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International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2024 Mar 15;36(2):167–176. doi: 10.1080/19317611.2024.2328717

Effect of Female Genital Mutilation on Sexual Function in Ibadan, Nigeria

Promise Ifechukwu Okpara 1, Serap Tekbaş 1,✉
PMCID: PMC11008539  PMID: 38616797

Abstract

Objective: Female genital mutilation, which harms women physically and psychologically, also causes serious problems in sexual life that continue throughout life. This study aimed to determine the impact of female genital mutilation on sexual outcomes in Ibadan, Nigeria. Method: This is a cross-sectional descriptive study. A self-administered questionnaire was used to obtain data from 161 women who agreed to participate in the study. After the data were collected, the sample group was divided into two groups those with female genital mutilation (84) and those without (77), and they were compared in terms of sexual outcomes. Results: Type I (77.3%) and type II (22.7%) mutilations were found in women with female genital mutilation. It was determined that women with FGM experienced statistically significantly more pain and bleeding during vaginal penetration than uncircumcised women. At the same time, the orgasm rate was found to be statistically significantly lower in this group. Conclusions: Our study revealed that female genital mutilation and enlargement of the incision area negatively affect sexual health.

Keywords: Female genital mutilation, sexual function, women

Introduction

Female genital mutilation (FGM) describes the partial and or total removal of the external genitalia of a female at any age or inflicting any form of injurious cut to the female genital organs for reasons that are not medically certified or required. It is a non-therapeutic and non-medical act that involves the removal (partial or total) of the female external genitalia. It causes untold hurt, pain, and injury to the female external genital organs (World Health Organisation [WHO], 2020). As a global health concern, women’s bodily rights, integrity, and health violation, (FGM) are suffered by more than 200 million females- women and girls across the globe (Agboli, 2020).

There are four main types of FGM. Type I refers to the partial or complete removal of the clitoris (clitoridectomy) and/or the prepuce. Type II is the partial or complete removal of the clitoris and labia minora with or without excision of the labia majora. Type III is defined as the application of all other harmful operations such as excision, insertion, and cauterization with or without the clitoris (narrowing the vaginal opening by cutting the inner lip and/or inner lip and/or creating a seal by closing the inner lip and/or the inner lip). Type IV includes all other harmful procedures such as cutting, dissecting, and cauterizing the female genitalia (Auricchio et al, 2021; Buggio et al, 2019; United Nations International Children’s Emergency Fund [UNICEF], 2013).

All types of FGM are harmful and life-threatening to victims, many of whom live with trauma, pain, and complications for the rest of their lives. The risks of socially and culturally driven dangerous practices can be enormous and permanent (Latham, 2016). These are excessive bleeding (hemorrhage), severe pain, fever, urinary problems, injury to surrounding genital tissue, genital tissue swelling, wound healing problems, and infections e.g., tetanus and shock. Some of the health implications that live with the victims, perhaps, forever, are vaginal problems, urinary problems, menstrual problems, sexual dysfunction, scar tissue, childbirth complications, psychological problems, and the need for later surgeries (WHO, 2020; Williams-Breault, 2018). Women with FGM have more sexual adverse effects than those without FGM. Studies found that women with FGM had higher rates of dyspareunia and a lack of sexual desire (El-Defrawi et al., 2001; Perez-Lopez et al, 2020). Dyspareunia has been related to the injury of the clitoral nerves as well as to scars, adhesions, and scarring of nervous tissues at the site of excision (Bazzoun et al., 2022). In a study conducted in Nigeria, it was found that 30.2% of women who underwent FGM had dyspareunia, and FGM practice significantly increased dyspareunia (Ndikom et al., 2017). FGM to the narrowing of the vaginal orifice which makes intercourse painful and difficult. Painful and difficult sexual intercourse, could, in turn, affect sexual functioning while inhibiting sexual pleasure and the ability to commit emotionally and mentally to relationships and lead to imbalances in marriage and adult life (Owojuyigbe et al., 2017). Women with FGM experience these physical problems more than women without FGM (Mahmoud, 2016).

