The relationship between female genital cutting and obstetric fistulae.
OBJECTIVE
To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor.


METHODS
A comparison was made between 255 fistula patients who had undergone type I or type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age; parity; length of labor; labor outcome (stillbirth or not); type of fistula; site, size, and scarring of fistula; outcomes of surgery (fistula closed; persistent incontinence with closed fistula; urinary retention with overflow; site, size, and scarring of any rectovaginal fistula; and operation outcomes), and specific methods used during the operation (use of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure.


RESULTS
The only statistically significant differences between the two groups (P=.05) were a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, a slightly higher use of a pubococcygeal sling at the time of fistula repair, and a slightly longer length of labor (by 0.3 day) in women who had undergone genital cutting.


CONCLUSIONS
Type I and type II female genital cutting are not independent causative factors in the development of obstetric fistulae from obstructed labor.
Browning
Andrew
A
From the Barhirdar Hamlin Fistula Centre, Barhirdar, Ethiopia; and the Department of Obstetrics and Gynecology and the Department of Anthropology, Washington University, St. Louis, Missouri.
Allsworth
Jenifer E
JE
Wall
L Lewis
LL
D000328:Adult; D016022:Case-Control Studies; D019093:Circumcision, Female / Q000009:adverse effects*; D004420:Dystocia; D005002:Ethiopia; D005260:Female; D006801:Humans; D011247:Pregnancy; D012006:Rectovaginal Fistula / Q000209:etiology*; D014719:Vesicovaginal Fistula / Q000209:etiology*; D055815:Young Adult