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DOI:
https://doi.org/10.57187/4785

Original article

Vol. 156 No. 6 (2026)

Female genital mutilation/cutting and risk of obstetric anal sphincter injury at delivery

Cite this as:
Swiss Med Wkly. 2026;156:4785
Published
17.06.2026

Summary

OBJECTIVE: To assess the incidence of obstetric anal sphincter injuries in women with female genital mutilation/cutting (FGM/C) who delivered vaginally at the University Hospital in Geneva and to examine potential predictive factors for obstetric anal sphincter injuries.

DESIGN: Retrospective observational study.

SETTING: Tertiary maternity hospital in Geneva, Switzerland.

POPULATION: Women with female genital mutilation/cutting who delivered vaginally between April 1, 2010, and December 31, 2018.

METODS: Data on demographics, medical and obstetric history, and delivery outcomes were collected, focusing on the occurrence of obstetric anal sphincter injuries. Predictive modelling was attempted using logistic regression to identify risk factors for obstetric anal sphincter injuries.

RESULTS: Out of 36,036 deliveries during the study period, 424 women had female genital mutilation/cutting, and 303 of these had a vaginal delivery. Perineal tears occurred in 57.4% of these deliveries, with 4.0% cases involving obstetric anal sphincter injuries. Defibulation was commonly performed, and its timing (during pregnancy or intrapartum) showed no significant correlation with the occurrence of severe injuries. The predictive model was inconclusive due to the low prevalence of obstetric anal sphincter injuries.

CONCLUSIONS: We found a relatively low occurrence of severe perineal injuries among women with female genital mutilation/cutting who received specialised care. The study was initially designed to develop a predictive model for obstetric anal sphincter injuries, but the low number of events precluded robust modelling. Nevertheless, our descriptive findings highlight the importance of specialised, individualised prenatal and intrapartum care, which may contribute to favourable perinatal outcomes in this population.