In the research conducted by UNICEF, it was determined that the first three countries where FGM is most common are Somalia, Guinea, and Djibouti, respectively. Nigeria ranks twentieth. The proportion of girls and women aged 15–49 who thought that the practice of female genital mutilation should continue was 76% in Mali and 23% in Nigeria (Demographic and Health Surveys [DHS], 2020). According to the Nigeria Demographic and Health Survey, the estimated prevalence of FGM in women in Nigeria aged 15–49 is 24.8%, even though the act is a criminalized offense. UNICEF aptly notes that the “more than twenty million” affected Nigerian girls and women represent 19% of the global total (Owojuyigbe et al., 2017; UNICEF, 2013). A study conducted in the southeastern region of Nigeria reported that type II FGM was more common (82%). An identified health implication of FGM among the respondents is perineal trauma (Anikwe et al., 2019). Another study carried out in the northeast region of Nigeria reported that most of the surveyed women underwent type 1, and mostly done by traditional healers and traditional birth attendants for cultural or religious reasons. In the same study, it was stated that FGM is still common in Nigeria, and it is important to address the issue from a religious perspective (Attah et al., 2020). In a qualitative study conducted in Nigeria, in-depth interview results showed that FGM leads to traumatic experiences and negative beliefs about sex, requiring a multitude of coping strategies used by women and their partners (Owojuyigbe et al., 2017). Studies show that the practice of FGM is still common in Nigeria, and adverse health effects continue to be experienced due to FGM (Fajobi et al., 2023; Tammary and Manasi, 2023). Although the obstetric and gynecological effects of FGM are discussed in different studies, there are fewer studies on its effects on sexual health. There are few studies on this subject in Nigeria. The present study aimed to determine the impact of FGM on sexual outcomes.

Materials and methods

Type of the research: This study was conducted with a cross-sectional study design.

Study setting

The research was conducted in Ibadan, the capital city of Nigeria’s Oyo state. Ibadan is Nigeria’s most populous city. It is the second fastest-growing city on the African continent. Ibadan consists of 11 local government areas.

The population and sample of the research

Ibadan consists of 5 urban areas (Ibadan North, Ibadan North-East, Ibadan North-West, Ibadan South-East, and Ibadan South-West). From each urban area, 4 primary health centers were randomly selected. Study data were collected from a total of 20 primary health centers. Sample size was calculated using a Cochran formula (n = z2pq/d2). The estimated prevalence was based on 24.8%, for FGM obtained from a previous study in Nigeria (Owojuyigbe et al., 2017). The minimum sample size of this study was n = 152. 167 women were recruited to allow for 10% of missing data. Since six participants did not answer all the questions in the survey form, these six forms were not included in the study. The sample group of our study consisted of 161 women.

Research process

Data was collected over 2 months (10 August and 10 October) in 2020 in primary health care centers. Primary health care centers carry out vaccination, follow-up of pregnant women, puerperium, infants, and children, and monitoring and screening for chronic diseases. Women who came to the primary health care center for different reasons were informed about the purpose of the study and the confidentiality of the data and women were invited to the study. Those who accepted were included in the study. Women who volunteered to participate in the study were given the questionnaire form after the doctor’s examination and were allowed to fill it out alone in the room. The researcher waited outside the room to answer the questions. After all the data were collected, the questionnaires with and without FGM were divided into two groups during the evaluation phase. It was determined that there were 84 participants with FGM and 77 participants without FGM in our sample group.

This study was approved by the Institutional Review Board (xxx-2020/81-1138). In addition, written permission was obtained from the managers of public health centers designated for this study. Participants were informed about the study’s aims and assured of the confidentiality of the information they volunteered. The consent of all participants was obtained before starting the survey and the study was conducted by the ethical principles of the Declaration of Helsinki.

Inclusion criteria: Literate and English-speaking youth and women aged 18–49 who were sexually active in the last 3 months.

Data collection tools

Sociodemographic Questions: These questions consist of the women’s demographic characteristics, including their financial status, education status, and their religious/cultural status.

FGM Questionnaire: A questionnaire created by the researchers using previous research was used to collect the data for the study (Abdulcadir et al., 2017; Davis & Jellins 2019; Rosen et al., 2000; Yassin et al., 2018). In addition to questions about pain, orgasm, and the need for lubrication, the survey also aimed to obtain information about bleeding during and after sexual intercourse. The sexual health status of the participants in the last 3 months was evaluated. Participants were asked to answer questions about sexual health with “yes” or “no” depending on whether they had experienced the problem in the last 3 months. After creating the survey, the opinions of five experts were taken. The final form of our survey was created in line with the feedback received from expert opinions. To evaluate the survey, a pilot study was conducted with 25 participants representing five regions, each consisting of five participants. These participants were not included in the final study. The internal consistency coefficient (Cronbach’s alpha) of the pilot study was found to be 0.79.

