Bakgrund: Kvinnlig könsstympning är en sedvänja som utförs av traditionella, kulturella eller religiösa skäl. Ökad invandring till västvärlden har inneburit att vårdpersonal kommer att möta kvinnor som könsstympats och brist på kunskap och praktiska färdigheter hos vårdpersonal kan få konsekvenser för vårdandet. Syfte: Att belysa könsstympade kvinnors erfarenheter av kulturella påverkansfaktorer i omvårdnaden. Metod: Litteraturstudie med en deduktiv riktad innehållsanalys. Det utfördes en litteratursökning i vårdvetenskapliga databaser. Resultat: Resultatet från elva vetenskapliga artiklar placerades in i de förutbestämda kategorierna vilka var; Erfarenheter av religiösa och kulturella värderingar, Erfarenheter av kommunikation och språk, Erfarenheter av teknologi, Erfarenheter av utbildning, Erfarenheter av släktskap och sociala band och Erfarenheter av lagar och politik. Slutsats: Mötet mellan könsstympade kvinnor och den västerländska sjukvården präglas ofta av kommunikationssvårigheter och kulturella skillnader. Sjuksköterskors bristande kunskap om att vårda könsstympade kvinnor kan medföra att kvinnorna känner sig osäkra och oprofessionellt bemötta vilket kan orsaka onödigt lidande. Framtida forskning bör fokusera på hur dessa kvinnor vill bli vårdade vilket kan vara till nytta för alla verksamma sjuksköterskor. / Background: Female genital mutilation (FGM) is a custom that is performed for traditional, cultural or religious reasons. The increase of immigration to the western world has caused that nursing staff will meet and care for females that have undergone FGM. Lack of knowledge and practical skills amongst the hospital personnel treating the patients may lead to implications for the caring procedures. Purpose: To highlight genitally mutilated women’s experiences of cultural factors in nursing care. Method: A literature study with a directed content analysis. A literature research was performed in health scientific databases. Results: The findings from eleven scientific articles were placed in the predetermined categories which were: experiences of religious and cultural beliefs, experiences of language and communication, experiences of technology, experiences of education, experiences of kinship and social ties and experience of politics. Conclusion: The meeting between genitally mutilated women and western healthcare is often characterized by communication problems and cultural differences. Nurses’ lack of knowledge in caring for women with FGM causes the women to feel insecure, badly threated and may cause unnecessary suffering. Future research should focus on how these women wants to be cared for which can be of benefit to all active nurses.

O Lobo-marinho-sul-americano (A. australis) apresenta particularidades em seu ciclo reprodutivo que revelam sua interação com o ecossistema onde habita. Dentre estas podemos citar o intervalo entre partos de 12 meses, a sincronização dos partos e cópulas no início do verão, umlongo período de diapausa e uma implantação do blastocisto no inicio do inverno, que ocorre 4 a 5 meses após a cópula. A anatomia e fisiologia reprodutivas desta espécie ainda não foram profundamente estudadas. O presente trabalho tem como objetivo, a partir do emprego de métodos não invasivos de pesquisa, descrever a anatomia, histologia, quando possível a ultraestrutura, e a vascularização arterial dos órgãos genitais femininos, bem como investigar proteínas e RNAs mensageiros de fatores de crescimento relacionados à vascularização nestes tecidos. Os dados morfológicos foram correlacionados com dados ambientais, oriundos de estações climatológicas próximas à área da colônia estudada. O A. australis apresenta especializações morfológicas passíveis de correlação com o ambiente, hábitos reprodutivos e ciclo reprodutivo sazonal. Estas estruturas foram identificadas como importantes em momentos específicos da biologia reprodutiva e auxiliam na manutenção do status de conservação da espécie. Análises dos dados climatológicos e sua relação com as variações durante o ano revelam que os eventos do parto, cópula e implantação embrionária, ocorrem em momentos onde as maiores variações ambientais acontecem. Os dados morfológicos revelam que existe uma interação entre o ciclo reprodutivo e as especializações anatômicas dos órgãos genitais femininos / The South-American-fur-seal (A.australis) presents unique features in its reproductive cycle, which reflect their interaction with the ecosystem where it lives. The parturition interval of 12 months, synchronization of parturition and copulation in the beginning of the summer, long diapause and implantation of the blastocyst in the beginning of the winter, which occurs 4 to 5 months after copulation are some of these features. The anatomy and reproductive physiology of this species have not been widely studied. This work describes the anatomy, histology, some ultrastructural characteristics, and the main arterial vascularization of the female genital organs using non invasive methods. Moreover, this study investigates the proteins and messenger RNAs of growth factors which are related to vascularization in these tissues. An association between morphological and environmental data from climatology stations near the area of the studied colony was investigated. A. australis presented morphological specialization in genital organs, which might be related to the environment, reproductive habits and seasonal reproductive cycle. Some of these identified structures are essential in specific stages of A. australis reproductive biology, and play an important role in the maintenance and conservation status of this species. Analysis of climatological data and their relation with changes over the year showed that parturition, copulation and embrionary implantation occur in time periods where the highest environmental variations take place. Morphological data revealed an interaction between the reproductive cycle and the anatomic specialization of female genital organs

