Examining the Types and Consequences of Female Genital Mutilation in Somalia: A Cross-Sectional Study on the Burden and Impact of Acute and Long-Term Complications

Background: In Africa, female genital mutilation (FGM) is a widespread and harmful practice, with Somalia having the highest incidence at 98%. This practice has severe and long-lasting physical and mental health consequences. The aim of the study was to evaluate the different types of FGM;immediate and long-term complications associated with the practice, and identify factors related to its prevalence. Method: In a one-year cross-sectional hospital-based study, data were collected from females aged 18 - 50 with a history of FGM. Face-to-face semi-structured questionnaires were used for data collection. Data analysis was performed using SPSS version 26, utilizing univariate and bivariate analyses to identify correlations between variables, which were presented in tables. Results: In a study involving 255 female participants, 65.5% were between 18 and 30 years old. The majority (82.7%) were married, while 47.1% were illiterate. FGM cases were more prevalent in rural areas (61.6%). Among the participants, 45.1% were employed. Type 3 FGM was the most common (44.3%), followed by Type 2 (32.2%) and Type 1 (23.9%). In terms of short-term complications experienced by circumcised women, the most common were bleeding, reported by 29.8% of participants, followed by infection (25.1%), and urinary retention (19.2%). Among the long-term complications observed, recurrent vaginal infections were the most prevalent, affecting 29.8% of the surveyed females. This was episiotomy during delivery (22.3%) and genital scarring (10.2%). Conclusion: The study reveals that Type 3 FGM is highly prevalent among the surveyed females, contributing to an increased risk of recurrent vaginal infections, prolonged second stage of labor, higher likelihood of episiotomy during delivery, and genital scarring. These findings emphasize the urgent need for effective preventive strategies and implementation from both international and local organizations to eliminate the harmful practice of FGM.

A Content Analysis Study Describing Information Regarding Female Genital Mutilation Present in US Medical Textbooks

This study examines the depth of information regarding Female Genital Mutilation (FGM)/Female Cutting (FC) present in US medical textbooks. According to Klein et al. (2018) [1], despite substantial attention regarding the effects of FGM, this practice is still ongoing all over the world. Healthcare providers are very important actors who need to understand FGM in order to provide care to girls and women subjected to it, but the small amount of existing work in this area shows a low level of knowledge and training about FGM/FC among U.S. physicians. The Center for Disease Control and Prevention (CDC) first published the estimated number of girls at risk of FGM/FC in the U.S. to be about 168,000 in 1997;that number had increased to 513,000 girls in the US by 2012 (according to Goldberg et al.) In this study, a small sample of medical textbooks were analyzed for the degree to which the textbooks include information regarding FGM/FC. The results of this study show that US medical textbooks do not include information regarding FGM/FC, suggesting that most medical providers don’t have knowledge and training about FGM/FC. The inadequate information on FGM/FC in medical textbooks reflects a culturally biased lack of recognition of the number of girls and women affected in the US. This maintains an ongoing pattern of silence that reinforces gender inequality. Considering the inadequate information covered in US medical textbooks on FGM/FC, and the concordant lack of provider training to provide advice and care to affected girls and women, incorrect and missed diagnoses may lead to harm to victims of FGM/FC. Providers would be better equipped to care for women and girls if their medical training included information regarding FGM/FC.

Urological Complications of Female Genital Mutilation: A Case Report of 15 Patients

Objective background: This was a retrospective study of the clinical and therapeutic aspects of urological complications of female genital mutilation in the urology department of Bamako’s Gabriel Touré University Hospital. Methods: Our study took place from 2002 to 2017 in the urology department of the Gabriel Touré University Hospital in Bamako and concerned cases of complications of female genital mutilation. Our study included all girls or women presenting with urinary disorders related to complications of genital mutilation and received in urological consultation and surgical management. Results: The average age of our patients was 2.5 years, with extremes ranging from 3 months to 35 years. The oldest patient had presented with dystocia during both deliveries. Acute urine retention (n = 7) was the most frequent reason for consultation. Other signs included urinary incontinence, pollakiuria and burning. Physical examination revealed clitoridectomy and abrasion of the labia minora in 13 patients. Type III of the WHO classification of female genital mutilation was the most frequent and corresponded to infibulation.

