Female genital cutting in southern urban and peri-urban Nigeria: self-reported validity, social determinants and secular decline

Despite growing public resistance to the practice of female genital cutting (FGC), documentation of its prevalence, social correlates or trends in practice are extremely limited, and most available data are based on self-reporting. In three antenatal and three family planning clinics in South-west Nigeria we studied the prevalence, social determinants, and validity of self-reporting for FGC among 1709 women. Women were interviewed on social and demographic history, and whether or not they had undergone FGC. Interviews were followed by clinical examination to affirm the occurrence and extent of circumcision. In total, 45.9% had undergone some form of cutting. Based on WHO classifications by type, 32.6% had Type I cuts, 11.5% Type II, and 1.9% Type III or IV. Self-reported FGC status was valid in 79% of women; 14% were unsure of their status, and 7% reported their status incorrectly. Women are more likely to be unsure of their status if they were not cut, or come from social groups with a lower prevalence of cutting. Ethnicity was the most significant social predictor of FGC, followed by age, religious affiliation and education. Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors. There is evidence of a steady and steep secular decline in the prevalence of FGC in this region over the past 25 years, with age-specific prevalence rates of 75.4% among women aged 45-49 years, 48.6% among 30-34-year olds, and 14.5% among girls aged 15-19. Despite wide disparities in FGC prevalence across ethnic, religious and educational groups, the secular decline is evident among all social subgroups.     

Female genital mutilation in the context of migration: experience of African women with the Swiss health care system

BACKGROUND: In contrast to other European countries, the Swiss health care system does not deal with the specific needs of women with female genital mutilation (FGM) in a consistent manner, though migrants from countries where FGM is commonly practised are living in Switzerland. METHODS: For this study, the interaction of women who had undergone FGM, with the Swiss health services was analysed both from the perspective of the women concerned and that of health care professionals (doctors and midwives). The methods used were mainly qualitative, including focus group discussions with 29 women from Somalia and Eritrea and telephone interviews with 37 health care professionals. RESULTS: It is estimated that some 6000 girls and women with FGM could be living in Switzerland. The fact that health care providers rarely see such patients and the absence of professional guidelines give rise to misunderstandings. Counselling of the women is often inadequate, and there is a striking lack of communication about FGM between health care providers and users, as well as within the women's communities. As a surprising finding, reinfibulation is carried out in Switzerland when requested by the patient. CONCLUSIONS: This study shows that at present the specific gynaecological and obstetric health care needs of migrant women who have undergone FGM are not adequately addressed in the Swiss health system. The situation could be easily improved by taking into consideration the fairly simple measures suggested by the women and the health care providers taking part in this study. KEY POINTS: Due to international migration, female genital mutilation (FGM) has become an issue of increasing concern in host countries such as Switzerland. Objectives of this study were to analyze how immigrant women with FGM experience gynaecological/obstetrical care in the Swiss health care system, and to investigate if gynaecologists/obstetricians and midwives treat and counsel FGM related complications adequately. Specific health care needs of women with FGM should--and easily could--be better considered by the Swiss health care system. Recommended measures include capacity building and professional guidelines on FGM for health care providers; and access to culturally appropriate information and self-help groups for the communities concerned.     

How experiences and attitudes relating to female circumcision vary according to age on arrival in Britain: a study among young Somalis in London

Objective. To examine the association between age on arrival in Britain and experiences and attitudes relating to female circumcision among young, single Somalis living in London.

Design. The study population consisted of single male and female Somalis aged 16–22 years living in the Greater London area. Quantitative data were collected using a cross‐sectional survey based on snowball sampling aiming to obtain data on 100 males and 100 females. Qualitative data were collected from 10 males and 10 infibulated females.

Results. Quantitative data were obtained for 94 females and 80 males. Living in Britain from a younger age was associated with increased assimilation in terms of language, dress and socialising. Seventy per cent of the females reported being circumcised with two‐thirds of operations being infibulation. Those who were living in Britain before the usual age range for circumcision (before age six) were less likely to be circumcised (42%) than those who arrived after the usual age range for circumcision (11 or older) (91%). During in‐depth interviews, health and sexual problems due to female circumcision were described with great emotion and interviewees acknowledged the association between the importance of virginity for marriage and circumcision. Half of males who arrived aged 11 or older wanted a circumcised wife compared with less than a quarter of those who arrived at a younger age. Eighteen per cent of female respondents and 43% of males intended to circumcise any daughters. Females were less likely than males to agree with the assumptions about sexuality and religion that underpin the practice. Substantial proportions of respondents perceived that their parents' expectations in terms of marriage and circumcision were more traditional than their own.

Conclusion. Living in Britain from a younger age appears to be associated with abandonment of female circumcision and with changes in the underlying beliefs on sexuality, marriage and religion that underpin it. Groups identified with more traditional views towards female circumcision include males, older generations, new arrivals and those who show few signs of social assimilation.     