Bakgrund: Kvinnlig könsstympning innebär att av icke-medicinska skäl utföra en partiell eller total borttagning av de yttre kvinnliga könsorganen. Det finns fyra olika typer av könsstympning med olika allvarlighetsgrader. Sannolika orsaker är att kontrollera kvinnans sexliv samt kulturella strukturer. Varje år genomgår 3,9 miljoner kvinnor en könsstympning i Afrika, Mellanöstern samt Asien. Ingreppet görs oftast på flickor mellan fyra och 14 år.  Syfte: Syftet med denna litteraturöversikt var att belysa sjuksköterskans kunskap, attityd samt erfarenhet gällande kvinnlig könsstympning.  Metod: En litteraturöversikt enligt Fribergs metod som inkluderade tio vårdvetenskapliga artiklar med olika metoder, fem kvalitativa och fem kvantitativa artiklar. Databaserna som användes för att hitta artiklarna var Cinahl Complete och PubMed. Analysen gjordes med hjälp av en tematisk syntes för att identifiera olika teman.  Resultat: Resultatet presenterades i tre separata teman samt tre subteman. Kunskapsnivån gällande ingreppet varierade, olika attityder gentemot kvinnlig könsstympning identifierades och majoriteten av hälso- och sjukvårdspersonalen uttryckte svårigheter i mötet med och vårdandet av kvinnor som genomgått en könsstympning.  Diskussion: Generellt besitter sjuksköterskan låg kunskap kring kvinnlig könsstympning, där attityden till ingreppet varierar världen över. Detta kan bland annat bero på bristande utbildning, låg medvetenhet, ett icke-jämställt samhälle, kulturell påverkan och ekonomisk vinning. Madeleine Leiningers soluppgångsmodell ligger till grund för diskussionen. / Background: Female genital mutilation (FGM) involves performing, for non-medical reasons, a partial or total removal of the external female genitalia. There are four different types of female genital mutilation with varying degrees of severity. Plausible reasons are to control the woman's sex life as well as cultural structures. Every year, 3.9 million women undergo FGM in Africa, the Middle East and Asia. The practice is most often done on girls between the ages of four and 14. Aim: The aim of this literature review was to enlighten the knowledge, attitudes and experiences of female genital mutilation among nurses.  Method: A literature review according to Fribergs method that included ten articles with different methods, five qualitative and five quantitative articles. The databases used to find the articles were Cinahl Complete and PubMed. The analysis was done using thematic synthesis to identify different themes.  Results: Results were presented in three separate themes together with three subthemes. The level of knowledge regarding FGM varied, different attitudes towards female genital mutilation were identified and the majority of the health personnel expressed difficulties in caring for women with FGM.  Discussion: In general, nurses have low knowledge of FGM, where the attitude towards the practice varies worldwide. This due to, among other things, the lack of education, awareness, a non-equal society, cultural influence and financial gain. Madeleine Leininger's sunrise model forms the basis of the discussion.

Female genital mutilation (FGM) is a public health challenge because it jeopardizes the health of women and girls. FGM is condemned worldwide but, it is still practiced in the Odi community of Nigeria. The literature on women's lived experiences of FGM in other parts of the world was reviewed, but knowledge is lacking on the lived experiences of women from Odi community in Nigeria. The purpose of this phenomenological study was to explore their lived experiences, their perspectives on the current legislation for the prevention of FGM, and their perspectives on the cultural myths surrounding the practice. The phenomenological lens was used both as the study design and as the theoretical framework which states that humans know the world through their experiences. This theory guided the study on how the women of Odi community attached meaning to their experiences with FGM. Nine women, 18 and older, who had experienced FGM, were recruited through a snowball technique. Data were collected through semi-structured, in-depth, face-to-face interviews. Colaizzi's method was used for data analysis. Five major themes emerged: (a) FGM is a traditional rite, (b) challenges of FGM, (c) FGM cultural myth instills fear, (d) ignorance of legislation against FGM, and (e) needs government intervention to halt FGM. Participants recommended the enforcement of the legislation against FGM. The findings of this study will be communicated to stakeholders of FGM in the Odi community and in public health journals to serve as a basis for further research. The implication for social change is that maternal and child health will be improved.