A Study of Monocyte Excretion of TNF- α and IL-6 and Monocyte Expression of HLA Class Ⅱ Antigen In Genital Herpes

Objective: To study the role of monocytes in the pathogenesis of genital herpes. Methods: TNF- α and IL-6 levels in 27 cases of genital herpes were detected by enzyme linked immunosorbant assay (ELISA). HLA class Ⅱ antigen expression on monocytes were detected by an alkaline phosphatase anti-alkaline phosphatase method. Results: Compared with normal controls, levels of TNF- a and IL - 6 secreted by monocytes responding to LPS mitogen in vitro were significantly decreased [(3.13 ± 0.44ng/ml) vs (4.68 ± 0.54ng/ml), P<0.05 and (3.32 ± 1.06ng/ml) vs (6.46 ± 1.94ng/ ml), P<0.05, respectively]. HLA class Ⅱ antigen expression on monocytes in the genital herpes group was also significantly decreased [HLA-DR (67.48% ± 1.51%) vs (81.03% ± 1.32%), P<0.01 and HLA-DQ (29.54% ± 1.15%) vs (37.63% ± 1.79%), P <0.01 respectively]. Conclusion: These findings suggest that the decreased monocyte function may contribute to the pathogenesis of genital herpes. Augmenting or inducing monocyte function may be important in the prevention, treatment, and reduction of genital herpes cases.

Association Between Genital Ulcer Disease and HIV Seroprevalence among STD Patients in Guangzhou

Objectives: To understand genital ulcer disease(GUD) among patients attending sexually transmitteddisease (STD) clinics in Guangzhou, China, and itsassociation with HIV infection.Methods: Between September 9th, 1997 and Octo-ber 30th, 2002, 8 962 patients with STDs wereevaluated. 285 patients were diagnosed with GUD basedon clinical manifestations and microbiologic evalua-tions including dark field microscopy and serologytest for syphilis (RPR, TPPA). Swabs of each genitalulcer were processed in a multiplex PCR assay (M-PCR) for simultaneous detection of Herpes simplexvirus (HSV), Treponema pallium, and Haemophilusducreyi. Other STDs were classified by routine diag-nostic criteria, including microscopy or culture forNeisseria gonorrhoeae, Chlamydia trachomatis,Urea- plasma urealyticum, Human papillomavirus,Trichomonas, etc.Results: Of the 8 962 patients with STDs, the HIVseroprevalence in patients with and without GUD was1.75% (5/285) and 1.53% (133/8677), respectively,with no statistically significant difference (χ 2=0.09,P>0.05; OR=1.15, 95%CI=0.47-2.81) . HIVseroprevalence in patients with syphilis, genital her-pes and other STDs was 2.81% (22/784), 0.74% (6/814) and 1.49% (110/7 364), respectively. Prevalencein patients with syphilis was significantly higher thanthat in patients with genital herpes and other STDs,(χ 2=9.92, P<0.005, OR=3.89, 95%CI=1.67-9.05;χ 2=7.66, P<0.001, OR=1.90, 95%CI=1.21-3.00).Conclusions: The study shows that the HIV sero-prevalence in this population of patients with GUDis very low. The results also indicate an associationbetween syphilis and HIV infection. The relationshipbetween genital herpes and HIV infection needsfurther research.

Combination of Circumcision and Microwave in Treatment of Genital Warts in Uncircumcised Patients

Objective: To investigate the efficacy of combina-tion of circumcision and microwave on genital wartsin uncircumcised men. Methods: A randomized, prospective study of 109uncircumcised adult men with genital warts was con-ducted in a STD clinic in Zhanjiang, Guangdong. Onegroup (n=54) received microwave therapy only, whilethe other group (n=55) was taken the combination ofcircumcision and microwave therapy. The recurrenceswere observed at the end of months 3, 6 and 12, andoperative complications were also recorded. Results: There were no significant differences inthe mean age and duration of the disease between twogroups (P>0.05). No serious operative complicationswere documented. The recurrence rate in circumci-sion plus microwave group was markedly lower thanthat in microwave group (12.7% vs 29.6%, P<0.05),while the differences in early and late recurrencesbetween two groups showed no statistical significance(P>0.05). Conclusion: Circumcision can be safely performedunder local anesthesia in an outpatient setting. Com-bination of circumcision and microwave can produceexcellent effect as well as less tissue damage,therefore, it may be ideal for uncircumcised patientswith extensive condylomas.

