Female Genital Mutilation and Reproductive Health: A Systematic Review of Obstetric, Gynecologic, Sexual, and Psychological Outcomes
Adaku Onwuka MS1,2, Sumanth Devaraju MD1, Shakira Rivera BA2, Dream Tuitt-Barnes2, Zukiswa Jwili2 , Cheyenne Allen2
1Department of Physiology, American University of Antigua college of Medicine, Jabberwock Road, Antigua and Barbuda
2The Next Generation John Foundation, 2796 Sudbury Trace Norcross Ga 30071
Abstract
Background
Female genital mutilation is defined as procedures involving partial or total removal of external female genitalia or other injury for non-medical reasons. It violates human rights and is associated with immediate and lifelong health harms. This review synthesizes evidence on direct and indirect impacts on reproductive health for better clinical care and support policy-making.
Objectives
The primary objective was to evaluate associations between female genital mutilation and reproductive health outcomes including obstetric complications, menstrual and urinary morbidity, and sexual function. A secondary objective was to assess psychological and psychosocial consequences relevant to reproductive health.
Methods
PubMed, MEDLINE, Web of Science, Scopus, and PsycInfo were searched, along with grey literature from the World Health Organization and other agencies. Eligible studies included peer-reviewed quantitative, qualitative, and mixed-methods research on adult women with Types I through IV reporting at least one outcome in maternal or neonatal health, menstrual health, sexual function, psychological health, contraception, or family health. Only English-language studies were included. Data were extracted into a prespecified template and synthesized narratively, with effect sizes summarized when available. Risk of bias was appraised using validated tools. PRISMA 2020 reporting was followed.
Results
Forty-five studies published between 1998 and 2025 from Sub Saharan Africa, the Middle East, and diaspora settings met inclusion criteria. Female genital mutilation was consistently associated with adverse obstetric outcomes including prolonged labor, perineal trauma, higher rates of instrumental or cesarean delivery, postpartum hemorrhage, and worse neonatal status, with greater risk at higher severity. Gynecologic morbidity included increased urinary tract infections and bacterial vaginosis. Evidence for menstrual disorders was mixed. Sexual health outcomes showed lower Female Sexual Function Index scores across multiple domains and higher prevalence of dyspareunia. Psychological harms included elevated symptoms of post traumatic stress, anxiety, depression, and sexual fear or avoidance of sex. Qualitative themes highlighted embodied trauma, shame, and healthcare avoidance. Heterogeneity arose from variation in type, setting, and measurement, yet the direction of effects was consistent.
Conclusions
Female genital mutilation is linked to substantial and multifaceted reproductive harms. Care models should integrate informed obstetric protocols, access to defibulation when indicated, sexual health assessment and treatment, and trauma informed mental health care within culturally competent services. Prevention and survivor support policies remain essential. Future research should prioritize longitudinal designs, type specific analyses, standardized outcome measures, and evaluations of clinical and community interventions.
Keywords
Female genital mutilation; obstetric complications; sexual dysfunction; urinary tract infection; mental health; trauma informed care; PRISMA