Nigerian women who have undergone female genital cutting are as likely as those who have not to achieve orgasm during sexual intercourse, but are significantly more likely to have recurrent symptoms of reproductive tract infection. In a study comparing women who had experienced genital cutting--mostly the less-severe types--with women who had not, 66% of the cut women and 59% of the uncut women said they usually or always had an orgasm during intercourse.1 Cut women, however, were more likely than uncut women to consider their breasts, rather than their clitoris, the most sensitive part of their body. Cut women were significantly more likely than uncut women to report symptoms such as yellowish and bad-smelling vaginal discharge (odds ratio, 2.8), white vaginal discharge (1.7) and lower-abdominal pain (1.5). The study was conducted in Southwest Nigeria, where approximately 45% of the female population has undergone female genital cutting, usually in infancy.
The researchers recruited women at urban and rural antenatal clinics and family planning clinics in Edo State, Nigeria, in 1998-1999. A structured questionnaire, administered by a trained nurse or midwife, was used to obtain data on the participants' social and demographic characteristics, sexual activity and obstetric and gynecologic history. A physical examination was performed by a physician to determine the type of circumcision, if any, that the women had undergone.
The study sample comprised 1,836 women, most of whom were married. Some 55% of participants had not undergone female genital cutting; 32% had undergone type I genital cutting (at least partial removal of the clitoris), 11% type II (at least partial removal of the clitoris and labia minora) and fewer than 2% type III (at least partial removal of the external genitalia and stitching or narrowing of the vaginal opening) or type IV (any other genital cutting).
In response to questions about sexual behavior, 56% of cut and 47% of uncut women reported that they had had sexual intercourse in the previous week; the proportions for the previous month were 81% and 71%, respectively. About one-third of each group reported that they were easily "turned on" during sexual intercourse (33% and 35%), and about two-thirds said they usually or always experienced orgasm during intercourse (66% and 59%). Most of the women in each group reported that their partner was sometimes or always the initiator of sexual intercourse (96% and 87%); more than half said that they themselves initiated sex at least some of the time (58% and 53%). When asked to name the most sensitive part of their body, 63% of cut women and 44% of uncut women cited their breasts; 11% and 27%, respectively, named their clitoris; and 26% and 29%, respectively, identified other parts of their body.
Multivariable logistic regression models showed that cut women were significantly more likely than uncut women to report that they initiated sexual intercourse with their partner at least some of the time (odds ratio, 1.3). Compared with women who had not experienced genital cutting, women who had were significantly more likely to consider their breasts the most sensitive part of their body (1.9), and they were significantly less likely to cite their clitoris (0.4).
The mean age at menarche was similar for cut and uncut women (14.6 and 14.4 years, respectively), but cut women had been younger at first intercourse (19.0 vs. 20.7 years), first pregnancy (22.1 vs. 24.3 years) and first marriage (22.9 vs. 25.8 years). After adjustment for confounding variables, however, only the difference in age at first pregnancy was statistically significant: For cut women, the risk of getting pregnant at a given age was approximately 1.3 times that for uncut women.
Reports of recurrent symptoms of reproductive tract infections were more frequent among women who had undergone genital cutting than among women who had not. For example, 17% of cut women reported experiencing lower-abdominal pain, compared with 11% of uncut women. In addition, the proportion reporting yellowish, malodorous vaginal discharge was three times as high among cut women as among uncut women (6% vs. 2%), and the proportion reporting white vaginal discharge was more than twice as high (12% vs. 5%). A greater proportion of cut women than of uncut women also reported itching sensations in the genital area (14% vs. 8%), pain while urinating (4% vs. 2%) and pain during sexual intercourse (4% vs. 2%). Small proportions of women in each group reported genital ulcers (slightly more than 2% of cut women and fewer than 1% of uncut women). After controlling for potentially confounding factors, women who had been cut were significantly more likely than uncut women to report lower-abdominal pain (odds ratio, 1.5), yellowish and malodorous vaginal discharge (2.8), white vaginal discharge (1.7) and genital ulcers (4.4).
According to the investigators, these findings contribute to a better understanding of sexuality outcomes in cut women and provide evidence to negate the argument of female genital cutting proponents that cut women experience reduced sexual sensation (which is expected to make them less likely than uncut women to become sexually promiscuous). In fact, this study found that women who had undergone genital cutting were just as likely as those who had not to report having had recent sexual intercourse and were more likely to report at least sometimes initiating sexual intercourse with their partner. Moreover, women who had been cut were at least as likely as uncut women to report regularly having an orgasm during sexual intercourse; however, they were less likely to cite the clitoris, and more likely to identify their breasts, as their most sensitive body part. Thus, according to the authors, the results of this study suggest that genital cutting does not eliminate a woman's sexual sensation, but instead "shift[s]...the point of maximal sexual stimulation from the clitoris...or labia to the breasts."
The authors assert that their data also are useful in disproving the argument that "genital cutting...enhances the reproductive health of women." Instead, the authors conclude, their results "suggest that genital cutting may predispose women to adverse sexuality outcomes."--C. Coren
REFERENCE
1. Okonofua FE et al., The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria, BJOG: an International Journal of Obstetrics and Gynaecology, 2002, 109(10):1089-1096.