Fitting a xenobiotic receptor into cell homeostasis: how the dioxin receptor interacts with TGFbeta signaling

As our knowledge on the mechanisms that control cell function increases, more complex signaling pathways and quite intricate cross-talks among regulatory proteins are discovered. Establishing accurate interactions between cellular networks is essential for a healthy cell and different alterations in signaling are known to underline human disease. Transforming growth factor beta (TGFbeta) is an extracellular cytokine that regulates such critical cellular responses as proliferation, apoptosis, differentiation, angiogenesis and migration, and it is assumed that the latency-associated protein LTBP-1 plays a relevant role in TGFbeta targeting and activation in the extracellular matrix (ECM). The dioxin receptor (AhR) is a unique intracellular protein long studied because of its critical role in xenobiotic-induced toxicity and carcinogenesis. Yet, a large set of studies performed in cellular systems and in vivo animal models have suggested important xenobiotic-independent functions for AhR in cell proliferation, differentiation and migration and in tissue homeostasis. Remarkably, AhR activity converges with TGFbeta-dependent signaling through LTBP-1 since cells lacking AhR expression have phenotypic alterations that can be explained, at least in part, by the coordinated regulation of both proteins. Here, we will discuss the existence of functional interactions between AhR and TGFbeta signaling. We will focus on regulatory and functional aspects by analyzing how AhR status determines TGFbeta activity and by proposing a mechanism through which LTBP-1, a novel AhR target gene, mediates such effects. We will integrate ECM proteases in the AhR-LTBP-1-TGFbeta axis and suggest a model that could help explain some in vivo phenotypes associated to AhR deficiency.     

Pregnancy with a pinhole introitus: A report of two cases and a review of the literature

Abstract

Objectives As over 125 million women worldwide have undergone female genital mutilation (FGM), 170,000 of whom are estimated to live in the UK alone, obstetricians and gynaecologists need to be aware of the grades and consequences of this devastating condition. Women with type III FGM, even when they are unable to have penetrative intercourse, can conceive, and obstetricians should be aware of this to ensure optimal care of these patients. To determine the most appropriate surgical approach, deinfibulation in pregnancy should follow some basic principles which take into account the psychological needs of women as well as the extent of scarring.

Cases We present two cases of women who had never engaged in penetrative intercourse and therefore presented with no knowledge that they were pregnant. They underwent antenatal deinfibulation and subsequent management based on individual request.

Conclusions Management in pregnancy can pose particular problems and should be individualised. In all childbearing women with FGM, even where intercourse has not been possible, pregnancy should be considered. Clinicians should be aware of the types of FGM and management should be undertaken by a designated clinician with appropriate expertise. Pregnant women who have undergone FGM should be examined to identify the requirement for antenatal surgical correction.

Chinese Abstract

摘要

目的 全世界1.25亿妇女经受了女性生殖器切割(FGM),经估计,其中有170000名妇女生活在英国,妇产科医生需意识到这种破坏性疾病的分级和带来的后果。FGM, 型的妇女即使不能进行插入式性交仍可受孕,妇产科医生应当了解这一情况以为此类患者提供最佳的治疗。为了确认最佳的手术方式,妊娠期的去锁阴术应当遵循一些基本原则,其中应考虑到女性的心理需要以及疤痕的范围。

病例 我们所报告的两例病例中的妇女没有进行过插入式性交,因此并未意识到自己已怀孕。基于两名妇女的个人需求,为她们实施了产前去锁阴术和术后管理.

结论 妊娠期管理可造成特定的问题并应当个体化。所有的育龄期FGM妇女,即使不能进行插入式性交,也应当考虑到怀孕的可能性。临床医生应当了解FGM的分型,也应由指定的具有专业知识的医师对FGM 进行处理。经受过FGM的妊娠妇女应接受检查以明确产前外科矫治的需要。

关键词

分娩;股间性交;去锁阴术;女性割礼;FGM;股性交;妊娠;手术终止妊娠     

钛-羟基磷灰石功能梯度材料骨结合强度的初步研究

目的从力学角度研究钛-羟基磷灰石功能梯度材料与骨组织的结合强度。方法将钛-羟基磷灰石功能梯度材料植入8只新西兰大耳白兔颅骨中,用同样规格的纯钛和纯羟基磷灰石作为对照。术后进行临床及X-ray观察、剪切强度及骨结合强度的测定。结果钛-羟基磷灰石功能梯度材料与骨结合界面的剪切强度均强于各个时期纯钛与骨结合界面的剪切强度(P<0.05),在8周后强于纯羟基磷灰石与骨结合界面的剪切强度(0.01相似文献   