Perceived Effects of Female Genital Mutilation on Gender Sports Participation and Performance： Implications to Sports Administration and Management in Nigeria

The purpose of this study was to find out the perceived effects of FGM （female genital mutilation） on gender sports performance： implications to sports administration and management in Nigeria. A total of 250 purposively selected regular female athletes from five Nigerian universities （two federal universities, two state universities and one private university）, in the south-East Geopolitical zone of the country. A self structured questionnaire with reliability value of 0.73. The test-retest method was used for data collection. Data collected were subjected to descriptive statistics of frequency, percentage and Chi-square inferential statistics at 0.05 level of significance. Findings revealed that majority perceived FGM as harmful and detrimental to excellent sports performance, administration and management. Based on the result of the study, it was therefore recommended that government should design programmes aimed at improving the education of the girl-child as this has been identified as one of the factors which will help to change the attitude of mothers towards the practice of FGM.

Age-related changes in seminal polymorphonuclear elastase in men with asymptomatic inflammation of the genital tract

Aim： To investigate age-related inflammatory events in the male genital tract. Methods： In a total of 4 265 randomly collected patients attending the andrological outpatient clinic of the Center for Dermatology and Andrology, University of Giessen, Germany, ejaculate volume, pH-value, sperm concentration, total and progressive sperm motility, concentration of polymorphonuclear （PMN） elastase, number of peroxidase-positive cells and fructose were measured and correlated with patient＇s age. Results： While ejaculate volume, motility and fructose all correlated negatively with age, sperm concentration, PMN elastase and the pH-value showed a positive correlation. The prevalence of male genital tract inflammation （as defined by PMN elastase 〉 250 ng/mL） and its severity increased significantly. PMN elastase did not correlate with sperm motility. Fructose as a marker of seminal vesicle function showed a significant negative relationship with the PMN elastase levels, the number of peroxidase-positive cells and sperm motility. Conclusion： The significant increases of PMN elastase levels as marker of male genital tract inflammation in older men appear to be indicative of age-related changes in local immunoregulatory mechanisms. Because there is no association of PMN elastase with sperm motility, a direct inhibitory effect of this enzyme can be excluded.

Detection of HPV Types and Neutralizing Antibodies in Women with Genital Warts in Tianjin City,China

The serum samples and corresponding cervical swabs were collected from 50 women with genital warts from Tianjin city, China. The neutralizing antibodies against HPV-16, -18, -58, -45, -6 and -11 in serum samples were tested by using pseudovirus-based neutralization assays and HPV DNAs in cervical swabs were also tested by using a typing kit that can detect 21 types of HPV. The results revealed that 36% （18/50） of sera were positive for type-specific neutralizing antibodies with a titer range of 160-2560, of which 22%（11/50）, 12%（6/50）, 10%（5/50）, 4%（2/50）, 4%（2/50） and 2%（1/50） were against HPVs -6, -16, -18, -58, -45 and -1 l, respectively. Additionally, 60% （30/50） of samples were HPV DNA-positive, in which the most common types detected were HPV-68（18%）, HPV-16（14%）, HPV-58（12%）, HPV-33（8%） and HPV-6, HPV-11, HPV-18 and HPV-52 （6% each）. The concordance between HPV DNA and corresponding neutralizing antibodies was 56% （28/50） with a significant difference （P〈0.05）. The full-length sequences of five HPV types （HPV -42, -52, -53, -58 and -68） were determined and exhibited 98%-100% identities with their reported genomes. The present data may have utility for investigating the natural history of HPV infection and promote the development of HPV vaccines.

