A case–control study on the association between female genital mutilation and sexually transmitted infections in Sudan


Dr S Elmusharaf, Department of Public Health Division of International Health (IHCAR), Karolinska Institutet, SE 17176 Stockholm, Sweden. Email sozan.elmusharaf@ki.se


Objective  To assess whether the extent of female genital mutilation (FGM) influences the risk of acquiring sexually transmitted infections (STIs).

Design  Hospital-based case–control study.

Setting  Two obstetric/gynaecological outpatient clinics in Khartoum, Sudan, 2003–2004.

Population  A total of 222 women aged 17–35 years coming to antenatal and gynaecological clinics.

Methods  Women recruited for the study were divided into cases with seropositivity for Neisseria gonorrhoeae (gonococcal antibody test), Chlamydia trachomatis (enzyme immunoassay) or Treponema pallidum (Treponema pallidum haemagglutination assay) (n= 26) and controls without antibodies to these species (n= 196). Socio-demographic data were obtained and physical examination including genital examination was performed in order to classify the form of FGM. Cases and controls were compared using logistic regression to adjust for covariates.

Main outcome measures  Extent of FGM and seropositivity for C. trachomatis, N. gonorrhoeae or T. pallidum.

Results  Of the cases, 85% had undergone the most severe form of FGM involving labia majora compared with 78% of controls (n.s.). Thus, there was no association between serological evidence of STIs and extent of FGM. The only factor that differed significantly between the groups was the education level, cases with STIs having significantly shorter education (P= 0.03) than controls.

Conclusions  There is a little difference between cases and controls in regard to FGM. Having in mind the relatively small sample size, the results still indicate that FGM seems neither to be a risk factor for nor protective against acquiring STIs. This is important as argument against traditional beliefs that FGM protects against pre/extramarital sex.