Female genital mutilation or cutting (FGM/C), a common practice among Sierra Leonean women, carries significant psychological and physical risks. Prior to this study, a substantial need existed for inquiry of the experiences and belief systems within this cultural group to better understand the effects of FGM/C on women and girls. Guided by feminist theory and the theory of cultural relativism, the goal of this phenomenological study was to review the cultural perspectives and experiences of Sierra Leonean women who underwent FGM/C to investigate their concerns about safety and their perceptions of the practices. In addition, this study explored concerns among Sierra Leonean women about the procedure performed on their daughters and to what they attributed the continued practice of FGM/C. Participants included a purposeful sample of 12 women from Sierra Leone who had experienced FGM/C. Data were collected via in-person, semi-structured interviews and analyzed thematically. Analysis revealed differences in participant definitions of FGM/C, cultural and social aspects of the procedure, personal beliefs and perceptions of the procedures. Results provide new understandings to help health and human rights organizations implement proactive safety measures for these women and girls. Positive social change from this investigation may occur via proper education about FGM/C. Goals include helping women understand the risks associated with the practice and to make their own informed decisions regarding the procedure. Findings revealed that a powerful strategy for protecting women's health and well-being related to FGM/C may be through education on the facts of the procedure.

Bakgrund: Varje år könsstympas fler än 2 miljoner kvinnor. Traditionen att könsstympa kvinnor går så långt tillbaka i historien att ingen historiker i dagsläget kan säga exakt hur, var och varför denna sedvänja uppstod. Det förekommer i ett trettiotal länder. Ingreppet sker ofta utan smärtlindring, sterila instrument och kompetent personal. I Sverige är kvinnlig könsstympning brottsligt, lagen gäller alla svenska medborgare oavsett om det sker inom Sveriges gränser eller utanför. Antalet könsstympade kvinnor i Sverige har ökat i takt med ökad invandring. Kvinnlig könsstympning kan ses som ett övergrepp och kan ge konsekvenser för kvinnor livet ut. Syfte: Syftet var att belysa de fysiska, psykiska och sociala konsekvenserna för kvinnor som genomgått könsstympning. Metod: En litteraturstudie genomfördes enligt Forsberg (2006) och startade med sökningar i databaserna Cinahl och PubMed. Sju kvantitativa och fyra kvalitativa artiklar valdes ut för analys. Resultat: De fysiska konsekvenserna rörde främst miktion, menstruation och sexuellt samliv. Känslomässiga trauman och en känsla av förlust dominerade de psykiska konsekvenserna. Gällande de sociala konsekvenserna berördes kvinnornas identitet till stor del samt deras upplevelser av hur västerlänningar ser på dem. Resultatet visar på övervägande negativa fysiska, psykiska och sociala konsekvenser. Även positiva aspekter har framkommit. Diskussion: I resultatet framgick tre större teman som var gemensamt för de fysiska, psykiska och sociala konsekvenserna. Dessa var kulturkrock, sociala påtryckningar och individ. De kan bidra till att förbättra omvårdnaden av kvinnor som genomgått könsstympning. Diskussionen inspireras av teorin Theory of cultural marginality där fokus ligger på att förklara människors reaktioner då två kulturer kolliderar. / Background: Each year, about 2 million women undergoes genital mutilation. The tradition of genital mutilation of women goes so far back in history that no historians in our time can say exactly how, where and why this practice occurred. The only thing we know is that the practice of female genital mutilation is performed in about thirty countries. The surgery is often done without analgesia, sterile instruments and medically skilled personnel. In Sweden, genital mutilation is a crime and the law applies to all Swedish citizens, regardless of whether it occurs within Sweden's borders or outside. The number of genitally mutilated women in Sweden has increased in line with increased immigration. Genital mutilation can be seen as an assault and may have consequences for women throughout their lives. Purpose: The purpose was to illuminate the physical, psychological and social consequences for women who have undergone genital mutilation. Methods: A literature review was conducted in accordance to Forsberg (2006). The search started out by using two databases, Cinahl and PubMed. Seven quantitative and four qualitative articles were selected for analysis. Results: The physical consequences were related to urination, menstruation and sexual intimacy. Emotional trauma and a sense of loss dominated the psychological consequences. The two largest social consequences that were found were the women's identity and their experiences of how westerners experience them. The result shows predominantly negative physical, psychological and social consequences, although positive aspects also emerged. Discussion: The results showed three major themes that were common to the physical, psychological and social consequences. These were culture clash, social pressures and individuals. They can help to improve the care of women who have undergone genital mutilation. The discussion was inspired by the theory "Theory of cultural marginality" where the focus is on explaining people's reactions when two cultures collide.