Data analysis

The data were analyzed using the Social Sciences Statistical Package version 20. The results were reported using percentage count and Chi-square test. Frequency analysis was used to determine the socio-demographic characteristics. The Chi-square test and Fisher’s exact tests were used to test associations between the categorical variables. The level of significance for the analysis was a p-value of < 0.05.

Results

Approximately half of the women participating in our study are between the ages of 18–24, and 91.3% of the women have a college or university education level. 28% of women have one child and most of the women stated that their income is lower than their expenses (Table 1). In addition to Table 1 data, in our study, 71.4% of experienced FGM women stated that their income was lower than their expenses, while this rate was 46.8% without FGM women. Since factors such as education and economic level may be potentially confounding, differences between the two groups in terms of sociodemographic factors were evaluated. There was no statistically significant difference between the FGM and non-FGM groups (p > 0.05).

Table 1.

Distribution of descriptive characteristics (n = 161).

Variables Number (n) Percentage (%)
Age
18–28 years 72 44.7
29–39 years 70 43.5
40–49- years 19 11.8
Religion
Christianity 81 50.3
Islam 80 49.7
Economic Situation
Income lower than expenses 149 92.6
Income is equal to expenditure 10 6.2
Income more than expenditure 2 1.2
Educational Level
Secondary 14 8.7
College or university 147 91.3
Number of Children
None 47 29.2
1 45 28.0
2 34 21.1
3 19 11.8
4 12 7.5
5 4 2.5
Working status
Yes 149 92.5
No 12 7.5
How old were you when you married
18–28 years 96 59.6
29–39 years 6 3.7
40–49 years 59 36.7
Have you experienced FGM?
Yes 84 52.2
No 77 47.8
Mutilation Types (n = 84)
Type I: Clitoridectomy 65 77.3
Type II: Excision 19 22.7
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When women with and without FGM were evaluated in terms of sexual problems in Table 2, it was found that women with FGM did experience discomfort or pain after more vaginal penetration (Χ2(1)> =110.367, p = 0.001). The rate of reaching orgasm during sexual intercourse was found to be significantly lower in women with FGM (Χ2(1) > = 91.654, p = .001). It was determined that women with FGM needed more lubrication during sexual intercourse and experienced bleeding problems during and/or after sexual intercourse, significantly more than women with FGM (Χ2(1)> = 86.271, p = 0.001).

Table 2.

Evaluation of obstetric and sexual problems of women with and without genital mutilation.

Sexual problems Experienced FGM Group (n = 84)
 Without FGM Group (n = 77)
 p
n % n %
Experience discomfort or pain following vaginal penetration Yes 63 75 18 23.4 0.001
No 21 25 59 76.6
Reach orgasm (climax) during sexual intercourse Yes 5 6 52 67.5 0.001
No 79 94 25 32.5
Need lubrication in every sexual intercourse Yes 63 75 15 19.5 0.001
No 21 25 62 80.5
Bleeding occurs during and/or after sexual intercourse Yes 67 79.8 10 13 0.001
No 17 20.2 67 87
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Chi-Square Test p < 0.05.

A significant relationship was found between FGM type and sexual problems in women included in the study (p < 0.05) (Table 3). Women with type II incisions reported a feeling of discomfort or pain after vaginal penetration (Χ2(1)> =45,680, p = 0.001), need for lubrication at every sexual intercourse (Χ2(1)> = 40.198, p = 0.001), during sexual intercourse and they experience bleeding (Χ2(1)> = 40.198, p = 0.001) afterward more than women with type I FGM. In addition, women with type II incisions have more difficulty in reaching orgasm during sexual intercourse than women with type I FGM (Χ2(1)> =18.233, p = 0.001).

Table 3.

Evaluation of sexual problems with genital mutilation type.

Sexual problems Mutilation Type 1
 Mutilation Type 2
 p
n % n %
Experience discomfort or pain following vaginal penetration Yes 49 75.4 16 84.2 0.001
No 16 24.6 3 15.8
Reach orgasm (climax) during sexual intercourse Yes 4 06.15 1 05.26 0.001
No 61 93.85 18 94.74
Need lubrication in every sexual intercourse Yes 46 70.8 16 84.2 0.001
No 19 29.2 3 15.8
Bleeding occurs during and/or after sexual intercourse Yes 45 69.2 17 89.5 0.001
No 20 30.8 2 10.5
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Fisher Exact Test p < 0.05.

Table 4 shows that FGM was mostly done at home and by parents’ volition. The majority 80.7% of the respondents know the health implications of FGM, and the majority have not done it on their daughters, do not intend to do it, and opined that FGM is not a good practice.

Table 4.

