Lower urinary tract symptoms, sexual satisfaction and post-traumatic stress disorder in circumcised and uncircumcised women referred to Mahabad health centers, 2020: a cross-sectional study

Abstract

Abstract

Introduction: Female genital mutilation (FGM) covers all procedures that result in incomplete or complete incision of the female genitalia or other types of damage for non-medical reasons. It is a gross violation of human rights and a major health problem for women in some societies. The present study aimed to compare lower urinary tract symptoms, sexual satisfaction and post-traumatic stress disorder among the Kurdish women with and without genital mutilation.

Methods: This was a cross-sectional study, performed on 310 women aged 18-45 years referring to Mahabad health centers in 2021. Participants were 155 circumcised and 155 uncircumcised women referred to Mahabad health centers. The selection of both groups was based on inclusion and exclusion criteria. After approval of the Committee of Ethics, researcher extracted the phone numbers of the women from the health records and checked the eligibility criteria for the study via call and invited them to the study. Participants were then invited to attend in health centers. The participants were chosen using convenience sampling method. Group matching was done based on the age variable with a difference of ± 2 years. After completing the informed consent form by the participants, the type of FGM/C was determined through the gynecological examination. Then, Individual-socio-information questionnaires, lower urinary tract symptoms(LUTS), sexual satisfaction and post-traumatic stress disorder (PTSD) checklist were completed in both groups by interview. Data were analyzed using SPSS25 software. To compare lower urinary tract symptoms, sexual satisfaction and symptoms of post-traumatic stress disorder between the two groups, independent t-test, Mann-Whitney U test, ANCOVA. and chi square were used.

Results: All 155 women (100%) had type 1 genital mutilation. The total mean (SD) score of LUTS was 7.94 (4.31) in women with FGM and 7.30 (3.33) in women without FGM, ranging from 5 -10 (P = 0.3). Among LUTS, only the mean (SD) score of retention symptoms in circumcised women 1.58 (1.53) was significantly higher than that in uncircumcised women 1.08 (1.17) (P = 0.004). The frequency of dysuria during urination from the retention area and the frequency of nocturnal enuresis/ nocturia from the voiding area in women withFGM were significantly higher than those in women without FGM (P = 0.005). The mean (SD) score of sexual satisfaction was 87.10 (6.15) and 86.99 (4.44) among women with and without GM/C, respectively. After controlling the effect of confounding variables, no significant difference was observed between the two groups (P = 0.84). The mean (SD) score of the PTSD symptoms among circumcised and uncircumcised women was 27.73 (6.79) and 17.85(4.70), respectively (P = 0.001).

Conclusion: Circumcised women are significantly more prone to have retention symptoms ‏ from LUTS and of which, the frequency of dysuria and nocturia from voiding area . In the present study, no significant difference was observed between the two groups regarding sexual satisfaction. This result could be due to the limited area of genital injury due to the high prevalence of type 1 circumcision in the study population. The results showed that post-traumatic stress disorder was higher in the group of circumcised women than in the group of uncircumcised women. It is recommended to conduct further study in communities with the prevalence of other types of FGM to generalize the results.