A critical new study published in BMC Public Health by Pallitto et al. (2025) offers the most comprehensive summary to date of the health complications associated with Female Genital Mutilation (FGM), reinforcing the urgent need for a robust public health response. This systematic review and meta-analysis synthesizes existing evidence to provide definitive insights into how FGM harms women’s physical, psychological, and mental well-being across their lifespan.
Key Aspects of the Study:
- Background and Significance: FGM is a harmful practice involving the partial or total removal of external female genitalia or other injury for non-medical reasons, affecting an estimated 230 million women and girls globally. It is considered a violation of human rights and has profound impacts on health and well-being. Understanding these health complications is crucial for both providing high-quality care to affected individuals and advocating for prevention efforts.
- Methodology: The researchers conducted a systematic review of literature published between February 2009 and December 2022, building upon previous reviews. They analyzed 78 studies, including 67 comparative studies and 11 population-based studies on immediate health complications, encompassing data from 486,949 women and girls. Studies compared women with various types of FGM against those without, across six domains of health complications: immediate, obstetric & neonatal, gynecological, urological, sexual, and mental. Random effects meta-analysis was employed to pool results, accounting for diversity in study settings and methodologies.
- Comprehensive Findings: The review provides compelling evidence that FGM is associated with a wide array of severe health complications:
- Obstetric Complications: Women with FGM showed increased risk for prolonged/obstructed labor, obstetric tears, caesarean birth, postpartum hemorrhage, episiotomy, fetal distress, extended maternal hospital stay, neonatal asphyxia, and stillbirth/neonatal death. For instance, women with any form of FGM were 2.61 times more likely to experience prolonged/obstructed labor compared to those without FGM.
- Gynecological Complications: Increased risks included genital tissue damage (e.g., keloids, clitoral neuroma, vulvar cysts) and menstrual difficulties.
- Urological Complications: FGM was linked to higher rates of urinary tract infections and difficulty urinating.
- Sexual Complications: A significantly increased likelihood of dyspareunia (painful sexual intercourse) and sexual dysfunction was observed. Women with FGM also reported significantly lower mean scores on the Female Sexual Function Index (FSFI).
- Mental Health Complications: The study found an increased likelihood of depression, anxiety, and somatoform disorders among women with any type of FGM.
- Immediate Complications: Data from population-based surveys revealed that a significant proportion of girls experienced immediate complications such as difficulties urinating (23.3%), excessive bleeding (20.4%), wound healing problems (10.9%), infections (10.3%), and swelling in the genital area (9%) after FGM.
- Implications: These findings are crucial for strengthening health systems to provide high-quality care for women and girls affected by or at risk of FGM. They inform the development and updating of clinical guidelines, training tools for health workers, and the integration of FGM prevention and care services into essential health service packages globally. The research also underpinned a study that estimated the global cost of treating FGM-related complications to be 1.4 billion USD per year.
- Limitations: The authors acknowledge limitations, including variability in FGM type classification and health outcome definitions across studies, the observational nature of the data which may not fully account for confounding factors, and the variable methodological quality of included studies (nearly half were considered low quality). However, the review concludes that sufficient evidence exists to demonstrate the harm caused by FGM, advocating for action to prevent the practice and respond to existing complications rather than solely generating more evidence on health risks through clinical studies.
This study underscores that FGM is entirely preventable, and therefore, its severe health complications are also preventable. It serves as a call to action for concerted efforts to end this harmful practice and support those affected.
Reference: Pallitto, C., Ruiz-Vallejo, F., Mochache, V., Stein, K., Vogel, J. P., & Petzold, M. (2025). Exploring the health complications of female genital mutilation through a systematic review and meta-analysis. BMC Public Health, 25(1387). https://doi.org/10.1186/s12889-025-21584-z.
