Impact of Female Genital Mutilation (FGM) on sexual health: A comprehensive interdisciplinary review

 Corresponding author: Oghogho.P. Izekor. Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Impact of Female Genital Mutilation (FGM) on sexual health: A comprehensive interdisciplinary review Oghogho.P. Izekor 1, *, Oyindamola Fagbore 1, Chinemelum Uzochukwu 1 and Sybil. O. T Etiaka 2 1 Department of Obstetrics and Gymaecology, Birmingham Heartlands Hospital. UK. 2 Longview Medical Centre, Huyton, Liverpool UK. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 Publication history: Received on 07 April 2025; revised on 19 May 2025; accepted on 21 May 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.2.2004 Abstract Female Genital Mutilation (FGM) remains a critical global health and human rights issue, with more than 200 million women and girls affected worldwide. Despite increased awareness and international efforts to eradicate the practice, FGM persists across various cultural and geographic contexts, particularly in parts of Africa, the Middle East, and Asia. This review examines the multifaceted impact of FGM on female sexual health, drawing from clinical, psychological, and sociocultural perspectives to provide a comprehensive analysis of its consequences. FGM encompasses a range of procedures involving partial or total removal of external female genitalia or injury to the female genital organs for nonmedical reasons. The practice has profound and lasting implications on sexual function, including diminished libido, dyspareunia (pain during intercourse), anorgasmia, and reduced genital sensitivity. These outcomes stem from both anatomical alterations and psychological trauma, leading to a complex interplay of physical and emotional dysfunction. Further, FGM is associated with complications such as chronic infections, scarring, and obstetric trauma, which exacerbate sexual discomfort and reproductive challenges. Psychologically, women with FGM may experience anxiety, depression, body image disorders, and post-traumatic stress, all of which further impair sexual well-being. Cultural taboos and stigma surrounding sexuality often silence affected women, impeding access to medical and psychological support. This review highlights the urgent need for culturally sensitive healthcare services, trauma-informed counselling, and legal frameworks to support survivors. It also emphasizes the importance of comprehensive sex education and community-driven advocacy to combat FGM. Addressing the sexual health repercussions of FGM is essential to promoting bodily autonomy, gender equity, and holistic well-being. Keywords: Female Genital Mutilation; Sexual Dysfunction; Women’s Health; Psychological Trauma; Reproductive Rights; Dyspareunia 1. Introduction 1.1. Background and Global Burden of FGM Female Genital Mutilation (FGM) constitutes a grave violation of human rights and a significant public health concern affecting millions of women and girls worldwide. Defined as all procedures involving the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons, FGM is deeply rooted in cultural, religious, and social norms [1]. Despite international advocacy and legal reforms, FGM remains prevalent in at least 30 countries, primarily in Africa, the Middle East, and parts of Asia, with growing evidence of its practice in diaspora communities across Europe, North America, and Australia [2]. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2931 According to UNICEF, over 200 million women and girls alive today have undergone FGM, with an estimated 3 million girls at risk annually [3]. The practice is typically performed on minors, often under unsanitary conditions and without anesthesia, increasing the risk of immediate complications such as hemorrhage, infection, and even death [4]. Longterm consequences include chronic pelvic infections, childbirth complications, and psychological trauma. FGM also reinforces gender inequality by controlling female sexuality and perpetuating male dominance within patriarchal structures [5]. Despite growing resistance from activists, survivors, and global health organizations, deeply embedded traditions continue to sustain the practice in many communities. Comprehensive efforts involving education, legal enforcement, and health system reform are essential to eradicate FGM and mitigate its extensive harm [6]. 1.2. WHO Classification and Typology of FGM The World Health Organization (WHO) classifies FGM into four distinct types based on the extent and nature of the genital alterations. Type I involves the partial or total removal of the clitoris and/or the prepuce, known as clitoridectomy. Type II, refers to the partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora [7]. Type III, the most severe form, is termed infibulation. It involves narrowing of the vaginal opening by creating a covering seal formed by cutting and repositioning the labia, sometimes including removal of the clitoris. Type IV includes all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping, or cauterizing [8]. Each type presents varying degrees of health risk and long-term sexual dysfunction. Understanding this typology is critical for healthcare providers and researchers when assessing clinical outcomes and tailoring intervention strategies [9]. 1.3. Rationale for Focusing on Sexual Health Outcomes Although much of the research on FGM has historically focused on physical and obstetric complications, there is a growing recognition of the significant toll it takes on women’s sexual health and psychosocial well-being. Survivors of FGM frequently report diminished sexual desire, arousal difficulties, painful intercourse, and an inability to achieve orgasm—all of which can profoundly impact quality of life and intimate relationships [10]. Sexual dysfunction resulting from FGM is not merely physiological but also rooted in psychological trauma, fear, and misinformation propagated through cultural narratives about female sexuality [11]. Moreover, limited access to sexual health education and support services exacerbates the silence and stigma surrounding these experiences. Focusing on sexual health outcomes not only validates the lived realities of survivors but also expands the framework for understanding FGM’s multidimensional impact. It aligns with global health goals that emphasize comprehensive sexual and reproductive rights as central to women's autonomy and dignity [12]. 