Norwegian Institute of Public Health, Oslo, Norway.
Department of Community Medicine, University of Tromso, Tromso, Norway.
BJOG. 2018 Feb;125(3):278-287. doi: 10.1111/1471-0528.14839. Epub 2017 Aug 28.
Female genital mutilation/cutting (FGM/C) changes normal genital functionality and can cause complications. There is an increasing demand for treatment of FGM/C-related complications.
We conducted a systematic review of empirical quantitative research on the outcomes of interventions for women with FGM/C-related complications.
A search specialist searched 16 electronic databases.
Selection was performed independently by two researchers. We accepted quantitative studies that examined the outcome of an intervention for an FGM/C-related concern.
We extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses.
We included 62 studies (5829 women), which investigated the effect of defibulation, excision of cysts, and clitoral reconstruction. Meta-analyses of defibulation versus no defibulation showed a significantly lower risk of caesarean section (relative risk, RR: 0.33; 95% confidence interval, 95% CI: 0.25-0.45) and perineal tears with defibulation: second-degree tear (RR: 0.44, 95% CI: 0.24-0.79), third-degree tear (RR: 0.21, 95% CI: 0.05-0.94), fourth-degree tear (RR: 0.06, 95% CI: 0.01-0.41). The meta-analyses detected no significant differences in obstetric outcomes of antenatal versus intrapartum defibulation. Except for one study, none of the studies on the excision of cysts indicated any complications, and the results were deemed favourable. Reconstructive surgery resulted in a visible clitoris in about 77% of women. Most women self-reported improvements in their sexual life, but up to 22% experienced a worsening in sexuality-related outcomes after reconstruction.
Women with FGM/C who seek therapeutic surgery should be informed about the scarcity of evidence for benefits and the potential harms of the available procedures.
Systematic review shows defibulation after FGM/C has obstetric benefits; effect of reconstruction is uncertain.
女性外阴残割/切割（FGM/C）改变了正常的生殖功能，并可能导致并发症。目前对 FGM/C 相关并发症的治疗需求不断增加。
我们对 FGM/C 相关并发症干预措施结果的实证定量研究进行了系统评价。
一名检索专家检索了 16 个电子数据库。
两名研究人员独立进行选择。我们接受了定量研究，这些研究检查了针对 FGM/C 相关问题的干预措施的结果。
我们将数据提取到一个预先设计的表格中，计算了效应估计值，并进行了荟萃分析。
我们纳入了 62 项研究（5829 名女性），这些研究调查了切开术、囊肿切除术和阴蒂重建术的效果。切开术与不切开术的荟萃分析显示，剖宫产的风险显著降低（相对风险，RR：0.33；95%置信区间，95%CI：0.25-0.45），切开术后会阴撕裂程度更低：二度撕裂（RR：0.44，95%CI：0.24-0.79）、三度撕裂（RR：0.21，95%CI：0.05-0.94）、四度撕裂（RR：0.06，95%CI：0.01-0.41）。荟萃分析未发现产前切开术与产时切开术在产科结局方面的显著差异。除了一项研究外，没有一项关于囊肿切除术的研究表明有任何并发症，结果被认为是有利的。重建手术使大约 77%的女性可见阴蒂。大多数女性自我报告性生活有所改善，但重建后有 22%的女性性生活相关结果恶化。
寻求治疗性手术的 FGM/C 女性应被告知现有手术获益的证据有限，且存在潜在危害。
FGM/C 后切开术具有产科获益，重建效果不确定。
