These considerations have theoretical implications for understanding premarital relationships and sex in a conservative setting. Finally, some shifts are occurring in the meaning of marriage and sexual mores among educated young women in Iran; these changes are discussed.     

Earnings and Expenditures on Household Services in Married and Cohabiting Unions

Despite the rise in women’s paid employment, little is known about how women and their partners allocate money to outsource domestic tasks, especially in unmarried unions. Tobit analyses of 6,170 married and cohabiting couples in the 1998 Consumer Expenditure Survey test hypotheses that recognize gender inequality between partners, gender typing of household tasks, and differences between cohabitation and marriage. Women’s earned income is more important than men’s for spending on female tasks. Men’s earnings are not more important for male tasks, but the earnings of married men are more strongly linked to expenditures on female tasks than are the earnings of cohabiting men. The research indicates that working women leverage their earnings to reduce their domestic burden through outsourcing.     

Autoerotism,Homoerotism, and Foreplay in African Women Who Practice Labia Minora Elongation: a Review

ABSTRACT. Objectives: Labia minora elongation is a female genital modification in which some women in certain linguistic groups from Africa engage. One of the purposes is to enhance sexual pleasure for their male partners. Methods: The literature has been reviewed to describe how labia minora elongation serves for women to increase their sexual pleasure, both as an autoerotic method and in the context of homoerotic and heterosexual relationships. Results and Conclusions: This aspect deserves to be investigated, as there are narratives from some women practitioners of labial elongation that this practice might contribute to improve the sexual health of some of the women who engage in it.