This article presents a comprehensive qualitative metasynthesis examining the experiences and perspectives of women who have undergone Female Genital Mutilation or Cutting (FGM/C) and are living in Western countries, specifically focusing on their sexual health. FGM/C, defined as the partial or total removal of external female genitalia for non-medical reasons, is a multifaceted issue with significant public health and human rights implications, particularly in Western countries due to increasing migratory movements. Over 200 million survivors have undergone FGM/C globally, with approximately 10% residing in Western countries.
Rationale and Gap in Research: While previous quantitative reviews have explored the psychosexual consequences of FGM/C, the perspectives of survivors themselves have remained largely understudied. Existing scientific literature often adopts a biomedical framework, emphasizing physiological consequences and reducing sexual experience to genital sensations, thereby overlooking crucial personal, nuanced, and subjective dimensions of sexuality such as sociocultural, moral, interpersonal, and psychoaffective aspects. This metasynthesis addresses this notable gap by providing a deeper insight into how women who have undergone FGM/C perceive and express their sexuality and what constitutes their sexual health, especially considering that migratory trajectories can significantly shape these perceptions.
Study Objective: The primary objective of this study was to synthesize existing qualitative data on the experiences of adult women (18 years and older) who have undergone FGM/C and live in Western countries (defined as the United States, Canada, European countries, Australia, and New Zealand), specifically focusing on their perspectives regarding sexual health.
Methodology: The study employed a qualitative metasynthesis design, which involves a systematic review of existing literature and the interpretation of findings from qualitative studies to generate a comprehensive and integrated understanding beyond original insights.
- Search Strategy: A systematic search was conducted in six databases (MEDLINE, PsycInfo, CINAHL, Embase, Scopus, and Google Scholar) using a wide range of terms related to FGM/C, sexual health, Western countries, and qualitative methodologies.
- Eligibility Criteria: Articles were included if they were primary, peer-reviewed qualitative or mixed-method empirical articles (only qualitative data extracted from mixed-method studies) focusing on sexual health-related matters, published in English or French, and containing direct quotations from adult participants (aged 18 and older) who had undergone any type of FGM/C and resided in a Western country. The World Health Organization’s broad definition of sexual health was adopted to cover various aspects of sexuality.
- Analysis and Synthesis: The thematic synthesis involved three stages, starting with independent inductive, line-by-line in vivo coding of direct quotations by the first two authors. A key methodological decision was to prioritize the voices and experiences of women with lived experiences, meaning only direct quotations from participants were coded, intentionally excluding researchers’ interpretations unless used to complement and inform the analytical themes at a higher abstraction level. This approach aimed to ensure participants’ perspectives remained central to the analysis.
Key Findings: The metasynthesis identified three overarching analytical themes, each with three subthemes, illustrating how FGM/C is central to mechanisms of control over women’s sexuality, negatively affecting their sexual health. These themes emerged from the synthesis of data from 27 articles published between 2004 and 2023, primarily from studies conducted in Western Europe.
- Rigid sexual and gender norms as obstacles to sexual fulfillment:
- Sexual and gender roles as sexual constraints: Women were often confined to narrowly defined roles (virgin, wife, mother) that limited their sexual autonomy and enjoyment. The expectation to maintain virginity and the marital duty to please husbands, often with contradictory expectations of sexual naivety and proficiency, were significant burdens. Sexuality was frequently seen as solely for procreation.
- Women’s worth determined by their adherence to sexual diktats: Women’s value was linked to compliance with societal sexual norms, including behaviors (no sex outside marriage), practices (only vaginal penetration), and feelings (libido/pleasure considered suspicious). Deviation led to mistrust and stigmatization, with uncut women often deemed morally corrupt.
- Sexual prescriptions as a threat to the sexual agency and freedom of women: Imposed roles and diktats restricted women’s sexual autonomy and rights, leading to feelings of powerlessness, with some experiencing forced marriage or sexual violence. Despite these constraints, many women expressed a desire to reclaim control over their bodies and sexuality, with migration often acting as a catalyst for emancipation, though it also presented new challenges.
- FGM/C as both creator and annihilator of sexual identity and feeling:
- Incompleteness: a physical and spiritual mutilation: Women described FGM/C as a profound physical and spiritual mutilation, using terms like “destroyed,” “incomplete,” and “missing something.” This feeling was often exacerbated by migration to contexts where FGM/C is not the norm, leading to self-comparison with uncut women and feelings of being handicapped or dissociated from their sexuality.
- The norm of being abnormal: condemned to difference: Feelings of abnormality arose at various life stages, intensified by migration and negative Western perceptions of FGM/C. Women reported immense pressure to conform to Western genital norms, sometimes leading to concealment or seeking reconstructive surgeries.
- FGM/C as a determinant of women’s sexual experience: FGM/C undeniably shaped women’s sexual experience, notably impacting physical sensations (absence of or difficulty feeling pleasure) and causing pervasive pain, often minimized or normalized. These physical difficulties intertwined with psychological and emotional challenges, influencing self-worth, and partners’ reactions played a significant role. FGM/C also affected women’s sense of womanhood, shifting from a defining aspect of identity to something that undermined it.
- The hegemony of the taboo related to FGM/C and sexuality leading to the sexual subjugation of women:
- A pervasive culture of silence surrounding sexuality: A deep-rooted taboo and culture of silence around sexuality in FGM/C-practicing communities led to reluctance to discuss sex, even intimately, fostering distress, shame, and isolation. While some saw silence as protection from stigma, it undermined women’s agency.
- The absence of adequate sexual education: Due to this pervasive taboo, women often lacked basic sexual health knowledge and understanding of their anatomy, leaving them unprepared for their sexual lives. Migration sometimes served as a catalyst for new knowledge, prompting a reevaluation of existing beliefs.
- Disinformation as a threat to sexual health: Lack of reliable sexual education contributed to false beliefs and misinformation about virginity, fertility, sexual activities, and STIs, impeding access to appropriate care. Negative conceptions of sexuality, often based on hearsay, contributed to apprehension, hindering enjoyment and reinforcing a narrow view of sex.
Conclusion and Implications: This metasynthesis critically highlights the multifaceted nature of factors influencing the sexual health of women who have undergone FGM/C, emphasizing the pervasive control over their sexuality through societal expectations, rigid norms, gender roles, and the barriers of taboo, silence, inadequate education, and misinformation. The findings underscore that FGM/C profoundly and directly impacts women’s sexual experiences and is central to their sexual lives. The study advocates for comprehensive, culturally sensitive sexual health promotion interventions for FGM/C survivors, integrating expertise from various fields and addressing structural factors. It also recommends challenging common myths, promoting diverse forms of intimacy beyond heteronormative frameworks, and empowering women through peer-led approaches and education on sexual rights and autonomy.
Reference: Gareau, E., Dufour, A., Zarowsky, C., & Ferlatte, O. (2025). A qualitative metasynthesis on the sexual health of women who have undergone female genital mutilation or cutting (FGM/C) living in western countries. SSM – Qualitative Research in Health, 7, 100523. https://doi.org/10.1016/j.ssmqr.2025.100523
