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

BackgroundFemale 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. ObjectivesWe conducted a systematic review of empirical quantitative research on the outcomes of interventions for women with FGM/C-related complications. Search strategyA search specialist searched 16 electronic databases. Selection criteriaSelection was performed independently by two researchers. We accepted quantitative studies that examinedtheoutcome of an intervention for an FGM/C-related concern. Data collection and analysisWe extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses. Main resultsWe 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. ConclusionsWomen 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 abstractSystematic review shows defibulation after FGM/C has obstetric benefits; effect of reconstruction is uncertain. Tweetable abstract Systematic review shows defibulation after FGM/C has obstetric benefits; effect of reconstruction is uncertain. This article includes Author Insights, a video abstract available at .