Female genital cutting/circumcision/mutilation (FGC) is found predominantly in the Sahel, Northern Africa, removing parts/all of the clitoris, labia minora and majora in girls. Cutting the highly innervated external genitalia may change sensory processing leading to chronic pain. Fourteen Somali women in the Greater Toronto Area (21-46, Type III FGC) completed qualitative, quantitative and psychophysical methods to evaluate pain. Interviews analyzed by interpretive phenomenology form the core method, examining circumcision stories and present, embodied life. The second Short Form McGill Pain Questionnaire and quantitative sensory testing with a vulvalgesiometer form secondary components. Somali women with FGC have pain-filled stories about circumcision and daily life. Socio-cultural considerations are central for women to comprehend how their own bodies feel. SF-MPQ-2 indicates low intensity or no pain symptoms; however, many body regions were indicated. QST reveals low vulvar pressure-pain thresholds. Reports from three measures suggest that FGC may cause sensory changes including chronic pain.

Female genital cutting/circumcision/mutilation (FGC) is found predominantly in the Sahel, Northern Africa, removing parts/all of the clitoris, labia minora and majora in girls. Cutting the highly innervated external genitalia may change sensory processing leading to chronic pain. Fourteen Somali women in the Greater Toronto Area (21-46, Type III FGC) completed qualitative, quantitative and psychophysical methods to evaluate pain. Interviews analyzed by interpretive phenomenology form the core method, examining circumcision stories and present, embodied life. The second Short Form McGill Pain Questionnaire and quantitative sensory testing with a vulvalgesiometer form secondary components. Somali women with FGC have pain-filled stories about circumcision and daily life. Socio-cultural considerations are central for women to comprehend how their own bodies feel. SF-MPQ-2 indicates low intensity or no pain symptoms; however, many body regions were indicated. QST reveals low vulvar pressure-pain thresholds. Reports from three measures suggest that FGC may cause sensory changes including chronic pain.

Bakgrund: Kvinnlig könsstympning är en gammal sed som är vanligt förekommande i flera länder. Seden innebär att delar av det kvinnliga könsorganet avlägsnas. Det beräknas att två miljoner flickor utsätts årligen. I vilken omfattning ingreppet sker i Sverige är okänt, men det förekommer. I Sverige är alla former av ingreppet förbjudet. Skolsköterskan har möjlighet att möta och hjälpa flickor som riskerar eller har utsatts för kvinnlig könsstympning. Syftet: Syftet med denna studie är att belysa skolsköterskors upplevelser kring kvinnlig könsstympning bland flickor i skolan. Metod: Kvalitativa intervjuer med fyra skolsköterskor i en kommun i Mellansverige samt frågeformulär från sju skolsköterskor i olika delar av Sverige. Kvalitativ innehållsanalys användes som analysmetod. Resultat: Skolsköterskorna upplevde känslor av Kluvenhet, Osäkerhet och Medkänsla. Samt att kvinnlig könsstympning var Känsligt men angeläget att samtala om. Diskussion: Resultatet i denna studie fokuserar på skolsköterskors upplevelser, vilket skiljer sig ifrån tidigare studier i ämnet. I denna studie framkommer det en osäkerhet och rädsla inför att samtala, samt en vilja att hjälpa utan att döma. Detta tyder på att skolsköterskor upplever en utmaning. De behöver stöd och utbildning för att våga möta flickor som utsatts eller riskerar att utsättas för kvinnlig könsstympning. / Background: Female genital mutilation is an old ritual common in several different countries. In female genital mutilation parts of the female genital organ are removed. About two millions girls are exposed every year. Female genital mutilation occurs in Sweden, but to what extent is unknown. All types of genital mutilation are forbidden in Sweden. School nurses have an opportunity to meet and aid girls who are at risk or have been subject to genital mutilation. Aim: The aim of this study is to highlight school nurses´ experience of female genital mutilation among girls in school. Method: A qualitative interview study with four school nurses in a municipality in the central of Sweden as well as qualitative questionnaire from seven school nurses in different parts of Sweden. The material was analyzed using qualitative content analysis. Results: School nurses experienced feelings of Ambivalence, Uncertainty and Compassion. As well as the subject being Sensitive but Vital to talk about. Discussion: The results of this study focus on school nurses experience, which differs from previous studies on the subject. The study shows an uncertainty and fear of talking, and a willingness to help without judging. This indicates that school nurses experience challenges and are in need of support and training in order to meet girls who have been or may be subject to female genital mutilation.

Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated