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In this article, we explore the beliefs, values and attitudes about female genital mutilation in the diaspora of sub-Saharan women and how the migration process has influenced these beliefs. Our qualitative analysis of the life stories and lifelines of 10 women in the sub-Saharan diaspora in light of the Social Convention Theory indicated that making public statements about the topic is complex and that the taboo permeating the practice remains intact even outside of Africa. Furthermore, we discovered that, in our context, this practice was not a requirement and did not improve the chances of marriage, with female behaviours considered ‘appropriate’ instead gaining value. Any interventions based on this theory must consider the broad networks that help shape marriages in this diaspora. This work opened new lines of research regarding the situation of the diaspora of sub-Saharan women and the relationship of the practice of female genital mutilation with marriage. This work was supported by the Generalitat Valenciana.

Objectives: Female Genital Mutilation and Cutting (FGM/C) is an act of gender-based violence (GBV) and a global public health issue with well-documented adverse outcomes. With the rise in global migration, there is an increasing prevalence of FGM/C among Arab diaspora living in the West and Global South. What remains unclear is how to reduce the practice. This study was designed to identify interventions exerting an effect on reducing the practice of FGM/C. Methods: A systematic review of peer-reviewed articles was conducted on interventions targeting individuals and/or the broader community to prevent FGM/C within the Arab League and its diaspora, up to December 2021. Databases searched included PubMed, Medline, Web of Science, PsycINFO, EMBASE, CINAHL, BIOSIS, ASSIA and Scopus. Quality assessment used the Mixed Methods Appraisal Tool (MMAT) 2018. Results: Twelve of 896 studies met the inclusion criteria. Eight interventions relied entirely on education with short-term gains but unchanged practices. Three interventions used social marketing and mixed media. Only one study took a multi-sectoral approach. Conclusions: At a macro level, opportunities to reduce or to end the practice of FGM/C exist through legislation, policy, a public health approach grounded in gender equality and human rights. Using multi-sectoral actions that consider the social context and challenge social norms at macro, meso and micro levels appears more effective than individual-level interventions. Promoting advocacy and developing supportive environments to reduce GBV, enhance gender equality and empower communities is crucial for interventions to succeed and achieve the Sustainable Development Goal target of FGM/C abandonment by 2030.

BackgroundThis systematic review aimed to identify and describe the factors that influence female genital mutilation/cutting (FGM/C).MethodsSearches were conducted in Medline, PsycInfo, Web of Science, Embase and the grey literature from 2009 to March 2020 with no language restrictions, using related MESH terms and keywords. Studies were included if they were quantitative and examined factors associated with FGM/C. Two researchers independently screened studies for inclusion, extracted data and assessed study quality. The direction, strength and consistency of the association were evaluated for determinants, presented as a descriptive summary, and were disaggregated by age and region.ResultsOf 2230 studies identified, 54 published articles were included. The majority of studies were from the African Region (n=29) followed by the Eastern Mediterranean Region (n=18). A lower level of maternal education, family history of FGM/C, or belonging to the Muslim religion (in certain contexts) increased the likelihood of FGM/C. The majority of studies that examined higher paternal education (for girls only) and living in an urban region showed a reduced likelihood of FGM/C, while conflicting evidence remained for wealth. Several studies reported that FGM/C literacy, and low community FGM/C prevalence were associated with a reduced likelihood of FGM/C.ConclusionsThere were several characteristics that appear to be associated with FGM/C, and these will better enable the targeting of policies and interventions. Importantly, parental education may be instrumental in enabling communities and countries to meet the Sustainable Development Goals.

Background: Female genital cutting (FGC) is a form of gender-based violence with obstetrical and gynecological complications that require recognition and care. Data suggest that United States' phys...