Polyvictimization and mental health consequences of female genital mutilation/circumcision (FGM/C) among Somali refugees in Kenya

ABSTRACT

Female genital mutilation or circumcision (FGM/C) is a perilous social and cultural practice that affects the physical, mental, and psychological health of affected women. It is widespread around the world, affecting 200 million women and girls. This study aimed to explore the relation of FGM/C to mental and physical conditions in Somali refugees displaced in a low-resource setting, applying the concept of poly-victimization to reveal multifaceted trauma sequelae. Data for this cross-sectional study with 143 female Somali youth living in Eastleigh, Kenya were collected between April and May in 2013. FGM/C was strongly associated with negative physical and mental health outcomes, including post-traumatic stress disorder and depressive, anxiety, and somatic symptoms. Logistic regression analysis revealed that separation from a parent and poly-victimization experiences were significantly associated with FGM/C experience. The results also showed that FGM/C and other traumas did not occur singly but were indicative of cumulative adversities, especially for women who were socially vulnerable and marginalized. The results of this study highlight the practice of FGM/C in the context of other adverse living conditions of refugees and the importance of attending to other co-occurring risk factors that prevail with FGM/C practice in the ecological system of refugee forced migration.     

Female genital mutilation de-infibulation: antenatal or intrapartum?

Women who have had female genital mutilation (FGM) often experience adverse short and long term health effects. Owing to increasing international migration FGM has become a global concern. Health professionals involved in the care of these women need to be aware of the complications that it may present during labour as well as the sensitivity of the matter. This review summarises the studies available looking into the ideal time for deinfibulation.     

New Innovation: Use of Flash Glucose Monitoring for Evaluating Glycaemic Variability,Patient Satisfaction and Clinical Utility in Pregnant Women with Diabetes

AimApplication of Flash glucose monitoring (FGM) system to evaluate glycaemic variability (GV), patient satisfaction and clinical utility in pregnant women with diabetes.MethodsThis prospective study was conducted in a tertiary care teaching hospital on 70 pregnant women with diabetes where blood sugar levels were monitored by FGM and self-monitoring of blood glucose (SMBG).ResultsFGM generated 19,950 readings versus 1470 readings by SMBG over 3 days. Glucose values measured by FGM and SMBG had significant positive correlation (r > 0.89; p < 0.001). Significant difference (p < 0.001) was present between minimum glucose values by FGM (52.49 ± 15.42 mg/dl) and SMBG (72.74 ± 18.30 mg/dl). FGM (20.9%) was able to pick exact duration of hypoglycaemia, while one-third of this duration was missed by conventional SMBG (14.7%; p < 0.05). Hypoglycaemic episodes were observed in 92.9% women by FGM as compared to 45.7% by SMBG (p < 0.001). No significant difference was observed in maximum glucose level or duration of hyperglycaemia by both methods. FGM identified hyperglycaemia in 74% women vs. 52% by SMBG (p < 0.001). GV calculated by using MODD by FGM was 118.4 ± 52.4 mg/dl and by SMBG was 83.2 ± 53.2 mg/dl (p < 0.001). 100% women preferred AGP vs. SMBG.ConclusionThis is the first study to evaluate FGM for GV and patient satisfaction in women with GDM. Significant correlation was observed in glucose values by FGM and SMBG. FGM was more sensitive in detecting GV and hypoglycaemic excursions as compared to SMBG. All women preferred FGM over SMBG. Use of FGM gave new insights in clinical management of challenging cases.     

The psychological impact of Female Genital Mutilation/Cutting (FGM/C) on girls/women’s mental health: a narrative literature review

Background: Female Genital Mutilation/Cutting (FGM/C) is the procedure of removing healthy external genitalia from girls/women for socio-cultural reasons. There is much scientific literature on the adverse physical health complications that can result from having FGM/C, but little is known about its psychological impact and treatment. Objective: To identify psychological problems that may follow from a woman having FGM/C and success of treatment herein, and relate findings to the role of the maternity care professional. Study design: A structured narrative review, which identified 10 studies, was carried out. Findings: Eight of ten studies reported psychological consequences, such as Post-Traumatic Stress Disorder (PTSD) and affective disorders. Also identified were socio-cultural differences in the meaning of perceived consequences for different individuals. Two studies reported inconclusive results regarding the psychological impact of FGM/C on women’s lives. Key conclusion: While these findings provide an indication of adverse psychological effects of women/girls having FGM/C, more studies are needed. In particular, studies that focus on the role that cutting extent, circumstances surrounding the cutting, and girls’ level of knowledge of what was going to take place, and their relationships to psychological outcomes. Implications for Practice: Raising awareness of the risk of negative psychological consequences is important, with maternal health care professionals requiring training on how to treat and care for women/girls who are suffering problems that result from having FGM/C.