Tc1/Tc2 Imbalance in the Peripheral Blood of Patients with Recurrent Genital Herpes

In order to investigate the IFN-γ and IL-4 expression of CD8^＋T lymphoeytes in the peripheral blood from patients with recurrent genital herpes （RGH） at different clinical periods and their relationship with the pathogenesis of RGH, flow cytometry was used to detect the intracellular cytokines （IFN-γ and IL-4） of CD8^＋ T lymphocytes in the peripheral blood of 30 patients with RGH at acute period, 20 patients with RGH at recovery period and 15 healthy volunteers. The results showed that RGH patients at acute period had a lower percentage of Tcl subsets in peripheral blood than that of healthy controls （P〈0. 001）, especially a remarkable decreased percentage of Tc1 subsets （P〈0. 001） among those RGH patients with recurrent number more than 3 in the recent half a year. Tc1/Tc2 ratio in the RGH patients at acute period was significantly decreased as conapared with normal control group （P〈0.05）. The recurrent number of acute patients in the recent half a year was significantly correlated with the percentage of Tc1 subsets and the ratio of Tc1/Tc2 （P〈 0.05）. A decreased percentage of Tc1 subsets was found among the RGH patients with recurrent number more than 3 in the recent half a year at recovery period in comparison with healthy volunteers （P〈0.05）, and it was significantly correlated with the recurrent number in the recent half a year （P〈0.05）. It is concluded that there are Tc1/Tc2 imbalance and a low level of Tc1 subsets in RGH patients who are relapsing repeatedly in the near period. The low level of Tc1 subsets may be an important factor for the recurrence of RGH and the reactivation of latent herpesvirus infection.

DETECTION OF PATHOGENS CAUSING GENITAL ULCER DISEASE BY MULTIPLEX POLYMERASE CHAIN REACTION

Objective To establish a multiplex polymerase chain reaction （M-PCR） assay for simultaneous detection of pathogens causing genital ulcer disease （GUD）. Mothods Based on the gene-specific region of the following pathogens： Chlamydia trachomatis omp l/ompb, herpes simplex virus （HSV） DNA polymerase, Treponema pollidum tpp47, Haemophilus ducreyi 16s rRNA, four sets of primers were designed and an M-PCR assay was developed to detect four pathogens in one test. The assay was evaluated with diagnostic result of golden standard for each pathogen.Results Of the 51 clinical samples, M-PCR showed slightly higher positive rate （47.1%） of HSV than cell culture （23.6%）. Meanwhile, the positive rate of T. pallidum detected by M-PCR and dark-field microscopy was 19.6% （10/51） and 15.7% （8/51）, respectively. Only one sample was positive for H. ducreyi and no sample was positive for C. trachomatis detected by both M-PCR assay and culture. Conclusion This primary study indicated that M-PCR assay can simultaneously and rapidly detect the four etiologic pathogens causing GUD.

Male genital schwannoma, review of 5 cases

Aim: To study the clinical features of male genital schwannoma. Methods: Five male patients with genital schwannoma admitted from 1991 to 2000 were reviewed. The lesions were located in the prostate, spermatic cord, testis or penis. Tumors were simply resected in 3 patients and radically eradicated in 2. Results: The average age of the cohort was 37 years. The most common sign at presentation was a palpable genital mass accidentally discovered by the patient or detected by the physician during a physical check. Diagnosis was made through postoperative pathological examination. Follow-up ranged from 2 years to 6 years (mean 4.5 years). Four cases were cured by simple excision and 1 patient with malignant testis schwannoma died of recurrence 1 year after surgery. Conclusion: Owing to the lack of characteristic clinical manifestation, the final diagnosis relys on postoperative pathological examination. S-100 and vimentin are useful markers for the diagnosis of these tumors.

A study of female genital swabs in a Nigerian Tertiary Hospital

Objective:To detect some common microbial agents of vaginal discharge and improve the current syndromic management of abnormal vaginal discharge.Methods:A prospective study of female genital swabs collected from obstetrics and gynecology units of Aminu Kano Teaching Hospital,Kano,Nigeria and an analysed of microscopy,culture and sensitivity in the medical microbiology and parasitology laboratory of this hospital were conducted from December 2007 to December 2008.Data on epidemiologic indices were collected from the patients,using structured interviewer-administered questionnaires.Results:Eight hundred and forty Candida species were detected,constituting 60%(n=840) of 1 400 female genital discharge samples of microbial etiology in a total of 2 000 female genital samples received.The distribution of vaginal candidiasis was tbe highest in young adults aged 21 to 30 years with 43%(n=360) of the total 840 cases. Pregnant women that presented with vaginal candidiasis constituted 40%(n=360) of the total 840 cases.Other risk groups included the immuno-suppression with 24%(n=202),group on hormonal therapy with 15%(n=126) and broad spectrum antibiotics users with 16%(n=134).Conclusions: The results show that Candida is the most common cause of vaginitis and vulvo-vaginal candidiasis followed by C.albicans in the young adults aged 21 to 30 years,pregnant mothers, immuno-suppression,contraceptive and broad spectrum antibiotic users.Proper management of vaginal candidiasis and vulvo-vaginal candidiasis is recommended especially among the risk groups in order to avoid complications and reduce HIV transmission.