Few studies have described the broader experience of survivors of female genital mutilation or cutting (FGM/C) who have sought asylum in the United States. To gain a better understanding of their exposure to gender-based violence (GBV), the study was conducted to help uncover themes and patterns of co-occurring individual and community factors among women asylum seekers who experienced FGM/C before they arrived in the United States. Following a retrospective chart review of FGM/C cases seen in a human rights clinic, 35 women met the inclusion criteria. The constant comparative method (CCM) was used to develop themes derived from clients' personal declarations and physicians' affidavits. A qualitative analysis revealed extensive histories of violence-physical, psychological, and sexual-demonstrating that FGM/C is only part of a larger arc of violence. Key themes developed via CCM include the experience of FGM/C, cultural attitudes toward FGM/C, cultural attitudes toward women, the lack of agency felt by women, silence around experiences of GBV and the constant reinforcement of that silence, the role of education in women's lives, and acts of resistance and social support. Placing FGM/C within its cultural context allows for a better understanding of its role in society's broader subjugation of women and elucidates how these social structures are maintained. For health care and other service providers, the high frequency of multiple forms of violence and the ingrained nature of women's oppression indicate the need for trauma-informed care and services as well as accessible resources beyond those explicitly related to FGM/C.

Background There is evidence that women who have had their genitals cut suffer substantial difficulties during and/or after childbirth, including the need for a caesarean section, an episiotomy, an extended hospital stay, post-partum bleeding, and maternal fatalities. Whether or not women in sub-Saharan Africa who have undergone female genital mutilation utilize the services of skilled birth attendants during childbirth is unknown. Hence, we examined the association between female genital mutilation and skilled birth attendance in sub-Saharan Africa. Methods The data for this study were compiled from 10 sub-Saharan African countries’ most recent Demographic and Health Surveys. In the end, we looked at 57,994 women between the ages of 15 and 49. The association between female genital mutilation and skilled birth attendance was investigated using both fixed and random effects models. Results Female genital mutilation and skilled birth attendance were found to be prevalent in 68.8% and 58.5% of women in sub-Saharan Africa, respectively. Women with a history of female genital mutilation had reduced odds of using skilled birth attendance (aOR = 0.91, 95% CI = 0.86–0.96) than those who had not been circumcised. In Ethiopia, Guinea, Liberia, Kenya, Nigeria, Senegal, and Togo, women with female genital mutilation had reduced odds of having a trained delivery attendant compared to women in Burkina Faso. Conclusion This study shed light on the link between female genital mutilation and skilled birth attendance among sub-Saharan African women. The study's findings provide relevant information to government agencies dealing with gender, children, and social protection, allowing them to design specific interventions to prevent female genital mutilation, which is linked to non-use of skilled birth attendance. Also, health education which focuses on childbearing women and their partners are necessary in enhancing awareness about the significance of skilled birth attendance and the health consequences of female genital mutilation.

The aim: To highlight legal measures of counteraction to genitals mutilating surgeries (female circumcision) and the perspectives for their possible improvement. Materials and methods: International regulatory legal acts, acts of “soft” law, statistical data, research results are the materials of the research. Comparative, comparative and legal, system analysis, formal and logical, other methods were applied during the research. Conclusions: It has been proved that although there are four different types of female circumcision, any such surgery performed without medical grounds is female genitals mutilating surgery. The authors have offered to enshrine a direct ban on performing genitals mutilating surgeries (female circumcision) in the norms of national legislation with appropriate measures of legal liability for those involved.

