Context: This study seeks to examine the relationship between female genital cutting (FGC) and the sexual behavior of women in Kenya and Nigeria. Although research evidence has shown that female genital cutting is a serious problem in many countries and needs to be eradicated, prevalence in many countries remains high. One of the reasons given for the continuation of this harmful practice, despite widespread global campaigns against it, is that it is deemed an essential aspect of grooming the female child in preparation for marriage. It is supposed to control female sexuality thereby ensuring that a girl remains a virgin until marriage and it enhances her chances of marriage. Little research has been carried out to evaluate how far FGC tempers the sexual behavior of women. Methods: The study uses the Kenya Demographic and Health Survey of 2008/09 as well as the Nigeria Demographic and Health Survey of 2008. The population being examined is sexually active women who knew about circumcision and were thus asked if they had been circumcised or not to which the response was either yes or no. The sample size for Kenya is 5 187 women while in Nigeria it is 12 253 women. The study hypothesis is that there is a difference in the sexual behaviour of women who are circumcised and those who are not circumcised. Multiple linear regression, logistic regression as well as Poisson regression were used examine the effect of selected predictor variables on sexual behaviour. The outcome variable is sexual behavior which was measured using age at first intercourse as well total lifetime number of sexual partners. Findings: The study results suggest that there is no association between female genital cutting and the sexual behaviour of women in Kenya and Nigeria. There was no difference in the age at which women first engage in sexual intercourse and in the number of sexual partners for women who were circumcised and those who were not. Thus there is no scientific evidence that the practice of FGC could control the sexual activities of women. Conclusions: Female genital cutting does not have any effect on the sexual behaviour of women in Kenya and Nigeria. There is no difference in the sexual behaviour of women who are circumcised and those who are not circumcised in both countries. This is an indication that FGC does not serve the purpose it is purported to serve and should therefore be eradicated.

In Egypt, female genital cutting (FGC) is illegal and declining in prevalence; however, the majority of women continue to support the practice. Using data from the 2005 and 2014 Egypt Demographic and Health Surveys, I examine changes in attitude toward FGC to explain social change through the framework of developmental idealism (Thornton 2015). Models are estimated using logistic regression to test if support for discontinuation of FGC is greater among women who have adopted progressive values or among women who are more traditional. Findings indicate that women who were Christian, rural, married younger, and that underwent FGC became supportive of discontinuation at greater rates than women who were Muslim, urban, married older, and did not undergo FGC. Women at various levels of education, wealth, and other indicators of development changed support at equal rates. Findings indicate that women in all social strata are receptive to messages against FGC.

Purpose: Egypt has the highest prevalence of chronic Hepatitis C virus (HCV) infections and also a high prevalence of female genital mutilation (FGM). The high prevalence chronic hepatitis C has been attributed to HCV transmission by contaminated injections for the control of schistosomiasis. HCV infection has not been well studied in the context of female genital mutilation (FGM). We sought to identify associations between FGM and HCV using the Egypt Demographic and Health Survey (EDHS), 2008. Methods: FGM was chosen as the main independent variable of interest. Other independent variables such as age, education, marital status, residence, beliefs associated with FGM, history of blood transfusion, surgery, sharing needles, and history of schistosomiasis were included in the analysis. Throughout the analysis, HCV infection was used as the main dependent variable. Results: Univariate analysis of FGM and HCV showed a statistically significant association with a Prevalence Odds Ratio of 4.82 (2.91 -7.96), after adjusting for age and schistosomiasis injection, the association between FGM and HCV remained statistically significant with an odds of 2.98 (1.76 – 5.05)Among the category for FGM performer and association with HCV infection, the OR was 4.28 (2.31 – 7.91) when the FGM was performed by a ghagaria, 3.68 (2.76 - 4.90) when the FGM was performed by daya, and 3.30 (1.81 -5.88) when the FGM was performed by a barber. Among other independent variables, a lack of education, rural residence, and having religious precepts for FGM had statistically increased odds of association with HCV infection. Conclusion: There is a statistically significant association between FGM and HCV infection. There are increased odds of HCV when the FGM is performed by providers other than doctors. Participants from a rural residence and who those who did not have any education were at increased odds of HCV. Subjects who believed in religious precepts for FGM and also who answered that FGM can continue had increased odds of association with HCV infections.