1.4. Objectives and Structure of the Paper This paper aims to explore the sexual health consequences of FGM by analyzing available clinical and psychosocial evidence, with particular emphasis on survivors ’lived experiences and access to supportive services. It seeks to bridge the gap between biomedical findings and human rights discourses to provide a holistic perspective on FGM’s impact. Following this introduction, Section 2 provides an overview of sexual dysfunction associated with FGM. Section 3 reviews clinical and qualitative evidence, while Section 4 discusses intervention strategies and healthcare challenges. Section 5 offers recommendations for research, policy, and practice to improve survivor-centered care and promote sexual health equity [13]. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2932 Figure 1 Global map showing prevalence of FGM by region 2. Historical, cultural, and societal dimensions of FGM 2.1. Cultural and Traditional Justifications Female Genital Mutilation (FGM) is sustained by a complex web of cultural, traditional, and pseudo-religious beliefs that vary across regions and communities. One of the most frequently cited justifications is its perceived alignment with religious values, although no major religious text mandates or explicitly endorses the practice [5]. In many contexts, FGM is erroneously associated with Islamic teachings, despite strong condemnation by various Islamic scholars and religious authorities [6]. The practice is also embedded in rites of passage ceremonies, marking the transition from girlhood to womanhood. Within these traditions, FGM is often celebrated through elaborate community rituals and storytelling, framing it as a necessary step toward social acceptance and maturity [7]. As such, it is viewed not merely as a medical act but as a cultural performance that reinforces communal identity. Furthermore, FGM is widely believed to promote cleanliness, femininity, and aesthetic appeal. In several societies, uncut female genitalia are perceived as dirty, shameful, or masculine, and the act of cutting is framed as essential for hygiene and beauty [8]. These beliefs are perpetuated by older women, midwives, and community elders, creating a cycle of generational transmission. Despite growing awareness campaigns, these cultural narratives remain deeply entrenched and resistant to change, particularly where education and healthcare infrastructure are limited [9]. Understanding these justifications is essential for developing culturally sensitive interventions that challenge harmful norms while respecting the communities' need for identity and belonging [10]. 2.2. Social Norms, Gender Roles, and Community Pressures FGM operates within a broader framework of gendered social norms that prioritize female chastity, obedience, and family honor. In many communities, a girl's virginity and fidelity are directly linked to her genital status, and FGM is promoted as a method of controlling female sexuality and preserving moral behavior [11]. This belief not only diminishes women’s autonomy but also reinforces patriarchal expectations about women’s roles within marriage and society. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2933 The social pressure to conform is immense. Girls and families who resist FGM risk ostracization, shame, and diminished marriage prospects. In several cultures, uncut women are considered impure or unfit for marriage, reducing their value in the eyes of potential suitors and undermining the family’s social standing [12]. This connection between FGM and marriageability makes it a deeply gendered institution, upheld not only by men but also by women who fear social exclusion. Community honor is often cited as justification for continuing the practice. Families comply with FGM not out of personal conviction but due to the fear of reputational damage if seen as transgressing tradition [13]. This collective enforcement is compounded by silence and taboo surrounding sexual health discussions, making open dissent difficult. Although some communities have begun to question and abandon the practice, change is often uneven and contested. Peer pressure, misinformation, and generational loyalty continue to reinforce adherence to FGM, especially in rural or isolated regions [14]. Addressing these social dynamics requires community-driven strategies that engage local influencers, challenge harmful gender norms, and create safe spaces for dialogue and resistance [15]. 2.3. Legal Frameworks and Policy Interventions Table 1 Summary of National and International Laws on FGM Country Anti-FGM Law (Year Enacted) Key Legal Provisions Penalties for Violation Ratified International Treaties Kenya Prohibition of FGM Act (2011) Criminalizes FGM, bans medicalization, extraterritorial application Up to life imprisonment and/or fines CEDAW, Maputo Protocol, CRC Egypt Penal Code Amendment (2008, 2016) Criminalizes all forms of FGM including medicalized procedures 5–15 years imprisonment for practitioners CEDAW, CRC Nigeria Violence Against Persons (Prohibition) Act (2015) Prohibits FGM nationwide, overrides state law Up to 4 years imprisonment and/or fines CEDAW, Maputo Protocol United Kingdom FGM Act (2003); Serious Crime Act (2015) Criminalizes FGM, travel for cutting, failure to protect child Up to 14 years imprisonment CEDAW, CRC France Penal Code Articles 222-9 to 222-10 Recognizes FGM as a form of violence, extraterritorial jurisdiction Up to 20 years imprisonment CEDAW, CRC Somalia No national ban; some regional laws Legal ambiguity, traditional norms dominate Not consistently enforced CRC (ratified); CEDAW (not ratified) United States Federal Prohibition Act (1996, revised 2021) Criminalizes FGM and transport of minors for cutting Up to 10 years imprisonment CEDAW (not ratified); CRC (signed, not ratified) Australia State and territory laws; Model Criminal Code Prohibits FGM nationally and abroad 7–21 years imprisonment depending on jurisdiction CEDAW, CRC Over the past two decades, legal and policy measures have played an increasingly prominent role in global efforts to combat FGM. Many countries where the practice is prevalent have enacted national laws criminalizing FGM, often supplemented by penalties for medicalization and cross-border cutting [16]. For instance, Kenya, Egypt, and Burkina Faso have implemented explicit criminal provisions with varying degrees of enforcement [17]. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2934 On the international level, instruments such as the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Maputo Protocol explicitly condemn FGM and obligate member states to take legislative and preventive action [18]. The Sustainable Development Goals (SDG 5.3) further reinforce the global mandate to eliminate harmful practices, including FGM, by 2030. However, significant gaps remain between law and practice. In many countries, enforcement is weak due to limited resources, corruption, or reluctance among local authorities who view FGM as a cultural issue rather than a legal one [19]. Additionally, victims and witnesses are often unwilling to report due to fear of retaliation or loyalty to community members. Legal ambiguity also persists in countries with pluralistic legal systems where customary law may contradict statutory provisions. Diaspora countries have introduced extraterritorial laws enabling prosecution of citizens or residents who take girls abroad for FGM. The UK, France, and Sweden are notable for taking legal action against FGM within immigrant communities [20]. Still, prosecutions are rare, and prevention remains a priority over punishment. Effective policy interventions require a multi-sectoral approach that includes education, community sensitization, and healthcare support alongside legal mechanisms. Integrating anti-FGM education into school curricula, training frontline health workers, and creating anonymous reporting channels are crucial to bridging the gap between legislation and meaningful impact [21]. 3. Medical and Anatomical Consequences of FGM 3.1. Overview of FGM Classifications and Surgical Methods FGM is medically classified into four types, each associated with varying degrees of anatomical alteration and health risk. Type I, also known as clitoridectomy, involves the partial or complete removal of the clitoris and/or the prepuce. This is the least extensive form but still results in pain, bleeding, and long-term dysfunction [22]. Type II, or excision, includes partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. This type is more invasive than Type I and is commonly practiced in several African and Middle Eastern countries [23]. Type III, referred to as infibulation, is the most severe. It involves narrowing of the vaginal orifice by cutting and repositioning the labia minora or labia majora, sometimes accompanied by clitoral removal. A small opening is left for urine and menstrual flow, and the vaginal opening is often cut open at marriage or childbirth [24]. Type IV includes all other non-medical modifications such as pricking, piercing, scraping, or cauterizing the genital area. Although often perceived as “minor,” Type IV still poses significant medical and psychological risks [25]. The tools used are frequently non-sterile, including razor blades, knives, or broken glass, and procedures are typically conducted without anesthesia by traditional practitioners. Understanding these classifications is critical for clinical diagnosis, patient care, and designing appropriate intervention strategies [26]. 3.2. Short-Term Medical Complications FGM can lead to a range of immediate medical complications, many of which are life-threatening. Severe pain is universal due to the lack of anesthesia, often causing trauma and shock. The pain response is heightened by the rudimentary tools used and the absence of antiseptic measures [27]. Hemorrhage is a major concern, especially in Type II and III procedures where extensive tissue is excised. Excessive bleeding can result in hypovolemic shock, requiring emergency intervention—unavailable in many rural settings [28]. Infection is another frequent complication. The use of unsterilized instruments introduces bacteria that can cause tetanus, sepsis, and localized abscesses, often progressing to systemic illness [29]. Urinary retention is also common due to swelling, inflammation, or the fear of urinating through a painful wound. This can lead to urinary tract infections (UTIs), which are recurrent in many survivors. Fever, vomiting, and acute genital trauma may follow, particularly among younger girls with lower body mass and immune capacity [30]. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2935 In rare but critical cases, girls die from uncontrolled bleeding or sepsis. These outcomes often go unrecorded due to social silence, misreporting, or burial customs that conceal the cause of death. The psychological aftermath begins immediately, with girls experiencing fear, confusion, and dissociation from their bodies [31]. Due to the stigma and secrecy surrounding FGM, many girls receive no follow-up care. Early complications can progress to long-term health issues if untreated, including chronic infections and menstrual problems. The short-term risks of FGM thus underscore the urgency for preventive strategies and early clinical intervention [32]. 