Summary Background Worldwide, 200 million girls and women have been subjected to female genital mutilation. To restore the clitoral function and vulvar anatomy, clitoral repair has been performed since the 2000s. Nevertheless, there is a lack of precise and comprehensive data on the clitoral anatomy during surgical repair. This study aimed to precisely describe the terminal anatomies of the dorsal nerve and artery of the clitoris, and the clitoral neurovascular flap advancement for reconstruction in patients with female genital mutilation. Methods This study was performed on seven fresh female cadavers. The site of origin, diameter, length, and trajectory of each nerve and artery were recorded. The clitoral neurovascular flap advancement was measured after a midline transection of the suspensory ligament was performed and after extensive liberation of the dorsal bundles at their emergence from the pubic rami. Results At the distal point of the clitoral body, the width of the dorsal nerve and artery was 1.9 ± 0.3 mm and 0.9 ± 0.2 mm, respectively. The total length of the dorsal bundles was 6.6 cm (± 0.4). The midpart of the suspensory ligament was sectioned, which allowed a mean anteroposterior mobility of 2.7 cm (± 0.2). Extensive dissection of the neurovascular bundles up to their point of emergence from the suspensory ligament allowed a mean mobility of 3.4 ± 0.2 cm. Conclusion We described the anatomical characteristics of the dorsal nerve and artery of the clitoris and the mobility of the clitoral neurovascular flap for reconstruction post clitoridectomy. This was done to restore the anatomic position of the glans clitoris while preserving and potentially restoring clitoral function in patients with female genital mutilation.

Given the increase of African immigrants from countries with high female genital cutting (FGC) prevalence, this study explored U.S. healthcare providers’ beliefs and attitudes regarding FGC. A total of 31 professionals who have provided services to FGC-experienced women in New York City were interviewed; data were analyzed using grounded theory. Results indicated that, although a majority of respondents emphasized maintaining a nonjudgmental and open-minded attitude toward clients’ experiences, some only focused on the negative aspects of FGC. Also, multifaceted efforts by providers to understand the cultural meanings of FGC and resolve their own cultural dissonance were identified. The implications for practice were discussed.

Background We examined the evidence derived from healthcare professionals’ interfacing with women with female genital mutilation (FGM) to comprehend the referral pathways available to these women in Australia. Main body Clinicians encountered FGM-related complications that included ruptured bladder and total urinary incontinence. Midwives and paediatricians indicated a lack of referral pathways for FGM, but used their discretion to refer such cases to social work departments, obstetric/gynaecological units, child protection service providers, psychological counsellors and surgeons. The continuum of care for women with FGM is characterised by inadequate and lack of clear referral pathways. This underscores the need to develop and strengthen referral pathways in response to physical, birthing and psychological complications of women with FGM to improve their care experiences in Australia. Short conclusion Capacity building initiatives on FGM-prevention and care for trainees and practising health providers and community involvement in high burden areas/populations should be implemented to promote uptake and utilization of the referral services. Provision of infrastructural support, including clinical management tools, job aids, posters, referral algorithms and electronic patient records with "drop-down menus" for referral sites for health complications of FGM to reinforce the providers’ efforts are critical.

Female genital cutting (FGC) and intimate partner violence (IPV) are highly prevalent forms of violence against women, and the UN has encouraged strengthening policy linkages between FGC and IPV programme work (UN Women, Female genital mutilation/cutting and violence against women and girls. Strengthening the policy linkages between different forms of violence. UN Women, 2017a). However few studies have examined the relationship between these behaviours. This study addresses two research gaps identified by the UN; (a) whether women with FGC are more likely to experience physical or sexual IPV, and (b) whether women's IPV experiences are associated with their support for FGC. Multilevel multivariate logistic regression models were run using Demographic and Health Survey data from 6 sub-Saharan African countries (Burkina Faso, Ethiopia, The Gambia, Ivory Coast, Kenya and Nigeria, n33,170). Our results show no association between FGC and IPV. Women with FGC are not at greater risk of experiencing IPV, and women who experienced IPV in the preceding year are not more likely to support FGC. Further, the importance of individual and community factors differ; IPV experience is influenced by individual factors, whereas FGC support is more influenced by ethnic group characteristics. Although the proposition that FGC and IPV could be tackled collaboratively is attractive for policy makers, these results are important because they indicate that eradication programmes will be more effective when targeted at specific behaviours.

