The effectiveness of surgical interventions for women with FGM/C: a systematic review

Abstract

Background: Female genital mutilation/cutting (FGM/C) changes normal genital functionality and can cause complications. There is an increasing demand for treatment of FGM/C-related complications.

Objectives: We conducted a systematic review of empirical quantitative research on the outcomes of interventions for women with FGM/C-related complications.

Search strategy: A search specialist searched 16 electronic databases.

Selection criteria: Selection was performed independently by two researchers. We accepted quantitative studies that examined the outcome of an intervention for an FGM/C-related concern.

Data collection and analysis: We extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses.

Main results: We included 62 studies (5829 women), which investigated the effect of defibulation, excision of cysts, and clitoral reconstruction. Meta-analyses of defibulation versus no defibulation showed a significantly lower risk of caesarean section (relative risk, RR: 0.33; 95% confidence interval, 95% CI: 0.25-0.45) and perineal tears with defibulation: second-degree tear (RR: 0.44, 95% CI: 0.24-0.79), third-degree tear (RR: 0.21, 95% CI: 0.05-0.94), fourth-degree tear (RR: 0.06, 95% CI: 0.01-0.41). The meta-analyses detected no significant differences in obstetric outcomes of antenatal versus intrapartum defibulation. Except for one study, none of the studies on the excision of cysts indicated any complications, and the results were deemed favourable. Reconstructive surgery resulted in a visible clitoris in about 77% of women. Most women self-reported improvements in their sexual life, but up to 22% experienced a worsening in sexuality-related outcomes after reconstruction.

Conclusions: Women with FGM/C who seek therapeutic surgery should be informed about the scarcity of evidence for benefits and the potential harms of the available procedures.

Tweetable abstract: Systematic review shows defibulation after FGM/C has obstetric benefits; effect of reconstruction is uncertain.

Keywords: Defibulation; excision of cyst; female genital mutilation/cutting; obstetric; reconstructive surgery; systematic review.