3.3. Long-Term Physical and Anatomical Sequelae Survivors of FGM face a lifetime of physical complications that significantly impact their sexual, reproductive, and overall health. Vulvar damage and scarring are among the most common outcomes, with extensive fibrosis leading to painful intercourse (dyspareunia), narrowed vaginal openings, and reduced sexual sensation [33]. In Type III infibulation, the vaginal orifice is often so constricted that menstruation and urination become painful and prolonged, increasing the risk of infections and reproductive tract damage. Neuroma formation, resulting from severed nerve endings during clitoral excision, can cause chronic pain and hypersensitivity. This discomfort persists throughout life and is often misunderstood by both patients and clinicians unfamiliar with FGM-specific pathologies [34]. Menstrual complications, including dysmenorrhea and hematocolpos, occur when blood flow is obstructed by scar tissue. These issues can result in abdominal swelling, anemia, and in some cases, require surgical correction. Obstetric risks are particularly concerning. Women with FGM are significantly more likely to experience obstructed labor, perineal tearing, postpartum hemorrhage, and the need for cesarean sections [35]. Urinary and vaginal infections are recurrent due to poor drainage and altered anatomy. The absence of normal genital structures also affects lubrication, leading to increased friction and tissue tearing during intercourse, which may predispose survivors to HIV and other sexually transmitted infections [36]. The anatomical damage is often compounded by psychological trauma. Many women associate their genital pain with shame and secrecy, leading to body image issues and avoidance of intimate relationships. This compounded trauma contributes to anxiety, depression, and sexual dysfunction, often in silence due to fear of stigmatization [37]. Recognizing these long-term sequelae is critical for developing trauma-informed care and tailored surgical or psychosexual interventions. Interdisciplinary healthcare teams must be trained to identify and address FGM-related complications across the patient’s lifespan to promote healing and restore dignity [38]. Figure 2 Illustration of genital alterations by FGM type This figure provides a visual comparison between a normal female genital anatomy and the alterations associated with Female Genital Mutilation (FGM) Types I, II, and III as classified by the World Health Organization (WHO): World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2936 • Normal Anatomy: This illustration shows the unaltered female genitalia, including the clitoris, urethral opening, labia minora, labia majora, and vaginal orifice, demonstrating natural anatomical orientation from anterior to posterior. • FGM Type I (Clitoridectomy): This type involves partial or total removal of the clitoral glans and/or the prepuce (clitoral hood). o Type Ia: Removal of the prepuce only. o Type Ib: Removal of the prepuce and the glans of the clitoris, either partially or totally. • FGM Type II (Excision): In this more extensive form, there is partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. This results in a broader range of tissue loss compared to Type I and significantly impacts sexual sensation and anatomical integrity. • FGM Type III (Infibulation): This most severe form involves the removal of part or all of the labia minora, and the labia majora are then sewn together to narrow the vaginal opening. A small opening is left for urine and menstrual blood to pass through. This closure can lead to chronic pain, infections, and severe obstetric complications unless surgically reversed (defibulation). 4. Impact of FGM on sexual function and experience 4.1. Neuroanatomical Disruption and Sensory Loss Female Genital Mutilation (FGM), particularly Types I and II, involves the excision of the clitoris and surrounding tissue, which results in significant neuroanatomical disruption. The clitoris contains over 8,000 nerve endings—more than any other part of the human anatomy—making it central to female sexual arousal and pleasure [39]. When these nerve endings are severed, there is not only a physical loss of sensation but also permanent damage to the pudendal nerve and associated sensory pathways, impeding neural transmission of sexual stimuli. The dorsal nerve of the clitoris, which plays a major role in sensory perception, is frequently injured or destroyed during the cutting process [40]. This damage significantly reduces the ability to perceive tactile stimulation, leading to anorgasmia and general loss of sexual sensation. In many women, this sensory loss is irreversible, even when surgical interventions attempt to reconstruct the clitoral area [41]. Additionally, scar tissue formation over damaged nerve endings may create neuromas, causing chronic pain or hypersensitivity. This condition is often misinterpreted or untreated due to limited awareness among healthcare providers. Neuroimaging studies also suggest that genital cutting may lead to reorganization in brain regions responsible for processing sexual pleasure, although further research is needed to substantiate these findings [42]. The extent of sensory loss depends on the type and extent of FGM, the age at which it was performed, and the skill of the practitioner. Regardless, the procedure invariably results in partial or complete elimination of the structures necessary for sexual sensory perception. Understanding these neurological consequences is crucial for informing clinical assessments, developing interventions, and validating survivors ’experiences of long-term dysfunction [43]. 4.2. Sexual Dysfunction and Dyspareunia Sexual dysfunction is among the most reported consequences of FGM, with dyspareunia (pain during intercourse) constituting a prevalent symptom across all forms of genital cutting. The removal or alteration of genital tissues— particularly the clitoris, labia minora, and vaginal opening—leads to anatomical changes that impair sexual activity and pleasure [44]. Women with infibulation (Type III) often experience narrowed vaginal introitus, which makes penetration painful or mechanically difficult, often necessitating defibulation surgery prior to sexual intercourse or childbirth [45]. In addition to physical alterations, the scarring and rigidity of remaining tissue reduce elasticity and lubrication, increasing the risk of tissue tears and further pain during intercourse. The reduction in lubrication is partly due to the removal of glands that contribute to vaginal moistening and partly due to autonomic nervous system suppression caused by emotional distress or trauma recall during intimacy [46]. Hormonal influences—such as stress-induced cortisol elevation—may further suppress arousal mechanisms, exacerbating dryness and pain [47]. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2937 Psychological factors also play a major role in sexual dysfunction post-FGM. Many women report feelings of shame, fear, or emotional disconnection from their genitals, which affect libido and sexual receptivity. Cultural silence around sexuality can intensify this disconnection, making it difficult to seek help or discuss symptoms with healthcare providers or partners [48]. Studies indicate that the prevalence of sexual dysfunction among women with FGM ranges from 60% to 80%, depending on the population and assessment criteria used [49]. Many women adapt to these changes by limiting sexual activity or enduring pain in silence, often driven by social obligations around marriage and procreation. Effective intervention requires both medical and psychosexual support, including physical rehabilitation, lubrication aids, trauma counseling, and sexual education. Multidisciplinary care teams that address both physical and emotional dimensions of dyspareunia are essential for improving sexual well-being among survivors [50]. 4.3. Orgasmic Disorders and Anorgasmia One of the most devastating consequences of FGM is the development of orgasmic disorders, particularly anorgasmia— the inability to achieve orgasm despite adequate stimulation and arousal. Orgasmic disorders are especially prevalent among women who have undergone Types I and II FGM, where partial or total clitoridectomy is common [51]. The clitoris is a critical organ for orgasm due to its high concentration of nerve endings and its role in the female sexual response cycle. When the clitoris is removed or extensively damaged, the neural circuits involved in generating and processing sexual pleasure are disrupted. Even in cases where some clitoral tissue remains, surrounding fibrosis, altered blood flow, and compromised nerve endings reduce the intensity and likelihood of orgasmic response [52]. Additionally, anatomical barriers, such as scar tissue or altered vulvar geometry, can obstruct stimulation of erogenous zones. Psychological contributors also exacerbate orgasmic difficulties. Survivors of FGM may associate sex with pain or violation, creating mental blocks that inhibit relaxation and pleasure. Moreover, a lack of sexual education in many practicing communities prevents women from understanding their bodies or seeking sexual fulfilment, reinforcing beliefs that female pleasure is unnecessary or immoral [53]. Prevalence studies across FGM-practicing countries show that 40% to 70% of cut women report difficulties achieving orgasm. In Western diaspora populations, the rates remain high despite access to more liberal sexual environments, indicating that physical damage is not the only determinant—cultural, emotional, and relational factors also play significant roles [54]. Medical interventions, such as clitoral reconstruction surgery, have shown some success in restoring sexual sensation and orgasmic function. However, outcomes vary and depend heavily on the extent of original damage, the timing of the procedure, and postoperative psychosexual support [31]. Therapy combining surgical, emotional, and educational components remains the most effective pathway for addressing FGM-related orgasmic disorders. 4.4. Psychosexual Sequelae and Intimacy Issues Beyond physical complications, FGM has profound psychosexual consequences that affect intimacy, body image, and personal identity. Many survivors report a diminished sense of sexual self-worth and an altered perception of femininity following the procedure. This disruption stems not only from the loss of erogenous tissue but also from the symbolic violation of their bodily autonomy [32]. The ritualistic framing of FGM—often accompanied by secrecy, coercion, or celebration—can create deep psychological conflict, particularly when girls grow older and understand the full implications of what was done to them. Feelings of betrayal, loss, and powerlessness are common, especially when trusted family members facilitated the act [33]. These experiences contribute to long-term emotional distress, including depression, anxiety, and post-traumatic stress disorder (PTSD). Sexual encounters often trigger emotional flashbacks, causing women to dissociate or avoid intimacy altogether. The fear of pain, judgment, or failure can inhibit arousal and closeness, creating tension in intimate relationships. Some women develop aversion to sexual activity entirely, while others participate out of obligation, suppressing their discomfort to fulfil marital or reproductive expectations [34]. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2938 FGM can also interfere with relationship dynamics. Partners may be unaware of the trauma or lack the language to discuss sexual difficulties, leading to misunderstandings and emotional distancing. In certain cases, FGM can contribute to marital conflict, infidelity, or even gender-based violence, particularly when male partners expect sexual performance without understanding the limitations imposed by cutting [35]. Addressing these sequelae requires trauma-informed care that respects cultural sensitivity while prioritizing survivors ’autonomy and well-being. Psychosexual counselling, peer support groups, and survivor-led education initiatives are essential tools in the healing process. Ultimately, restoring intimacy and self-confidence for FGM survivors involves not only physical recovery but also the reclamation of their identity, sexuality, and personal agency [36]. Table 2 Summary of Reported Sexual Dysfunctions by FGM Type FGM Type Anatomical Alteration Common Sexual Dysfunctions Prevalence Estimates Clinical Observations Type I Partial/total removal of clitoris and/or prepuce Reduced sexual desire, decreased clitoral sensation, delayed orgasm 50%–70% Moderate loss of erogenous stimulation Type II Removal of clitoris and labia minora (± labia majora) Dyspareunia, anorgasmia, reduced lubrication, sexual aversion 60%–85% Greater nerve damage, increased emotional trauma Type III Infibulation: removal of clitoris and labia, narrowing of vagina Severe dyspareunia, anorgasmia, penetration difficulties, low libido 75%–95% Most restrictive; often requires defibulation for intercourse Type IV Pricking, piercing, cauterization, or scraping Variable: sexual anxiety, fear, occasional dyspareunia Unknown; fewer studies available Psychological trauma often significant despite minimal cutting Figure 3 Graph of sexual health outcomes