Background Female genital circumcision (FGC) is still a challenge in reproductive health. This study investigated socioeconomic disparities in FGC in the Kurdish region of Mahabad, Iran. Methods A case-control study was conducted in three comprehensive health centers on 130 circumcised girls as the case group and 130 girls without a history of circumcision as the control group, according to the residential area and the religious sect. The participants completed a previously validated demographic and circumcision information questionnaire. A multivariate logistic regression model with a backward method at a 95% confidence level was used to determine the relationship between socioeconomic variables and FGC. Results Multivariate logistic regression showed that a family history of FGC (AOR 9.90; CI 95%: 5.03–19.50), age ranging between 20 and 30 years (AOR 8.55; CI 95%: 3.09–23.62), primary education (AOR 6.6; CI 95%: 1.34–33.22), and mothers with primary education (AOR 5.75; CI 95%: 1.23–26.76) increased the chance of FGC. Conclusion The present study provided evidence on socioeconomic factors related to FGC in girls. A family history of FGC, age ranging between 20 and 30 years, and girls’ and their mothers’ education level were strong predictors of FGC. The findings indicate the need to design effective interventions to address these factors to help eradicate FGC.

OBJECTIVE Female genital mutilation is a public health problem resulting in multiple health complications. In Ethiopia, female circumcision is widely practiced, with women taking center stage in the perpetuation of the practice. Using the Theory of Planned Behavior for variable selection, the following study assessed the association between maternal attitude towards female circumcision and daughter's circumcision status. METHODS From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 6948 women. The outcome variable assessed daughter's circumcision status; the main independent variable assessed participant's opinion towards female circumcision. We conducted univariate, bivariate, and multiple logistic regression analyses. RESULTS In the bivariate analysis, none of the variables, except for religion, showed any association with daughter's circumcision status. In the multivariable regression model, several variables showed a significant association with daughter's circumcision status. Older, rural, and circumcised women were more likely to have at least one daughter circumcised, but wanting female circumcision to stop, being a Muslim, and having at least a secondary education were negatively associated with daughter's circumcision status. CONCLUSION Our findings suggest that eliminating female circumcision may require changing maternal attitudes towards the practice by targeting rural, circumcised, and older women with no formal education.

Female genital mutilation/cutting (FGM/C) remains a global problem. We aimed to explore Kenyan health care professionals’ (HCPs) perceptions of FGM/C abandonment and, in particular, those focused on those serving Maasai communities who continue to practice FGM/C. Using a grounded theory Straussian approach, 18 interviews were conducted with HCPs in Kajiado County, Kenya, to understand perceptions of FGM/C as a cultural practice, identify barriers and facilitators to abandonment, and explore attitudes to medicalization (FGM/C conducted by HCPs) and alternatives of FGM/C. Within a substantive theory, one core category (“FGM/C persists but can be abandoned”) comprised two subcategories: “exploring the influencers of persistence” and the “roadmap to abandonment.” HCPs believed collaborative multilateral efforts were necessary to support successful abandonment and that “enlightening” the community needed to focus on changing the perception of FGM/C as a social norm alongside a health risk educational approach. Future effective intervention is needed to support the abandonment of FGM/C in Kenya.

International journal of environmental research and public health 19(17), 10855 (2022). doi:10.3390/ijerph191710855 special issue: "Special Issue "Using Digital Health Technologies to Improve Healthcare Quality" / Special Issue Editors: Dr. Anna Janssen, Guest Editor; Dr. Melissa Brunner, Guest Editor", Published by MDPI, Basel