To understand how genital self-image affects sexual well-being, it is important to consider its influence on sexual function and distress. It is also important to learn what type of genital appearance is considered visually appealing to men and women, and whether genitalia modified by cosmetic surgery are judged as more attractive compared to unmodified genitalia. The present study assessed women’s genital self-image, sexual functioning and sexual distress in order to elucidate the relationship between these three elements of sexual well-being. Additionally, genital photographs were presented to men and women in order to assess conceptions of female genital attractiveness relative to surgical status (i.e. before and after). Four hundred and seventy-six women (M age=24.38) completed online questionnaires to assess genital self-image, sexual satisfaction, functioning and distress. The female sample along with 429 men (M age = 27.47) also reviewed pictures of pre- and post-surgery genitalia and rated them on levels of attractiveness. The Female Genital Self-Image Scale, the Relational Concern and Personal Concern subscales of the Sexual Satisfaction Scale – Women, and the Female Sexual Functioning Index were administered. Genital self-image was positively correlated with functioning variables including arousal, lubrication, orgasm, satisfaction and pain, and negatively correlated with sexual distress. Men rated unaltered and altered genitalia as more attractive than women; older participants rated unaltered and altered genitalia as more attractive than younger participants, and men and women of all ages found altered genitalia more attractive than unaltered genitalia.Women with positive genital self-image experience higher levels of sexual functioning and lower levels of sexual distress. Female genitalia modified by genital cosmetic surgery are considered more attractive regardless of age and gender. / text

Abstract In recent decades there has been increased immigration to New Zealand of women from East Africa. These countries have the highest prevalence rates (between 90-97%) of Female Genital Mutilation (FGM) worldwide. FGM therefore has become part of the care experience of some New Zealand health providers. Information on FGM is available on the New Zealand Ministry of Health website. This study captures the experience of a group of East African women in Christchurch who have undergone FGM and given birth in Christchurch Hospitals. Two focus groups, each with ten women, were held so that women could talk about their health services experience. A narrative approach was adopted, listening to their stories in order to explore, to gain insight and to understand how these women felt during reproductive and antenatal care, childbirth and after childbirth. Interviews with three health providers sought their experiences of caring for women with FGM. The study identifies diverse potential explanations with the focus group members telling their stories and identifying issues related to FGM. Several short case histories are presented to illustrate these experiences. The thematic analysis reported four themes: satisfaction with clinical care, concern about infibulation, barriers to knowledge for women, and problems of cross-cultural communication. Health providers reported similar issues, with themes related to their own clinical experience, knowledge gaps, and need for greater cultural understanding and communication. These themes reflect the journey of the East African women with FGM in Christchurch and the challenges faced by them and their providers. This research recommends that women with FGM receive more education and support to manage their relationships with the health system and their own health. Health providers need continuing education and further support in the psychosocial, psychological and physical health needs of East African women living in Christchurch. Service outcomes should be evaluated.