References

  1. 1. Soins pour les filles et les femmes vivant avec des mutilations sexuelles féminines: manuel clinique [Care of women and girls living with female genital mutilation: a clinical handbook]. Genève: Organisation mondiale de la Santé; 2020.
  2. 2. United Nations Children’s Fund. Female Genital Mutilation/Cutting: A global concern. New York: UNICEF; 2016.
  3. 3. Cottler-Casanova S, Horowicz M, Gayet-Ageron A, Abdulcadir J. Female genital mutilation/cutting (FGM/C) coding capacities in Swiss university hospitals using the International Classification of Diseases (ICD). BMC Public Health. 2021 Jun;21(1):1151. 10.1186/s12889-021-11160-6
  4. 4. UNICEF. Female genital mutilation (FGM) [Internet]. WHO; 2024 [cited 2024 Apr 19]. https://data.unicef.org/topic/child-protection/female-genital-mutilation/. Accessed 19 Apr 2024
  5. 5. Swiss Federal Office of Public Health. Measures against female genital mutilation [Internet]. 2023 [cited 2024 Apr 19]. https://www.bag.admin.ch/bag/en/home/strategie-und-politik/nationale-gesundheitsstrategien/gesundheitliche-chancengleichheit/chancengleichheit-in-der-gesundheitsversorgung/massnahmen-gegen-weibliche-genitalverstuemmelung.html. Accessed 19 Apr 2024
  6. 6. Sylla F, Moreau C, Andro A. A systematic review and meta-analysis of the consequences of female genital mutilation on maternal and perinatal health outcomes in European and African countries. BMJ Glob Health. 2020 Dec;5(12):e003307. 10.1136/bmjgh-2020-003307
  7. 7. Lurie JM, Weidman A, Huynh S, Delgado D, Easthausen I, Kaur G. Painful gynecologic and obstetric complications of female genital mutilation/cutting: A systematic review and meta-analysis. PLoS Med. 2020 Mar;17(3):e1003088. 10.1371/journal.pmed.1003088
  8. 8. Berg RC, Underland V. Obstetric Consequences of Female Genital Mutilation/Cutting (FGM/C) [Internet]. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2013 [cited 2024 Apr 19]. http://www.ncbi.nlm.nih.gov/books/NBK464778/. Accessed 19 Apr 2024
  9. 9. Balachandran AA, Duvalla S, Sultan AH, Thakar R. Are obstetric outcomes affected by female genital mutilation? Int Urogynecol J. 2018 Mar;29(3):339–44. 10.1007/s00192-017-3466-5
  10. 10. Davis G, Jellins J. Female genital mutilation: obstetric outcomes in metropolitan Sydney. Aust N Z J Obstet Gynaecol. 2019 Apr;59(2):312–6. 10.1111/ajo.12954
  11. 11. Bonavina G, Spinillo SL, Sotiriadis A, Bulfoni A, Kaltoud R, Salvatore S, et al. Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis. Heliyon. 2024 Apr;10(8):e29336. 10.1016/j.heliyon.2024.e29336
  12. 12. Johnson-Agbakwu CE, Michlig GJ, Koukoui S, Akinsulure-Smith AM, Jacobson DS. Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself? Int J Impot Res. 2023 May;35(3):218–27. 10.1038/s41443-022-00661-6
  13. 13. Abdulcadir J, Marras S, Catania L, Abdulcadir O, Petignat P. Defibulation: A Visual Reference and Learning Tool. J Sex Med. 2018 Apr;15(4):601–11. 10.1016/j.jsxm.2018.01.010
  14. 14. Abdulcadir J, McLaren S, Boulvain M, Irion O. Health education and clinical care of immigrant women with female genital mutilation/cutting who request postpartum reinfibulation. Int J Gynaecol Obstet. 2016 Oct;135(1):69–72. 10.1016/j.ijgo.2016.03.027
  15. 15. WebApp Let’s Talk FGM/C - Sciences. Sexes, Identités - UNIGE [Internet]. 2021 [cited 2024 Apr 19]. https://www.unige.ch/ssi/tuiles/webapp-lets-talk-mgf/. Accessed 19 Apr 2024
  16. 16. Abdulcadir J, Dewaele R, Firmenich N, Remuinan J, Petignat P, Botsikas D, et al. In Vivo Imaging-Based 3-Dimensional Pelvic Prototype Models to Improve Education Regarding Sexual Anatomy and Physiology. J Sex Med. 2020 Sep;17(9):1590–602. 10.1016/j.jsxm.2020.05.025
  17. 17. Desinfibulation - ENGLISH [Internet]. 2021 [cited 2024 Apr 19]. https://www.youtube.com/watch?v=S9UWBmDBzac. Accessed 19 Apr 2024
  18. 18. Horowicz M, Cottler-Casanova S, Abdulcadir J. Diagnoses and procedures of inpatients with female genital mutilation/cutting in Swiss University Hospitals: a cross-sectional study. Reprod Health. 2022 May;19(1):104. 10.1186/s12978-022-01411-z
  19. 19. Wuest S, Raio L, Wyssmueller D, Mueller MD, Stadlmayr W, Surbek DV, et al. Effects of female genital mutilation on birth outcomes in Switzerland. BJOG. 2009 Aug;116(9):1204–9. 10.1111/j.1471-0528.2009.02215.x
  20. 20. Klokk R, Bakken KS, Markestad T, Holten-Andersen MN. Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: a case-control study. BMC Pregnancy Childbirth. 2022 Apr;22(1):277. 10.1186/s12884-022-04621-2
  21. 21. Eshraghi B, Hermansson J, Berggren V, Marions L. Risk of obstetric anal sphincter tear among primiparous women with a history of female genital mutilation, giving birth in Sweden. PLoS One. 2022 Dec;17(12):e0279295. 10.1371/journal.pone.0279295
  22. 22. Rodriguez MI, Seuc A, Say L, Hindin MJ. Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis. Reprod Health. 2016 Oct;13(1):131. 10.1186/s12978-016-0242-9
  23. 23. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. The Lancet. Elsevier; 2006;367:1835–41. https://doi.org/10.1016/S0140-6736(06)68805-3
  24. 24. Mahgoub S, Piant H, Gaudineau A, Lefebvre F, Langer B, Koch A. Risk factors for obstetric anal sphincter injuries (OASIS) and the role of episiotomy: A retrospective series of 496 cases. J Gynecol Obstet Hum Reprod. 2019 Oct;48(8):657–62. 10.1016/j.jogoh.2019.07.004
  25. 25. Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth - Jiang, H - 2017 | Cochrane Library. [cited 2024 Sept 18]; https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000081.pub3/full?contentLanguage=en. Accessed 18 Sept 2024
  26. 26. World Health Organization. WHO guidelines on the management of health complications from female genital mutilation [Internet]. Geneva: World Health Organization; 2016 [cited 2024 Apr 20]. https://iris.who.int/handle/10665/206437. Accessed 20 Apr 2024
  27. 27. Taraldsen S, Vangen S, Øian P, Sørbye IK. Risk of obstetric anal sphincter injury associated with female genital mutilation/cutting and timing of deinfibulation. Acta Obstet Gynecol Scand. 2022 Oct;101(10):1163–73. 10.1111/aogs.14424
  28. 28. Schrot-Sanyan S, Kolanska K, Haimeur Y, Varlas V, Parisot-Liance L, Daraï E, et al. Language barrier as a risk factor for obstetric anal sphincter injury - A case-control study. J Gynecol Obstet Hum Reprod. 2021 Oct;50(8):102138. 10.1016/j.jogoh.2021.102138
  29. 29. Cinelli H, Lelong N, Lesclingand M, Alexander S, Blondel B, Le Ray C, et al. Female genital mutilation/cutting in women delivering in France: An observational national study. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet; 2024. 10.1002/ijgo.15880

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