Background: This article investigates the practice of female genital mutilation (FGM) as a long-held custom in Qeshm Island, which makes many African-descended women face different physical and psychological health problems. Objective: To investigate the prevalence of female genital mutilation in Qeshm Island and the traditional mode of thinking of Afro-Iranian people of the Island about this practice. Methods: This study is based on the descriptive analysis method. The questions of the study are (a) Why female genital mutilation is still practiced in Qeshm Island; (b) What are the mental and physical effects of female genital mutilation on women; and (c) How government or NGOs are fighting against this tradition. The results: This article has found out that female genital mutilation resulted in many lifelong diseases and sexual degradation in African-descended women of Qeshm Island. This article also illustrates that the best way to combat this wrong tradition is to inform people by gradual training without any insult to their beliefs.Conclusion: This study reveals the prevalence of a false tradition and the necessity of behavioral change. In doing so, the government and NGOs' strong actions and attracting the support of the community elders are also needed. Keywords: Female Genital Mutilation; Gender Discrimination; Human Rights violation; NGOs' Campaign; Qeshm Island.

Introduction: Female genital cutting/mutilation (FGC/M) is a ritual to remove any or all of the external female genitalia. Educational strategies regarding the teaching of FGC/M for nursing students are scarce. The focus of this article is to describe the development, implementation, and evaluation of a virtual, FGC/M-related dramatization simulation with a standardized patient (SP). Methods: This educational intervention used an East African immigrant woman as the SP with 35 undergraduate nursing students in two nursing schools in the Midwest United States. Results: Participants appraised the simulation as an effective way to teach and learn about FGC/M. Debriefing was a key part of the simulation. Discussion: Students felt the simulation was novel and engaging for a highly sensitive topic. The SP thought the virtual setting made it more comfortable for her to reveal sensitive facts. The researchers confirmed that the simulation required extensive time commitment to develop, critique, and implement.