Male genital damage in COVID-19 patients:Are available data relevant?

Over the past few weeks,we have observed increasing concern about the possible impact of coronavirus disease 2019(COVID-19)which is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2 virus)on male fertility.Precise mechanisms of male reproductive damages are still unclear,but it seems that high temperature resulting from persistent fever and triggering a secondary autoimmune response leading to an autoimmune orchitis are the most likely involved mechanisms.Also,angiotensin conversion enzyme 2(ACE2)plays a highly important role in cellular entry for SARS-CoV-2 and male genital system presents high ACE2 expression.All these preliminary findings suggest that COVID-19 could impact men's reproductive health.Thus,we examined available data including published and unpublished articles to assess the potential risk of COVID-19 in particular on the male reproductive system.

Effects of shallomin and podophyllin solution 25% for genital HPV warts in women: a randomized controlled trial

Objective: To compare the effect of shallomin (pure fraction of Allium hirtifolium) with podophyllin 25% solution on external genital human papillomavirus warts in women. Methods: This study was a randomized controlled trial which was performed on two groups of 25 Iranian women with external genital warts at Imam Khomeini Hospital in Ahvaz, Iran. In the first group, shallomin was used once a day for six weeks at home. In the second group, 25% podophyllin solution, was applied on the lesion once weekly for six weeks. Results: Shallomin and podophyllin resulted in wart clearance in 13/23 (56.5%), and 12/24 (50%) of patients, respectively. The clearance rate for shallomin was not significantly different from that of podophyllin (P=0.082). Six weeks after the treatment, the sizes of the lesions in the shallomin group and the podophyllin group decreased by (1.43±0.53) mm and (1.64±0.70) mm, respectively. Conclusion: Shallomin is an effective treatment for genital warts, with similar efficacy to that of podophyllin.

Long Dan Xie Gan Formula Granule Promotes Pro-Inflammatory Cytokine Expression in Female Guinea Pigs with Recurrent Genital Herpes

Objective To explore the effects of Long Dan Xie Gan formula granule(LDXGFG)on regulation of pro-inflammatory cytokines in female guinea pigs with recurrent genital herpes(herpes simplex virus 2,HSV-2).Methods Levels of pro-inflammatory cytokines in blood of HSV-2-infected guinea pigs,including IL-6,IL-8,IL-10,IL-12,IFN-α,IFN-β,IFN-γ,and TNF-α,were detected by ELISA;corresponding gene expression levels in tissues were detected by real-time PCR.Results IL-6,IL-10,IL-12,IFN-α,IFN-γand TNF-αdecreased significantly in both blood and diseased tissues after infection with recurrent genital herpes.Upon feeding LDXGFG to HSV-2-infected guinea pigs,IL-6,IL-10,IL-12,IFN-α,IFN-γand TNF-αdemonstrated significant increases,similar to the effects of acyclovir(ACV).LDXGFG promoted the expression of pro-inflammatory cytokines in blood and tissue,with a stronger effect than ACV.Moreover,LDXGFG demonstrated broader effects than ACV.Conclusion The present results suggest that LDXGFG can serve as an alternative,inexpensive,and long-term treatment for HSV-2 infection.