Female genital mutilation (FGM) is defined by the World Health Organisation as the deliberate total or partial removal of the external female genitalia, or other deliberate injury to the female genitalia, which is carried out for non-therapeutic purposes. The practice is widely condemned. Even though the adverse effects of the practice have been well documented in many small studies and case reports, FGM is still common in many countries. The effects of this practice are also being felt in many developed countries due to substantial migration in recent years. One of the limiting factors in encouraging eradication is the availability of high quality evidence of the effects of the practice on the process of childbirth. By highlighting the effects of FGM on the process of childbirth, the objective was to encourage policy makers, in co-operation with many relevant organisations, to work together to eradicate the procedure. This original study investigates the effects of FGM on the process of childbirth using a large international epidemiological case control study involving three centres in three different countries. The inclusion criteria were strict and comprised of agreement by the woman and or her husband to participate in the study, for a normal singleton pregnancy at term with a cephalic presentation which resulted in a normal baby, for the women with and without FGM during the period of study. Women who did not fulfil these criteria were excluded. Maternal outcome measures included length of labour, obstruction to the progress of labour, operative delivery, urine retention, perineal complications, intrapartum and postpartum haemorrhage and blood loss during the process of labour. Newborn outcome measures included birth status at delivery, Apgar scores at 5 and 10 minutes, requirement for resuscitation, admission to special care unit and time taken from delivery to the first breast feed. Psychological sequelae were not assessed. The total number of participants in these three centres was 1,970 women; 526 with no FGM (control) and 1444 with different types of FGM. Every effort was taken to keep confidentiality and not to interfere with management of labour during data collection. The results indicate a highly significant difference between the two groups when comparing length of the process of labour, mode of delivery and the need for instrumental deliveries, episiotomies and tears, blood loss during and after delivery, the need for catheterisation following deliveries and duration of hospital stay following birth. Adverse effects were not confined to women and were found to have extended to the new-borns in the two groups again with highly significant difference with regard to birth trauma, requirement for resuscitation and medical attention. The time taken for the first breast contact was different in the two groups with possible effects which may be difficult to establish and require further research. The data provide clear evidence that the practice of FGM is associated with clinical adverse effects, which are not only confined to women but involve the newborn as well. It is hoped that this systematic and comprehensive collection of evidence will make a substantial contribution to the world wide effort to eradicate this harmful practice.

Female genital mutilation (FGM) has been illegal in Tanzania since 1998; nonetheless this procedure is still being performed in some regions of the country. Since the prohibition of this practice it has become harder to detect the practitioners. Nurses are one of the professions who can identify the women who have been exposed to FGM, which creates an opportunity to provide care for these women and educate them about the practice. The aim of this study is to describe Tanzanian nursing students’ views on FGM. Data was collected with focus group interviews with second and third year students at a nursing school in northwest Tanzania. Data was analysed inductively by content analysis. The results, the students’ views on FGM, were categorised into four themes; ‘FGM creates suffering’, ‘the right to sexual integrity’, ‘the role of nurses’ and ‘educating the patient and the community’. The findings clearly demonstrate that the students’ negative attitudes toward the practice are based on their knowledge of its harmful implications on health. For further research, it may be of interest to study nursing students’ views of the practice in more FGM-prevalent regions of Tanzania. / <p>Röda Korsets sjuksköterskeförening stipendium 2017</p>