Despite efforts to reduce the burden of female genital mutilation (FGM) in Guinea, the practice remains prevalent, and health care providers are increasingly being implicated in its medicalization. This formative study was conducted to understand the factors that facilitate or impede the health sector in providing FGM prevention and care services to inform the development of health sector-based interventions.Between April and May 2018, a mixed methods formative study was carried out using a rapid assessment methodology in three regions of Guinea-Faranah, Labe and Conakry. A structured questionnaire was completed by one hundred and fifty health care providers of different cadres and 37 semi-structured interviews were conducted with health care providers, women seeking services at public health clinics and key stakeholders, including health systems managers, heads of professional associations and schools of nursing, midwifery, and medicine as well as representatives of the Ministry of Health. Eleven focus group discussions were conducted with female and male community members.This study revealed health systems factors, attitudinal factors held by health care providers, and other factors, that may not only promote FGM medicalization but also impede a comprehensive health sector response. Our findings confirm that there is currently no standardized pre-service training on how to assess, document and manage complications of FGM nor are there interventions to promote the prevention of the practice within the health sector. This research also demonstrates the deeply held beliefs of health care providers and community members that perpetuate this practice, and which need to be addressed as part of a health sector approach to FGM prevention.As integral members of FGM practicing communities, health care providers understand community beliefs and norms, making them potential change agents. The health sector can support them by incorporating FGM content into their clinical training, ensuring accountability to legal and policy standards, and promoting FGM abandonment as part of a multi-sectoral approach. The findings from this formative research have informed the development of a health sector intervention that is being field tested as part of a multi-country implementation research study in Guinea, Kenya, and Somalia.RéSUMé: CONTEXTE: Malgré les efforts déployés pour réduire le fardeau des mutilations génitales féminines (MGF) en Guinée, cette pratique reste répandue et les prestataires de soins de santé sont de plus en plus impliqués dans sa médicalisation. Cette étude formative a été menée pour comprendre les facteurs qui facilitent ou empêchent le secteur de la santé de fournir des services de prévention et de soins des MGF afin de promouvoir le développement d'interventions basées sur le secteur de la santé. MéTHODES: Entre avril et mai 2018, une étude formative à méthodes mixtes a été réalisée en utilisant une méthodologie d'évaluation dans trois régions de la Guinée: Faranah, Labe et Conakry. Un questionnaire structuré a été rempli par cent cinquante prestataires de soins de santé de différentes structures de santé et 37 entretiens semi-structurés ont été menés avec des prestataires de soins de santé, des femmes sollicitant des services dans des structures de santé publique et des parties prenantes clés, notamment des gestionnaires de systèmes de santé, des responsables d'associations professionnelles et d'écoles d'infirmières, de sages-femmes et de médecine, ainsi que des représentants du ministère de la Santé. Onze discussions de groupe ont été menées avec des membres féminins et masculins de la communauté. RéSULTATS: Cette étude a révélé des facteurs liés aux systèmes de santé, des facteurs liés aux attitudes des prestataires de soins de santé, et d'autres facteurs, qui peuvent non seulement promouvoir la médicalisation des MGF mais aussi empêcher une réponse globale du secteur de la santé. Nos résultats confirment qu'il n'existe actuellement aucune formation initiale standardisée sur la manière d'évaluer, de documenter et de gérer les complications des MGF, ni aucune intervention visant à promouvoir la prévention de cette pratique dans le secteur de la santé. Cette recherche démontre également les croyances profondes des prestataires de soins de santé et des membres de la communauté qui perpétuent cette pratique, et qui doivent être abordées dans le cadre d'une approche du secteur de la santé pour la prévention des MGF. CONCLUSION: En tant que membres à part entière des communautés pratiquant les MGF, les prestataires de soins de santé comprennent les croyances et les normes de la communauté, ce qui fait d'eux des agents de changement potentiels. Le secteur de la santé peut les soutenir en intégrant le contenu des MGF dans leur formation sanitaire, en veillant à ce qu'ils respectent les normes juridiques et politiques et en promouvant l'abandon des MGF dans le cadre d'une approche multisectorielle. Les résultats de cette recherche formative ont permis de développer une intervention du secteur de la santé qui sera testée sur le terrain dans le cadre d'une étude de mise en œuvre multi-pays en Guinée, au Kenya et en Somalie.Despite the implementation of various interventions to prevent female genital mutilation (FGM), it is still widely practiced in Guinea, and health care providers are increasingly being implicated in the practice. We conducted research in three regions of Guinea, namely, Faranah, Labe and Conakry, to understand factors that might be addressed to strengthen the role of the health sector in prevention and care of women and girls who have undergone FGM. Our findings highlight the need to strengthen the capacity of health care providers to be able to identify cases of FGM and manage complications. The study also highlights the importance of engaging health care providers in efforts to prevent FGM, which will require that any trainings include an opportunity to discuss their own values and beliefs around FGM so that they are better equipped to communicate with their clients and patients in a sensitive and non-judgmental manner, whether during consultation visits or community health outreach activities. The results of this research have informed the development of a health system strengthening intervention package for the prevention and care of FGM, which is being tested in Kenya, Somalia, and Guinea.

Sudan has about 87% of females aged 15–49 years living with female genital mutilation (FGM), mostly performed by midwives (64%). In 2016, the Federal Ministry of Health (FMoH) adopted the WHO’s global strategy to stop healthcare providers from performing FGM. Our review of activity reports from 2016 to 2018 found the format of activities (N=95) was mainly meetings (58%) and trainings (31%) with median costs of US$10 645 and US$14 964, respectively. The FMoH (57%) and student/professional associations (25%) implemented activities at national (36%) and state (62%) level. The costs of activities were highest for FMoH compared with student/professional associations and academia, respectively.Sudan addressed WHO’s global strategy pillars through FGM-related policies and plans (pillar 1), trainings (pillar 2) and monitoring, evaluation and accountability materials (pillar 3) targeting mainly community midwives (N=16 183) as well as creating supportive legislative and regulatory environment (pillar 4). Governmental funding on training was comparable to donor’s resulting into 31% of community midwives trained on FGM complications management. Further, 31% of community midwives signed declarations or petitions to end FGM practice, while 19% were sensitised on punitive administrative measures for conducting FGM.Although Sudan implemented a laudable health sector response to address FGM, there is a need to evaluate the quality and effectiveness of past and ongoing interventions. Particular attention to costs and quality assurance data is essential to identify cost efficient implementation approaches to reach the remaining sizeable number of health professionals to stop their involvement in FGM.

