Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA.
Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
Arch Sex Behav. 2021 Jul;50(5):1913-1927. doi: 10.1007/s10508-019-1427-4. Epub 2019 Jul 29.
At least 200 million girls and women across the world have experienced female genital cutting (FGC). International migration has grown substantially in recent decades, leading to a need for health care providers in regions of the world that do not practice FGC to become knowledgeable and skilled in their care of women who have undergone the procedure. There are four commonly recognized types of FGC (Types I, II, III, and IV). To adhere to recommendations advanced by the World Health Organization (WHO) and numerous professional organizations, providers should discuss and offer deinfibulation to female patients who have undergone infibulation (Type III FGC), particularly before intercourse and childbirth. Infibulation involves narrowing the vaginal orifice through cutting and appositioning the labia minora and/or labia majora, and creating a covering seal over the vagina with appositioned tissue. The WHO has published a handbook for health care providers that includes guidance in counseling patients about deinfibulation and performing the procedure. Providers may benefit from additional guidance in how to discuss FGC and deinfibulation in a manner that is sensitive to each patient's culture, community, and values. Little research is available to describe decision-making about deinfibulation among women. This article introduces a theoretically informed conceptual model to guide future research and clinical conversations about FGC and deinfibulation with women who have undergone FGC, as well as their partners and families. This conceptual model, based on the Theory of Planned Behavior, may facilitate conversations that lead to shared decision-making between providers and patients.
全球至少有 2 亿名女孩和妇女经历过女性生殖器切割。近几十年来，国际移民大幅增长，这使得世界上不施行女性生殖器切割地区的医疗保健提供者需要了解并熟练掌握对接受过该手术的妇女的护理。女性生殖器切割有四种公认的类型（I 型、II 型、III 型和 IV 型）。为了遵守世界卫生组织（WHO）和众多专业组织提出的建议，提供者应该与接受过缝合术（III 型女性生殖器切割）的女性患者讨论并提供切开术，特别是在性交和分娩之前。缝合术涉及通过切割并使小阴唇和/或大阴唇靠拢来缩小阴道开口，并通过靠拢的组织在阴道上形成覆盖密封。WHO 发布了一本针对医疗保健提供者的手册，其中包括关于对切开术进行咨询和进行该手术的指导。提供者可能会受益于更多关于如何以一种对每位患者的文化、社区和价值观敏感的方式讨论女性生殖器切割和切开术的指导。几乎没有研究可以描述接受过女性生殖器切割的女性对切开术的决策过程。本文介绍了一个理论上的概念模型，以指导未来对接受过女性生殖器切割的女性以及其伴侣和家人的女性生殖器切割和切开术的研究和临床讨论。该概念模型基于计划行为理论，可能有助于促进提供者和患者之间的共同决策。