across different FGM types World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2945 A well-functioning team ensures that survivors receive coordinated and continuous care, beginning with needs assessments and extending to follow-up and community reintegration. For example, gynaecologists and surgeons handle defibulation or reconstruction, while psychotherapists address trauma, and social workers assist with legal, housing, or immigration concerns. Midwives and nurses play a key role in reproductive counselling and childbirth planning, ensuring that survivors receive culturally competent prenatal care and respectful delivery services [35]. Collaboration among disciplines enhances care quality, reduces gaps in service delivery, and supports comprehensive healing. Regular case reviews, shared electronic health records, and patient navigators help maintain alignment and accountability across the care continuum. Multidisciplinary teams also support advocacy, research, and training initiatives to improve system-wide responses to FGM. Ultimately, this integrated approach not only addresses immediate clinical needs but also promotes long-term resilience, dignity, and empowerment for survivors navigating the aftermath of FGM [36]. 9. Strategies for prevention and global health advocacy 9.1. Community Education and Empowerment Sustainable eradication of Female Genital Mutilation (FGM) requires community-centered education and empowerment initiatives that confront deeply rooted beliefs while promoting informed decision-making. Education programs targeting parents, adolescents, and caregivers can shift attitudes by highlighting the health risks and human rights violations associated with FGM [30]. Interactive workshops, school-based curricula, and multimedia campaigns that use local languages and culturally relevant narratives have proven effective in changing perceptions. Crucially, these initiatives must move beyond awareness to foster empowerment, especially among women and girls. Programs that promote girls ’education, delay marriage, and support economic independence increase the likelihood that they will resist FGM and advocate for others in their community [31]. Empowerment also involves creating safe spaces for dialogue, storytelling, and peer support, where survivors and at-risk individuals can share experiences without fear of judgment or retaliation. Evidence from successful interventions in countries like Senegal and Ethiopia shows that when communities are actively involved in designing and delivering education campaigns, abandonment of FGM becomes more sustainable [32]. These grassroots approaches are most impactful when combined with access to healthcare, counselling, and legal protection, reinforcing the message that abandoning FGM is both safe and socially acceptable. 9.2. Engagement of Religious and Traditional Leaders Religious and traditional leaders hold significant influence in many FGM-practicing communities and are therefore essential allies in the fight against the practice. Misconceptions that FGM is a religious obligation are widespread, despite the absence of scriptural justification in both Islam and Christianity [33]. Engaging faith leaders to publicly denounce FGM helps to dispel these myths and reassures followers that abandoning the practice does not conflict with spiritual beliefs. Traditional leaders, including elders, chiefs, and circumcisers, also shape cultural norms and practices. Involving them in dialogue and alternative rites of passage programs has been successful in reinterpreting tradition without perpetuating harm [34]. Community declarations made in partnership with these leaders carry significant weight and can catalyze collective abandonment. Importantly, engagement efforts must be framed as collaborative and respectful, rather than accusatory or external. Leaders are more likely to participate when they are included in solution-building, acknowledged for their authority, and equipped with accurate health information and theological guidance [35]. Successful programs often provide capacity-building for leaders, empowering them to act as champions for change within their own communities. This approach not only accelerates behavioural change but also lends legitimacy to anti-FGM efforts, fostering trust and cooperation at the grassroots level. 9.3. Policy Advocacy, Law Enforcement, and Global Coalitions Policy reform, legal enforcement, and international collaboration are integral to the global strategy for eliminating FGM. National legislation criminalizing FGM exists in over 30 countries, yet enforcement remains inconsistent due to World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2946 corruption, limited resources, and social resistance [36]. Advocacy efforts are essential to strengthen legal frameworks, ensure protection for at-risk girls, and hold perpetrators accountable through fair and transparent judicial systems. Global coalitions—led by organizations such as UNFPA, UNICEF, and the World Health Organization (WHO)—have united stakeholders through multi-sectoral initiatives like the Joint Programme on the Elimination of FGM. These coalitions support national governments by funding education, healthcare infrastructure, legal reform, and data collection to monitor progress [37]. International instruments such as the Convention on the Rights of the Child, CEDAW, and the Sustainable Development Goals (Target 5.3) provide the normative basis for global action. Policy advocacy should align national strategies with these international obligations, encouraging governments to implement cross-cutting interventions that span health, education, and justice sectors [38]. Furthermore, civil society organizations play a critical role in monitoring implementation, engaging communities, and holding states accountable. When supported by strong legal frameworks and international cooperation, policy advocacy becomes a powerful driver of lasting change in the global fight to end FGM. 10. Conclusion and future directions 10.1. Key Findings and Interdisciplinary Implications This paper has critically examined the multifaceted impact of Female Genital Mutilation (FGM), emphasizing its devastating consequences on