Peer-reviewed article
Deinfibulation for improving obstetric, neonatal, gynecologic, and sexual health outcomes in women and girls with type III female genital mutilation: A systematic review and meta-analysis.
Okusanya B, Esu E, Nwachuku N, Adaramoye V, Olughu E et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined whether deinfibulation, a surgical procedure to remove scar tissue from type III female genital mutilation, improves health outcomes for women and girls. The review included eight studies with over 3,000 women and found that deinfibulation reduced the need for emergency cesarean delivery and genital tract injuries during childbirth compared to those without the procedure. However, the review found very limited evidence and no studies on other important health areas like sexual function or urinary health, and highlighted concerns about timing of the procedure.
Key points
- Deinfibulation reduced odds of emergency cesarean birth by 84% compared to women with type III FGM who did not have deinfibulation (OR 0.16)
- Deinfibulation reduced odds of genital tract lacerations by 52% (OR 0.48)
- Antepartum deinfibulation (before pregnancy) may reduce labor duration but may increase postpartum hemorrhage and cesarean births compared to intrapartum deinfibulation (during labor)
- No studies were found examining gynecologic, urologic, or sexual health outcomes
- All included studies had serious risk of bias, making the certainty of evidence very low to low
Limitations
The review included only eight studies with serious methodological limitations, resulting in very low certainty of evidence. No evidence was available on important health outcomes such as gynecologic, urologic, or sexual health outcomes, limiting understanding of deinfibulation's broader impact on women's and girls' well-being.
Abstract
Background Type III female genital mutilation (FGM) is corrected by the scar tissue removal of the vaginal opening, known as deinfibulation. Objectives To determine the current evidence on whether deinfibulation leads to improved obstetric, neonatal, gynecologic, and sexual health outcomes. Search strategy The following databases were searched from inception to May 18, 2023: CINAHL Plus (EBSCOhost), MEDLINE (Ovid), PsycINFO (EBSCOhost), SCOPUS, and Web of Science. Selection criteria Two review authors independently screened the titles and abstracts, extracted data, and performed the risk of bias assessment. Data collection and analysis Meta-analysis was conducted with RevMan, and the quality of evidence was assessed using the GRADE approach. Main results Eight studies with serious risk of bias involving 3166 women were included. Very low-certainty evidence indicates that deinfibulation for women with type III FGM reduced the odds of an emergency cesarean birth (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06-0.42) and genital tract lacerations (OR 0.48, 95% CI 0.29-0.79) when compared to women with type III FGM without deinfibulation. Reduced odds of an emergency cesarean birth apply when compared to women without FGM (OR 0.59, 95% CI 0.37-0.93). Antepartum deinfibulation, compared to intrapartum deinfibulation, may lead to a reduction in the duration of labor, with little or no difference in the risk of prolonged labor (low-certainty evidence). Antepartum deinfibulation may increase the likelihood of postpartum hemorrhage and cesarean births in pregnant women with type III FGM (low-certainty evidence). We found no studies for inclusion on gynecologic, urologic, and sexual health outcomes for this update. Conclusions The evidence of deinfibulation for women with type III FGM is available only for obstetrics outcomes. Larger observational studies in settings where type III FGM is predominantly practiced are required to improve the certainty of the evidence in these findings.