Sarcomas of the female genital tract are rare tumors and account for less than 5% of gynecologic malignancies. Traditionally, gynecologic sarcomas have been divided into different tumor types according to their histopathological features. The most common are leiomyosarcoma (LMS), malignant mixed Müllerian tumors (MMMT), endometrial stromal sarcoma (ESS) and (Müllerian) adenosarcoma. The different tumor types are highly aggressive with early lymphatic and/or hematogenous spread. Treatment is difficult and it is believed that sarcomas have a low radio-and chemosensitivity, and the mainstay in treatment is surgical removal of the tumor. The most important prognostic feature has been tumor stage. Nevertheless, there are some early-stage tumors that run a biological course different from that expected and additional prognostic factors indicating high-risk tumors are desirable. The study cohort consists of 49 uterine LMS, 44 uterine MMMTs, 17 uterine ESS, 11 uterine adenosarcomas and 26 ovarian MMMTs. The tumors were analyzed in a retrospective manner for DNA ploidy, S-phase fraction (SPF), p53 and mdm-2 expression, as well as traditional clinical and pathological prognostic factors, such as tumor stage. grade, atypia and mitotic index. Of the 49 LMS, 36 (86%) were non-diploid and 13 (27%) were p53-positive. Among the 44 uterine MMMTs, 30 (68%) were non-diploid and 27 (61%) had an SPF&gt;10%. Twenty-seven (61%) overexpressed p53 and 11 (25%) were mdm-2 positive. Furthermore, 40 (91%) of the uterine MMMTs had a high mitotic count and 42 (95%) had high grade cytologic atypia. All low-grade ESS were DNA diploid and had a low SPF. Among the four high-grade ESS, three (75%) were DNA aneuploid and three (75%) were p53-positive. Among 1 1 adenosarcomas, eight (73%) were non-diploid. All ovarian MMMTs were non-diploid and all but two had an SPF&gt;10%. 19 (73%) ovarian MMMTs were p53positive. The 5-year survival rate was 33% for LMS, 38% for uterine MMMT, 57% for ESS, 69% for adenosarcoma and 30% for ovarian MMMT. Thirty-five (71%) patients with LMS died of disease and two of intercurrent disease. Stage was found to be the most important factor for survival (p=0.007); in addition DNA ploidy (p=0.045) and SPF (p=0.041) had prognostic significance. Twenty-seven (61%) patients with uterine MMMT died of disease and six (14%) died of intercurrent disease. Stage was the only prognostic factor for survival. Nine (53%) patients with ESS died of disease. There was a significant correlation of survival to tumor grade (p=0.007), DNA ploidy (p=0.026), SPF (p=0.048) and stage (p=0.026). Of the 11 patients with adenosarcoma, four (36%) patients died of disease and three (27%) patients died of intercurrent disease. There were no variables that correlated with survival. Eighteen (69%) patients with ovarian MMMT died of disease and two (8%) patients died of intercurrent disease. In a multivariate analysis, only stage reached independent prognostic significance for survival (p=0.023). In summary, stage represents the most important prognostic factor for survival for uterine and ovarian sarcomas. DNA flow cytometry is useful in gaining additional prognostic information for LMS and ESS. P53-and mdm-2 overexpression had no prognostic value for survival rate. Most of the MMMT overexpressed p53 and were non-diploid. Treatment of sarcomatous neoplasms is difficult and the mainstay remains surgical removal of the tumor. For patients with early stage sarcoma there was a high recurrence rate, which suggests that a large proportion of patients may have systemic micrometastasic disease at the time of diagnosis. Recurrent and metastatic uterine sarcoma remains an incurable disease, and treatment must be considered palliative. / On the day of the public defence the status of the articles III and IV was: Accepted for publication. ; Bild/Image 1=p53/mdm-2 interaction ; Bild/Image 2=Leiomysarcoma stage I ; Bild/Image 3=Survival in uterine sarcoma.

When professionals meet people from other cultures, there are some problematic issues that may appear, especially when considering human rights. Every individual has the right to live as they choose, and have the right to their own culture and traditions even if they have immigrated to another country. Female genital mutilation is a tradition that violates human rights. In this study we will look at what conflicts of values that professionals can have while meeting clients who have been mutilated. We have made qualitative interviews with four professionals working in a small town in Sweden in an area where many immigrants live. Professionals who meet people that have been genital mutilated have to balance respect for the individual with official restrictions and law. Knowledge about other countries and cultures can be important in the meeting between the professional and the client. Many conflicts of values appear and in this study we lift some of these conflicts.

Female genital mutilation is an important human rights and health issue in both Canada and Africa. The Canadian government has made efforts towards eradicating this practice by making it a criminal offense, a “remedy” popularly used in Africa as well. Despite the efforts made by governments, law enforcement, along with international human rights organizations, female genital mutilation persists among African immigrants living in Canada and is still practiced by some in Africa. Using international and government laws and policies, documents, case study reports and articles, this thesis questions why the criminalization of female genital mutilation has not reduced this practice among Africans and immigrants living in Canada. Using qualitative case study research methodology as well as the theories of cultural relativism and feminist human rights, this thesis suggests that cultural practices are resistant to change, even among families who move to societies where the practices are legally criminalized and socially rejected. As such, the strategy of eradicating this cultural practice through criminalization has been largely unsuccessful because of strong social forces as exemplified in myths, cultural reasons and the medicalization of female genital mutilation. This thesis concludes by proposing the need to address the status of females among groups who perpetuate this practice and adopting other measures to supplement the laws which are already in place. / February 2016