title: Coping and chronic psychosocial consequences of female genital mutilation in The Netherlands.
abstract: OBJECTIVE
  The study presented in this article explored psychosocial and relational problems of African immigrant women in The Netherlands who underwent female genital mutilation/cutting (FGM/C), the causes they attribute to these problems--in particular, their opinions about the relationship between these problems and their circumcision--and the way they cope with these health complaints.
  
  
  METHODS
  This mixed-methods study used standardised questionnaires as well as in-depth interviews among a purposive sample of 66 women who had migrated from Somalia, Sudan, Eritrea, Ethiopia or Sierra Leone to The Netherlands. Data were collected by ethnically similar female interviewers; interviews were coded and analysed by two independent researchers.
  
  
  RESULTS
  One in six respondents suffered from post-traumatic stress disorder (PTSD), and one-third reported symptoms related to depression or anxiety. The negative feelings caused by FGM/C became more prominent during childbirth or when suffering from physical problems. Migration to the Netherlands led to a shift in how women perceive FGM, making them more aware of the negative consequences of FGM. Many women felt ashamed to be examined by a physician and avoided visiting doctors who did not conceal their astonishment about the FGM.
  
  
  CONCLUSIONS
  FGM/C had a lifelong impact on the majority of the women participating in the study, causing chronic mental and psychosocial problems. Migration made women who underwent FGM/C more aware of their condition. Three types of women could be distinguished according to their coping style: the adaptives, the disempowered and the traumatised. Health care providers should become more aware of their problems and more sensitive in addressing them.
authors.affiliation: Research & Development Department, PHAROS-Knowledge and Advisory Centre on Refugees' and Migrants' Health, Utrecht, The Netherlands. e.vloeberghs@pharos.nl
authors.forename: Erick
authors.initials: E
authors.lastname: Vloeberghs
authors.forename: Anke
authors.initials: A
authors.lastname: van der Kwaak
authors.forename: Jeroen
authors.initials: J
authors.lastname: Knipscheer
authors.forename: Maria
authors.initials: M
authors.lastname: van den Muijsenbergh
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D001007:Anxiety / Q000208:ethnology / Q000209:etiology*; D019093:Circumcision, Female / Q000009:adverse effects / Q000145:classification / Q000208:ethnology / Q000523:psychology*; D003863:Depression / Q000208:ethnology / Q000209:etiology*; D054242:Emigrants and Immigrants / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009426:Netherlands; D020018:Sexual Dysfunctions, Psychological / Q000208:ethnology / Q000209:etiology*; D012752:Shame; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology / Q000209:etiology*; D011795:Surveys and Questionnaires; D055815:Young Adult