Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway

Abstract

Background Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. Methods We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. Findings We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants' intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal-sexual partner scenarios. Participants

The benefits and disappointments following clitoral reconstruction after female genital cutting: A qualitative interview study from Sweden

“…Consequently, FGC-related problems may be context specific. Studies have demonstrated that psychosexual complaints are higher in low-prevalence countries than in high-prevalence ones [16,17]. One explanation might be that FGC is normalized in high-prevalence countries so that its effects are taken for granted whilst this might not be the case in low-prevalence countries.…”

“…Another may be that women are enabled to speak out about these effects in one context but not in another. Yet another explanation might be that exposure to educational material about the negative effects of FGC on sexual function makes women experience problems they would otherwise not recognize if not exposed to such messages [16]. On the other hand, it may be that the educational material enables women already experiencing sexual dysfunction to make sense of and report sexual dysfunction.…”

“…Because CR is part of specialist care in Sweden, women who want it are required to seek referral for the surgery via primary healthcare, often their own gynaecologist or a specialized clinic providing care for FGCaffected women in Stockholm. CR is technically a relatively simple surgical procedure and involves removal and dissection of scar tissue covering the remaining parts of the clitoris [16]. The technique of CR used in Sweden is a modified version of Foldès' [20] method; it involves incision of the skin over the clitoral shaft stump.…”

“…They had heard about the availability of CR through the radio, TV, newspapers, the Internet, a specialist FGC clinic, their GP or friends [28]. This seems to differ from other countries where CR is promoted through media campaigns and advertisements [16]. In this second part of the study we aim at exploring how the same group of women experienced the surgical process and its aftereffects from a physical, sexual and psychosocial perspective, and thus whether CR leads to the expected benefits.…”

“…The women's negative view of the psychosexual counselling stands in stark contrast to the views of the experts in the area who promote psychosexual counselling as an important prerequisite and part of the CR treatment [16,27,[49][50][51]. Psychosexual counselling is meant to distinguish those 'ready' for surgery from those who are not [49], make women think thoroughly about their decision, help them adapt to their new clitoris, and/or prevent negative outcomes such as PTSD [52].…”