Evaluation of genital mutilation according to place, performer, and perception.

Place, Performer, and Perception n %
Genital Mutilation Place I don’t know 5 51.5
Home 52 32.3
Health Center/Hospital 18 11.2
Traditional health home 8 5
Who performed genital mutilation on you Parents 46 28.6
Nurse 7 4.3
Midwife 6 3.7
Physician 11 6.8
Have you done genital mutilation on your daughters Yes 1 0.6
No 160 99.4
Will you do genital mutilation on your daughters Yes 1 0.6
No 160 99.4
Do you think genital mutilation on females is a good practice Yes 1 0.6
No 160 99.4
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Discussion

In our study, we aimed to evaluate the impact of FGM on sexual health. Most of the women included in the study had type I FGM (77.3%). It has been found that the most common sexual health problem experienced by women with FGM is bleeding following vaginal penetration (79.8%), and pain during sexual intercourse was more common in the FGM group. Most of the women stated that their income was lower than their expenses. Like the studies, most women with low socio-economic status were women with FGM (Morhason-Bello et al., 2020; Nabaneh & Muula, 2019). In our study, no difference was found between women with FGM and women without FGM in terms of economic level. However, despite the high level of education of the women included in our study, 92.6% of the women stated that their income was lower than their expenses. Using the Women’s Empowerment Index, the study found that women in Nigeria earn lower wages than men and that women face employment problems (Rettig et al., 2020). It is difficult for low-paid working women to be in a decision-making position within the family. Mothers and daughters at low economic levels may lack the power to make important household decisions, including on established traditions and cultural norms such as FGM/C (Adeosun & Owolabi, 2021; Oyefara, 2014;). The studies found that women in the wealthiest wealth quintile and their daughters were less likely to undergo FGM compared to women in the poorest wealth quintile (Ahinkorah et al., 2020; Fagbamigbe et al., 2021).

According to our study results, there is a statistically significant difference in “discomfort or pain” between the with FGM and without FGM women. This result indicates that pain because of vaginal penetration is experienced by FGM women, unlike, perhaps, more than the without FGM women. Multiple studies corroborate our findings that discomfort or pain following vaginal penetration with FGM (Andro et al., 2014; Ismail et al., 2017; Jordal et al., 2022).

In our study, there is a statistically significant difference in “orgasm” between with FGM and without FGM women. Supporting our results different studies reported that there were statistically significant differences between the with FGM and without FGM groups in their scores for orgasm (Alsibiani & Rouzi, 2008; Oyefara, 2015). In addition, other studies supporting our findings about orgasm have determined the negative effect of FGM on orgasm (Biglu et al., 2016; Esho et al., 2017).

According to our study results there is a statistically significant difference in the “need for lubrication” between with FGM and without FGM. Consistent with our results, Alsibiani and Rouzi (2008) reported statistically significant differences between the two groups in their scores for lubrication. Other supporting findings reported significant differences between with FGM and without FGM women groups in lubrication (Biglu et al., 2016; Esho et al., 2017).

In our study, there is a statistically significant difference in “bleeding during/after sex” between the with FGM and without FGM women. In agreement with this result, Yassin et al. (2018) reported a significant difference in the means of bleeding with FGM women after the first attempt of sexual intercourse. There are limited studies evaluating the effects of FGM on sexual health in Nigeria. No study was found to address the problem of bleeding after sexual intercourse in women with FGM.

The FGM types of the women who participated in our study were Type I and Type II. In a systematic review and meta-analysis study examining the prevalence of FGM in African countries, it was concluded that the most common type of FGM was type I (42.9%). Type II was 39.5% and type III was 26.79% (Ayenew et al., 2024). In our study, we evaluated the relationship between participants’ FGM type and sexual problems. There was a significant difference between type I and type II in terms of sexual health problems such as discomfort or pain after vaginal penetration, orgasm during sexual intercourse, the need for lubricant during each sexual intercourse, and bleeding during and/or after sexual intercourse. Women with type II FGM were found to be significantly more likely to experience these sexual problems. In Nigeria, it is mostly Type I and Type II, although there are also studies involving women with Type III FGM (Anikwe et al., 2019; Oyefara, 2015). However, studies conducted in Nigeria have shown that the effect of the type of female circumcision on sexual health has not been evaluated. In studies conducted in different countries and including only women with type I and type II female circumcision, it was found that women with type II female circumcision had more severe sexual dysfunction than women with type I female circumcision (Hassannezhad et al., 2024; Ismail et al., 2017).