Epidemiological and Histological Aspects of Women Genital Cancers in Cote d’Ivoire

Genital cancers in women play an important role in cancer pathology in the developing countries. Objectives: This study aimed at clarifying the epidemiological and histopathological aspects of woman genital cancers in C?te d’Ivoire. Materials and Methods: This was a retrospective and descriptive study conducted in the anatomical pathology laboratories of the university hospitals in Abidjan. The study was carried out over a period of twenty-four years (1984-2007). The variables studied were: frequency, age, histological type and prognosis. Results: Genital cancers in women accounted for 41.28% (n = 2491) of cancer in women and 21% of cancers. The average age of patients was 46.65 years (range 2 - 88 years). The cervix (82.85%) was the main location followed by the ovary (8.6%). Histologically, carcinomas (92.93%) were the most common types of sarcomas. Cervical cancers were diagnosed at an average age of 47.36 years (range 2 to 88 years). Carcinomas were the predominant histological type (92.88%) with 57.4% (n = 450) diagnosed at pT2N0M0 stage. The average age of patients bearing ovarian cancer was 39.13 years (range 8 to 82 years).Common malignant epithelial tumours were the most common histological type (57.48%) (n = 123) followed by non-Hodgkin lymphoma (14.95%). Conclusion: Genital cancers in women are common and poorly prognosed in Cote d’Ivoire. The adoption of a policy of routine screening is needed to improve the prognosis of these tumours.

Importance of defining the best treatment of a genital gunshot wound: A case report

Twenty percent of genital traumas are caused by penetrating injuries; accordingly gunshot and stab wounds have increased in the last couple of years around the globe, even in Colombia. A 67-year-old male patient was admitted to the emergency room because he received multiple gunshot wounds. On physical examination, multiple wounds on his penis with loss of tissue in the foreskin, glans, anterior urethra(distal third) and cavernous corpora were found. The urologist performed a partial penectomy with a penis reconstruction, he debrided the cutaneous flap of the dorsal foreskin and its glans, sutured the distal cavernous corpora and dissected the urethra. Penetrating genital injuries are extremely important due to their impact on the functional, psychological and the aesthetic consequences. It is necessary to define the best possible treatment to minimize the damage.

Efficacy and safety of oral Chinese herbal medicine combined with nucleoside antiviral drugs against recurrent genital herpes:a systematic review and meta-analysis

Background:To compare the efficacy and safety of Chinese herbal medicine combined with nucleoside antiviral drugs and nucleoside antiviral drugs alone in treating recurrent genital herpes.Methods:PubMed,Embase,Web of Science,Cochrane Library,Chinese Biomedical Literature Database,China National Knowledge Internet,VIP Database,and Wanfang Data were searched from inception to April 2021.Randomized controlled trials on the efficacy and safety of oral Chinese herbal medicine combined with nucleoside antiviral drugs for recurrent genital herpes were collected.All included trials were independently assessed by two reviewers with the Cochrane risk-of-bias tool,and a meta-analysis was conducted using Review Manager 5.4.Results:Compared with the use of nucleoside antiviral drugs alone,combination therapy with oral Chinese herbal medicine plus nucleoside antiviral drugs effectively reduced the herpes recurrence rate after the end of treatment(3 months:P=0.0002;6 months:P<0.00001;1 year:P<0.00001)and the number of recurrences each year(P<0.00001),improved the recurrent Genital Herpes Quality of Life Questionnaire score(P<0.00001),and regulated the levels of interferon-γ,interleukin-2,tumor necrosis factor-α,and T lymphocyte subsets in the peripheral blood,and the difference was statistically significant.Different subgroups reported mixed results with respect to the efficacy in the short term.The incidence of adverse reactions and the time of symptom disappearance between the two groups were not significantly different.Conclusion:Chinese herbal medicine combined with nucleoside antiviral drugs can effectively reduce the recurrence rate of recurrent genital herpes,improve the patient’s quality of life and enhance the body’s immunity.Considering the possible risk of publication bias,more high-quality randomized controlled trials are still needed to verify the conclusions of this article.

New models to study vulvodynia: hyperinnervation and nociceptor sensitization in the female genital tract

Vulvodynia is a prevalent form of chronic pain, most com- monly affecting the vaginal vestibule （vestibulodynia） （Pukall et al., 2016）. Women with vulvodynia describe intense pain in response to light touch of the affected region, such that sexual function and other activities can be severely limited. Medical costs associated with vulvodynia are high, exceeding $21 billion annually in the United States （Xie et al., 2012）. The high level of direct medical costs has been linked to high treatment failure rates. Many women with the disorder consult multiple practitioners and undergo multiple courses of treatment with limited benefit.