sexual health, psychological well-being, reproductive outcomes, and relational dynamics. The evidence demonstrates that FGM leads to a wide range of chronic physical and psychosexual dysfunctions, including pain during intercourse, anorgasmia, infections, infertility, and trauma-induced aversion to intimacy. Beyond its physiological toll, FGM undermines women's autonomy, self-perception, and access to equitable healthcare. A central finding is the need for interdisciplinary collaboration in managing FGM-related outcomes. Effective care requires integration of medical, surgical, psychological, and social services tailored to the survivor's specific type of cutting, cultural background, and lived experience. Gynaecologists, psychotherapists, social workers, community health educators, and policy advocates must work together to ensure that clinical interventions are paired with traumainformed therapy, legal protection, and culturally responsive outreach. Moreover, prevention and eradication strategies are most successful when rooted in community engagement and supported by religious and traditional leaders. Global health coalitions, legal institutions, and grassroots movements must operate in unison to dismantle harmful norms and uphold the rights of women and girls. FGM is not only a medical or legal issue—it is a deeply social, emotional, and ethical challenge that demands holistic, interdisciplinary responses. 10.2. Recommendations for Research, Policy, and Clinical Practice To enhance survivor support and accelerate the eradication of FGM, future efforts should prioritize survivor-centered research that captures long-term physical, psychological, and sexual health outcomes across diverse cultural settings. Rigorous, longitudinal studies are needed to evaluate the effectiveness of surgical and therapeutic interventions, including clitoral reconstruction and trauma-informed psychosexual therapy. On the policy front, national governments should strengthen legal enforcement mechanisms while expanding access to education and social protection for girls at risk. Policies must bridge the gap between legislation and practice by investing in capacity-building for frontline workers and community leaders. Legal reforms should also include provisions for confidential reporting and safe shelters for survivors and at-risk individuals. Clinically, all health professionals should receive training on identifying and managing FGM-related complications using culturally sensitive and patient-centered approaches. Multidisciplinary teams must be embedded into health systems to ensure seamless coordination between surgical care, counseling services, reproductive health, and advocacy support. Ultimately, the eradication of FGM and the healing of survivors require a united effort across disciplines—blending science, compassion, policy, and grassroots empowerment to uphold dignity, restore health, and protect future generations from harm. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2947 References [1] World Health Organization. Female genital mutilation: Key facts. Geneva: WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation [2] UNICEF. Female Genital Mutilation: A Global Concern. New York: UNICEF; 2016. Available from: https://data.unicef.org/resources/female-genital-mutilationcutting-global-concern/ [3] United Nations Population Fund. FGM Frequently Asked Questions. UNFPA; 2023. Available from: https://www.unfpa.org/female-genital-mutilation [4] Nour NM. Female Genital Cutting:: Clinical and Cultural Guidelines. Obstetrical & gynecological survey. 2004 Apr 1;59(4):272-9. [5] LAST M. Female ‘Circumcision’in Africa: culture, controversy and change edited by BETTINA SHELL-DUNCAN and YLVA HERNLUND Boulder, CO: Lynne Rienner, 2000. Pp. viii+ 349. US $59· 95. The Journal of Modern African Studies. 2001 Dec;39(4):717-43. [6] Kandala NB, Ezejimofor MC, Uthman OA, Komba P. Secular trends in the prevalence of female genital mutilation/cutting among girls: a systematic analysis. BMJ global health. 2018 Oct 1;3(5):e000549. [7] World Health Organization. Eliminating female genital mutilation: an interagency statement. Geneva: WHO; 2008. [8] UNICEF. Child protection from violence, exploitation and abuse: Female genital mutilation/cutting. New York: UNICEF; 2022. Available from: https://data.unicef.org/topic/child-protection/female-genital-mutilation/ [9] Berg RC, Denison E. A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls. Paediatr Int Child Health. 2013;33(4):322–33. [10] Johansen REB. Pain as a counterpoint to culture: toward an analysis of pain associated with infibulation among Somali immigrants in Norway. Med Anthropol Q. 2002;16(3):312–40. [11] Almroth L. Genital mutilation of girls in Sudan: community-and hospital-based studies on female genital cutting and its sequelae. Karolinska Institutet (Sweden); 2005. [12] Elmusharaf S. Female genital mutilation: Determinants and consequences among girls and women in Sudan. Karolinska Institutet (Sweden); 2013. [13] Refaei M, Aghababaei S, Pourreza A, Masoumi SZ. Socioeconomic and reproductive health outcomes of female genital mutilation. Archives of Iranian Medicine. 2016 Nov 1;19(11):0-. [14] Abdelshahid A, Campbell C. “Should I circumcise my daughter?” Exploring diversity and ambivalence in Egyptian parents' social representations of female circumcision. J Community Appl Soc Psychol. 2015;25(1):49–65. [15] Foldès P, Cuzin B, Andro A. Reconstructive surgery after female genital mutilation: a prospective cohort study. Lancet. 2012;380(9837):134–41. [16] Balogun OO, Hirayama M, Wariki WM, Koyanagi A, Mori R. Interventions for improving outcomes for pregnant women who have undergone female genital mutilation: a systematic review and meta-analysis. BJOG. 2016;123(3):439–47. [17] Brady M. Female genital mutilation: complications and risk of HIV transmission. AIDS Patient Care STDS. 1999;13(12):709–16. [18] Berg RC, Denison E. Does female genital mutilation/cutting affect women's sexual functioning? A systematic review of the sexual consequences of FGM/C. Sex Res Soc Policy. 2012;9(1):41–56. [19] Johnson-Agbakwu CE, Helm T, Killawi A, Padela AI. Perspectives on the sexual health experiences of African immigrant women: a case study from the Somali community in the U.S. Ethn Health. 