The results of this study show that FGM is performed at home by relatives, doctors, and midwives, respectively. When done at home, parents invite local/traditional circumcisers to carry out the FGM, while some parents do it themselves or by elderly members of the family. This is thought to be because FGM is prohibited in Nigeria, so it may be more practiced at home, or it may have been marked as home practiced in the survey for the same reason. In a study conducted in Nigeria, where the sample group consisted of married women, it was found that half of the persons who perform FGM are traditional practitioners (57.2%), followed by grandmothers (36.1%) (Onah et al., 2023). This result is consistent with the findings of studies conducted in different countries on the African continent that FGM is mostly performed by traditional circumcisers. (Adeniran et al., 2015; Anjulo & Lambebo, 2021). It is noteworthy that in our research results, 11.2% of female circumcision practices were performed in health centers/hospitals, and 8% of the participants stated that nurses or midwives performed female circumcision. Some studies show that health workers perform FGM to prevent women from having it performed by traditional healers (Ikechukwu et al., 2021; Mahmoud, 2016). However, no matter who practices FGM, it is condemned by international organizations as a violation of women’s human rights and violence against women (UNICEF, 2013; WHO, 2016).

Almost all the women who participated in our study stated that they were aware of the health effects of FGM on women and that they did not perform it on their daughters. It was concluded that women perceive FGM/C as a bad practice against girls and have a negative attitude toward this practice. Studies on women’s attitudes toward their daughters’ FGM have revealed different results. In a study conducted in Nigeria, most women stated that FGM was a bad practice (91.3%) and a form of violence against women (85.8%), while 87.2% stated that the practice should be stopped (Obijiofor et al., 2020). Unlike these results, in the health research report on female circumcision conducted by UNICEF, the rate of women aged 15–49 who stated that female circumcision should continue in Nigeria was found to be 23% (DHS, 2020). The reason for the response that almost all the participants in our study did not plan to have their daughters undergo FGM was that although we assured them of confidentiality, they may have said that they would not or did not have their daughters undergo FGM because they were afraid of the consequences of the authorities. It should be considered that other members of the family may also have a say in deciding whether FGM should be performed and may insist on FGM on their daughters due to social pressure. In some studies, it is seen that family elders or fathers also advocate for the implementation of FGM (Doucet et al. 2022; Newton & Glover, 2022; Obiora et al. 2021). A recent study in Nigeria found that 20.2% of mothers had their daughters circumcised, while 7.4% planned to have their future daughters circumcised (Onah et al., 2023). This result may mean that the problem will continue to occur.

Limitations

One of the biggest challenges of the study was the Covid-19 pandemic during the data collection process. During this period, it was difficult to collect data due to the decrease in the number of people going to health institutions. Another limitation is that the participants’ responses may have been affected by the law on FGM. For this reason, women were informed about the confidentiality of the study so that they could be confident before answering the questions. In addition, this study only represents 20 primary health centers in Ibadan, Nigeria. The results cannot be generalized to the whole of Nigeria. Another limitation of the study is that women’s self-reports regarding whether they had undergone FGM and its specific type were not confirmed by physical examination. Additionally, the measurement tool used in our study is not a standard scale. In addition, in retrospective studies, it may be difficult to reach the cause due to factors such as forgetting and misinformation. Therefore, there are the same risks in the retrospective information provided by the participants in our study. However, the long-term nature of the problems caused by female circumcision and the evaluation of the sexual health problems experienced by the participants in the last 3 months reduce this risk in our study.

Conclusion

The results of this study indicate that women living in Nigeria with Type I and II FGM report more sexual problems than those who have not experienced FGM.

The women included in the study had only type I and II FGM. Despite this, women’s sexual health was greatly affected. Almost all with FGM women do not orgasm, experience pain during sexual intercourse and even have bleeding problems during sexual intercourse. It was observed that the sexual problems experienced were different between Type I and Type II mutilation, and women with Type II genital mutilation had more problems. Although almost all the women stated that they did not want to do this practice to their daughters, it was found that the FGM was mostly performed by family members. This result shows us that the practice is supported in the family, even if the mothers do not want it, due to the influence of the culture.

In line with all these results, the sexual problems experienced by FGM women should not be ignored, provided education and support to manage the resulting problems. In addition, to prevent injury, not only mothers but also all decision-makers in the family should be informed, considering the cultural structure.

Funding Statement

The author(s) reported there is no funding associated with the work featured in this article.

Authors contribution

PIO conceived, designed and did statistical analysis.

PIO, ST editing of manuscript & did data collection and manuscript writing.

ST did review and final approval of manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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