Female sexual dysfunction (FSD), characterized by persistent problems with desire, arousal, orgasm, or pain, can occur in women with any type of female genital mutilation (FGM) as a result of anatomical changes, pain, or psychological trauma.
To systematically review the evidence on the effects of non-surgical interventions, including sexual counseling, mechanical devices, and lubricants, on the sexual function in women living with FGM.
A comprehensive search was conducted in CINAHL Plus, IRIS, MEDLINE (Ovid), PsycINFO (EBSCOhost), SCOPUS, and Web of Science from inception to November 2025. Reference lists were hand-searched and study authors contacted for additional data.
Studies were eligible if they involved women with any type of FGM who received non-surgical interventions for FSD.
One controlled trial met the inclusion criteria. Data were extracted independently by two reviewers, and the certainty of the evidence was assessed using the GRADE approach.
In women with Type I FGM, use of the FDA-approved Eros-Clitoral Therapy Device (CTD) combined with psychotherapy led to statistically significant improvements across all domains of the Female Sexual Function Index compared with psychotherapy alone. In the control group, only orgasm scores improved.
Evidence on non-surgical interventions for FSD in women with FGM is extremely limited and based solely on a small single trial in women with Type I FGM. Although Eros-CTD shows promise, findings cannot be generalized to other FGM types, and data on safety and contraindications are lacking. Further research is needed across diverse populations and FGM types to inform practice and policy.
Objective: Combined oral contraceptives (COCs) for dysmenorrhea management have been covered by the Japanese universal health insurance system since 2008. Several public awareness events regarding COC prescriptions for dysmenorrhea were implemented between 2013 and 2015, including media reports on COC-related fatalities in 2013, drug safety alerts in 2014, and new clinical guidelines in 2015. This study aimed to examine the trends in patient characteristics, coagulation testing, and thromboembolism incidence before and after these events.
Methods: We used the JMDC claims database to identify patients with dysmenorrhea prescribed COCs between 2009 and 2021. We evaluated the annual trends in guideline-listed thromboembolism risk factors (age ≥ 40 years, obesity, and smoking), frequency of patients undergoing coagulation testing among patients prescribed COCs, and thromboembolism incidence.
Results: Of 860 840 patients with dysmenorrhea, 173 502 received COCs. The proportion of patients prescribed COCs decreased temporarily from 12.2% to 11.2% in 2014. The proportion of new COC prescriptions increased for women aged <40 years and decreased for those aged ≥40 years. The proportions of patients with obesity and smokers remained stable from 2016. The frequency of coagulation testing increased annually, rising sharply from 15% to 22% in 2014. The incidence of thromboembolism with treatment decreased from 11.8 to 9.9 per 10 000 person-years from 2016 to 2021.
Conclusion: Although no direct causal relationship is clear, public health awareness events might have influenced clinical practices, including the preferential selection of lower-risk patients and promotion of coagulation screening, possibly resulting in a decline in the incidence of thromboembolism.
Female genital mutilation (FGM) affects more than 230 million girls and women globally and poses substantial public health, human rights, and gender-equality challenges. While community and legislative initiatives remain central to elimination efforts, emerging evidence underscores the pivotal role of health systems in prevention, clinical management, and rights-based support for survivors.
This editorial synthesizes findings from six systematic and mixed-method reviews that inform the 2025 WHO guideline on the prevention of FGM and the management of its complications, with a focus on community interventions, health-worker capacity building, legal and policy frameworks, deinfibulation, clitoral reconstructive surgery, and non-surgical sexual-health interventions.
Evidence suggests that community education may shift knowledge and attitudes supporting abandonment. Training improves provider knowledge and confidence but requires stronger ethical and regulatory alignment. Laws and professional codes influence provider behavior but may generate unintended harms without clear guidance. Clinical interventions, including deinfibulation and reconstructive surgery, show potential benefits but are supported by low-certainty and methodologically limited evidence. Research on non-surgical sexual-health interventions is minimal.
Eliminating FGM and improving survivor care require an integrated health-systems approach, aligned legal and professional frameworks, and survivor-centered, methodologically robust research to guide prevention, clinical management, and ethical practice.
Objective: This study compares rates of menopausal hormone therapy (MHT) initiation between perimenopausal and postmenopausal women with moderate-severe vasomotor symptoms (VMS) with and without substance use in a longitudinal cohort of diverse US women with or without HIV.
Methods: Using menopause symptoms, hormone use, and substance use data from Women's Interagency HIV Study biannual visits (10/2008-9/2019), we compared initiation of and breaks in MHT among participants with moderate-severe VMS (1) with or without current substance use and (2) with or without ever using substances. We calculated unadjusted rates and adjusted rate ratios (RR) for demographics and health variables using Poisson regression.
Results: The median age of participants (n = 1579) with moderate-severe VMS was 50 years old, with 73% living with HIV, and 68% identifying as Black. They reported ever using tobacco (76%), heavy alcohol (39%), cannabis (45%), and other drugs (43%). Few reported hormonal contraception (5%) or MHT (9%) during the study period. Hormone initiation (overall 3.53 per 100 person-years; 95% confidence interval [CI]: 2.93, 4.26) was less likely with current tobacco use (RR: 0.67, 95% CI: 0.45, 0.99) or ever using other drugs (RR: 0.61; 95% CI: 0.40, 0.91). Hormone breaks (overall 52.58 per 100 person-years [95% CI: 44.52, 61.90]) were not associated with substance use.
Conclusion: The rate of MHT initiation was low and the rate of MHT breaks was high in this sample of perimenopausal and postmenopausal participants with moderate-severe VMS. Patients and providers might benefit from specific guidance regarding MHT use among individuals with current tobacco use and those who have ever used other drugs.
Objectives: This paper examines the incidence, risk factors, and clinical variables of lower urinary tract symptoms (LUTS) following vaginal delivery and evaluates the diagnostic accuracy of urethral angles and bladder neck descent (BND) in stress urinary incontinence using two dimensional (2D) transperineal ultrasoufnd.
Methods: Four hundred and eight low-risk women at ≥37 weeks gestation undergoing vaginal delivery were recruited. On day 2 postpartum, the ICIQ-FLUTS questionnaire was applied for presence of urinary symptoms. Cases were defined as women having LUTS on day 2 postpartum (n = 82). An equal number of controls were taken from the cohort without LUTS as per nested case-control study design (n = 82). At 6 weeks, subjects were re-evaluated for resolution or persistence of urinary symptoms. In addition, Pelvic Floor Distress Inventory 20 (PFDI 20) score and Oxford grading were performed for pelvic floor dysfunction. 2D transperineal ultrasound was performed to compare the pubourethral angle (α), the posterior urethrovesical angle (β) at rest, and Valsalva.
Results: Incidence of LUTS on day 2 postpartum was 20.1%, nocturia being the most common symptom. Approximately 43% of these subjects reported persistence of symptoms at 6 weeks. Multivariate logistic regression analysis revealed prolonged second stage of labor (odds ratio [OR], 1.054; P = <0.001) and higher birth weight (OR, 3.132; P = 0.026) as risk factors. Cutoffs obtained for Rα, Rβ, and BND were >10°, >13°, and 12 mm, respectively, with almost equal accuracy in diagnosing stress urinary incontinence and posterior urethrovesical rotation angle (Rβ) being the best predictor.
Conclusion: Incidence of LUTS postpartum is high and urinary symptoms might persist for several weeks after vaginal delivery. Careful attention in the postnatal clinics, counseling, appropriate management, and follow-up should be offered.
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