2014;19(6):538–54. [20] Dawson A, Homer CSE, Turkmani S, Black K, Varol N. A systematic review of studies on the health outcomes of female genital mutilation/cutting: issues of quality and evidence. Int J Obstet Gynaecol. 2015;122(3):278–87. [21] Behrendt A, Moritz S. Posttraumatic stress disorder and memory problems after female genital mutilation. Am J Psychiatry. 2005;162(5):1000–2. [22] Vloeberghs E, van der Kwaak A, Knipscheer J, van den Muijsenbergh M. Coping and chronic psychosocial consequences of female genital mutilation in the Netherlands. Ethn Health. 2012;17(6):677–95. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2948 [23] Nour NM. Health consequences of female genital cutting: a systematic review. JAMA. 2007;297(5):513–7. [24] Essén B, Johnsdotter S. Female genital mutilation in the West: traditional circumcision versus genital cosmetic surgery. Acta Obstet Gynecol Scand. 2004;83(7):611–3. [25] Berg RC, Taraldsen S, Said MA, Søftestad S, Lien IL. An updated systematic review and meta-analysis of the consequences of female genital mutilation. BMJ Glob Health. 2021;6(12):e005397. [26] Abdulcadir J, Rodriguez MI, Say L. Research gaps in the care of women with female genital mutilation: an analysis. BJOG. 2015;122(3):294–303. [27] Chalmers B, Omer-Hashi K. Female genital mutilation: cultural and psychological implications. Obstet Gynecol Surv. 2000;55(2):137–43. [28] Berg RC, Denison E, Fretheim A. Psychological, social and sexual consequences of female genital mutilation/cutting (FGM/C): a systematic review of quantitative studies. Oslo: Norwegian Knowledge Centre for the Health Services; 2010. [29] Johnsdotter S, Mestre RM. Female genital cutting and medicalization: risk reduction or promotion of the practice? Arch Sex Behav. 2021;50(3):945–55. [30] WHO. Guidelines on the management of health complications from female genital mutilation. Geneva: World Health Organization; 2016. [31] Emmanuel Oluwagbade and Oluwole Raphael Odumbo. Building resilient healthcare distribution networks: Adapting to crises, securing supplies and improving scalability. Int J Sci Res Arch. 2025;14(01):1579–98. Available from: https://doi.org/10.30574/ijsra.2025.14.1.0265 [32] UNFPA and UNICEF. Joint Programme on Female Genital Mutilation: Accelerating Change. New York: UNFPA and UNICEF; 2020. [33] UN Women. The role of religious and traditional leaders in ending FGM. New York: UN Women; 2019. [34] Shell-Duncan B, Naik R, Feldman-Jacobs C. A state-of-the-art synthesis on female genital mutilation/cutting: What do we know now? Evidence to end FGM/C: Research to Help Women Thrive. New York: Population Council; 2016. [35] Varol N, Dawson A, Turkmani S, Hall J, Nanayakkara S, Jenkins G, et al. Obstetric outcomes for women with female genital mutilation at an Australian hospital, 2006–2012: a descriptive study. BMC Pregnancy Childbirth. 2016;16:328. [36] Elnashar A, El-Dien Ibrahim M. The impact of female genital cutting on health of newly married women. Int J Gynaecol Obstet. 2007;97(3):238–44. [37] Hodes D. Female genital mutilation/cutting in the UK—challenging the inconsistencies. Arch Dis Child. 2017;102(8):701–5. [38] UNICEF. Changing a harmful social convention: female genital mutilation/cutting. Innocenti Digest No. 12. Florence: UNICEF Innocenti Research Centre; 2005. [39] Leye E, Mergaert L, Arnaut C, O'Brien Green S. Towards a better estimation of prevalence of female genital mutilation in the European Union: interpreting existing evidence in all EU Member States. Genus. 2014;70(1):99– 121. [40] Raymond Antwi Boakye, George Gyamfi, Cindy Osei Agyemang. DEVELOPING REAL-TIME SECURITY ANALYTICS FOR EHR LOGS USING INTELLIGENT BEHAVIORAL AND ACCESS PATTERN ANALYSIS. International Journal of Engineering Technology Research & Management (IJETRM). 2023Jan21;07(01):144–62. [41] Berg RC, Underland V. The obstetric consequences of female genital mutilation/cutting: a systematic review and meta-analysis. Obstet Gynecol Int. 2013;2013:496564. [42] Abdulcadir J, Say L, Pallitto C. What do we know about assessing healthcare students and professionals' knowledge, attitude and practice regarding female genital mutilation? A systematic review. Reprod Health. 2017;14(1):64. [43] Eunice Olowomeye. Exploring interdisciplinary family medicine approaches to improve chronic disease management and patient-centered outcomes. Int J Res Publ Rev. 2025 May;6(5):12378–12395. World Journal of Advanced Research and Reviews, 2025, 26(02), 2930-2949 2949 [44] Ejedegba Emmanuel. Innovative solutions for food security and energy transition through sustainable fertilizer production techniques. World Journal of Advanced Research and Reviews. 2024 Dec;24(3):1679–1695. Available from: https://doi.org/10.30574/wjarr.2024.24.3.3877 [45] Ogundu PG. Economic policies, financial markets, and global currency dynamics shaped by US trade tensions. Int J Res Publ Rev. 2025 Jan;6(1):4819-31. Available from: https://doi.org/10.55248/gengpi.6.0125.06410 citations [46] Essén B, Mosselmans L, Wilund D. Providing culturally competent care for women living with FGM: what does the evidence say? Best Pract Res Clin Obstet Gynaecol. 2020;62:86–98. [47] WHO. Care of girls and women living with female genital mutilation: a clinical handbook. Geneva: World Health Organization; 2018. [48] Khosla R, Banerjee J, Chou D, Say L, Fried ST, Temmerman M. Gender equality and human rights approaches to female genital mutilation: a review of international human rights norms and standards. Reprod Health. 2017;14(1):59. [49] UNFPA. Female genital mutilation (FGM) frequently asked questions. New York: United Nations Population Fund; 2021. [50] United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015. [51] Earp BD. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework. J Med Ethics. 2016;42(7):429–34. [52] UNICEF. Female genital mutilation: a statistical overview and exploration of the dynamics of change. New York: UNICEF; 2013. [53] Creighton SM, Hodes D. Female genital mutilation: what every paediatrician should know. Arch Dis Child. 2016;101(3):267–71. [54] WHO, UNICEF, UNFPA, World Bank. Trends in maternal mortality 2000 to 2020. Geneva: WHO; 2023.