Aim: The aim of this study was to identify and compare birthing complications in women originating from countries where they are at risk (may become victims) of FGM with those of Spanish women, all having given birth from 2012 to 2015 at the “Virgen de la Arrixaca” University Clinical Hospital in Murcia, Spain. Methods: A transversal, observational, quantitative study was carried out, retrospectively, comparing 245 sub-Saharan women originating from countries where FGM is practiced with 490 Spanish women, in terms of obstetric complications. Data collection was performed via electronic clinical records. Results: The sub-Saharan women presented higher rates of intrapartum and emergency caesareans, intense postpartum haemorrhages, concurrent episiotomies and tears (2nd and 3rd degree), failed inductions, and non-progressive labours, and a more severe risk of foetal distress when compared with Spanish women. Conclusions: The fact that the sub-Saharan women originating from countries where FGM is practiced presented a greater number of birthing complications than the Spanish women proves the need for Spanish healthcare professionals to receive training towards cultural competency acquisition, in order to provide a multidisciplinary approach, with standardized action protocols focused fundamentally on prevention.

Over the last two decades, improvements in Ethiopia’s socio-economic context, the prioritization of health and development in the national agenda, and ambitious national health and development policies and programmes have contributed to improvements in the living standards and well-being of the population as a whole including adolescents. Improvements have occurred in a number of health outcomes, for example reduction in levels of harmful practices i.e., in child marriage and female genital mutilation/cutting (FGM/C), reduction in adolescent childbearing, increase in positive health behaviours, for example adolescent contraceptive use, and maternal health care service use. However, this progress has been uneven. As we look to the next 10 years, Ethiopia must build on the progress made, and move ahead understanding and overcoming challenges and making full use of opportunities by (i) recommitting to strong political support for ASRHR policies and programmes and to sustaining this support in the next stage of policy and strategy development (ii) strengthening investment in and financing of interventions to meet the SRH needs of adolescents (iii) ensuring laws and policies are appropriately communicated, applied and monitored (iv) ensuring strategies are evidence-based and extend the availability of age-disaggregated data on SRHR, and that implementation of these strategies is managed well (v) enabling meaningful youth engagement by institutionalizing adolescent participation as an essential element of all programmes intended to benefit adolescents, and (vi) consolidating gains in the area of SRH while strategically broadening other areas without diluting the ASRHR focus.

Introduction Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the female external genitalia or any other injury of the female genitalia that is performed for nonmedical reasons. FGM is classified into 4 types. Surgical clitoral reconstruction was first described by Thabet and Thabet in Egypt and subsequently by Foldes in France. The technique was then modified by different authors. Aim This article aims to provide a detailed description of clitoral surgical reconstruction and the modifications which have been made over time to improve the procedure while recalling current knowledge in the anatomy of the clitoris. Methods We performed a broad systematic search in PubMed/Medline and EMBASE bibliographic databases for studies that report the surgical technique of clitoral reconstruction. From the anatomical point of view, we examined available evidence (from 1950 until 2020) related to clitoral anatomy, the clitoral role in sexual functioning, female genital mutilation/cutting, and surgical implications for the clitoris. Main Outcomes A review of the surgical techniques for clitoral reconstruction after female genital mutilation/cutting Results We described the current anatomical knowledge about the clitoris, and the procedures based on the surgical technique by Pierre Foldes, We included the technical modifications and contributions described in articles published subsequently. Conclusion Surgical repair of the clitoris for FGM offers anatomical and functional results although they still have to be evaluated. However, it should not be the only therapeutic solution offered to women with FGM. Botter C, Sawan D, SidAhmed-Mezi M, et al. Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique. J Sex Med 2021;18:996–1008.