{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:05:34Z","timestamp":1789668334948,"version":"4.0.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Sexual dysfunction after female genital mutilation\/cutting (FGM\/C) is poorly characterized, limiting targeted clinical intervention. In a concentrated FGM\/C referral population, we aimed to characterize patterns of sexual dysfunction and evaluate associations with organ-specific genital anatomy, trauma history, and psychiatric comorbidities among women with FGM\/C. We conducted a retrospective cross-sectional study of adults with FGM\/C evaluated between 2014 and 2025 in an obstetrics and gynecology clinic specializing in sexual trauma. Using standardized abstraction tools, we obtained sexual symptoms, genital examination findings, demographics, and trauma-related and psychiatric variables from the electronic medical record. Associations between these variables and three primary outcomes (loss of libido, loss of sexual pleasure, dyspareunia) were assessed using univariate logistic regression. A composite arousal\u2013pleasure dysfunction outcome was evaluated in secondary analyses adjusted for age and organ-specific genital anatomy. Among 135 women with FGM\/C, approximately two-thirds reported sexual dysfunction, most commonly dyspareunia (45.9%), loss of sexual pleasure (28.9%), and loss of libido (25.9%). Absence or attenuation of the clitoris, labia minora, or labia majora was not associated with these outcomes. In contrast, depression (odds ratio [OR] 2.80), post-traumatic stress disorder (PTSD) (OR 3.86), and intact memory of the FGM\/C event (OR 2.82) were associated with loss of libido. Depression was also associated with loss of sexual pleasure (OR 4.67). After adjustment for age and genital anatomy, depression (adjusted OR 3.87) and PTSD (adjusted OR 3.67) remained associated with composite arousal-pleasure dysfunction. In this well-documented cohort with FGM\/C, sexual dysfunction was more closely associated with trauma-related and psychiatric factors than with genital tissue loss. These findings support prioritizing mental health and trauma-focused interventions for sexual health after FGM\/C and underscore the need for prospective multicenter studies.<\/jats:p>","DOI":"10.1371\/journal.pone.0356761","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:25:33Z","timestamp":1789665933000},"page":"e0356761","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sexual dysfunction after female genital mutilation\/cutting: A retrospective cross-sectional study of associations with organ-specific genital anatomy, trauma history, and psychiatric comorbidity"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0254-8180","authenticated-orcid":true,"given":"Emily","family":"Lock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9163-7511","authenticated-orcid":true,"given":"Veronica","family":"Ades","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"issue":"11","key":"pone.0356761.ref001","article-title":"Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis","volume":"4","author":"RC Berg","year":"2014","journal-title":"BMJ Open"},{"key":"pone.0356761.ref002","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.ejogrb.2020.09.031","article-title":"Association of female genital mutilation and female sexual dysfunction: A systematic review and meta-analysis","volume":"254","author":"FR P\u00e9rez-L\u00f3pez","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"pone.0356761.ref003","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s12978-017-0433-z","article-title":"The \u201cheat\u201d goes away: sexual disorders of married women with female genital mutilation\/cutting in Kenya","volume":"14","author":"T Esho","year":"2017","journal-title":"Reprod Health"},{"issue":"13","key":"pone.0356761.ref004","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1111\/1471-0528.12004","article-title":"Sexual quality of life in women who have undergone female genital mutilation: a case-control study","volume":"119","author":"SHA Andersson","year":"2012","journal-title":"BJOG"},{"issue":"3","key":"pone.0356761.ref005","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.fertnstert.2008.10.035","article-title":"Sexual function in women with female genital mutilation","volume":"93","author":"SA Alsibiani","year":"2010","journal-title":"Fertil Steril"},{"issue":"1","key":"pone.0356761.ref006","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12978-017-0309-2","article-title":"The mothering experience of women with FGM\/C raising \u201cuncut\u201d daughters, in Ivory Coast and in Canada","volume":"14","author":"S Koukoui","year":"2017","journal-title":"Reprod Health"},{"key":"pone.0356761.ref007","unstructured":"UNICEF. Female genital mutilation: UNICEF data. 2024. https:\/\/data.unicef.org\/resources\/female-genital-mutilationcutting-global-concern\/"},{"key":"pone.0356761.ref008","unstructured":"Organization WH. Types of female genital mutilation. https:\/\/www.who.int\/teams\/sexual-and-reproductive-health-and-research-(srh)\/areas-of-work\/female-genital-mutilation\/types-of-female-genital-mutilation. Accessed 2025 November 30."},{"issue":"1","key":"pone.0356761.ref009","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2017.02.044","article-title":"Effects of female genital mutilation\/cutting on the sexual function of Sudanese women: a cross-sectional study","volume":"217","author":"AA Rouzi","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"pone.0356761.ref010","doi-asserted-by":"crossref","first-page":"15633","DOI":"10.1038\/s41598-022-19949-0","article-title":"Somalian women with female genital mutilation had increased risk of female sexual dysfunction: a cross-sectional observational study","volume":"12","author":"AH Mohamed","year":"2022","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0356761.ref011","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12905-023-02860-9","article-title":"The comparison of sexual function in types I and II of female genital mutilation","volume":"24","author":"K Hassannezhad","year":"2024","journal-title":"BMC Womens Health"},{"issue":"1","key":"pone.0356761.ref012","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12978-017-0371-9","article-title":"Effect of female genital mutilation\/cutting; types I and II on sexual function: case-controlled study","volume":"14","author":"SA Ismail","year":"2017","journal-title":"Reprod Health"},{"key":"pone.0356761.ref013","doi-asserted-by":"crossref","first-page":"943949","DOI":"10.3389\/fsoc.2022.943949","article-title":"\u201cDamaged genitals\u201d-Cut women\u2019s perceptions of the effect of female genital cutting on sexual function. A qualitative study from Sweden","volume":"7","author":"M Jordal","year":"2022","journal-title":"Front Sociol"},{"issue":"9","key":"pone.0356761.ref014","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1177\/10497323211001862","article-title":"The Consequences of Female Genital Mutilation on Psycho-Social Well-Being: A Systematic Review of Qualitative Research","volume":"31","author":"S O\u2019Neill","year":"2021","journal-title":"Qual Health Res"},{"issue":"6","key":"pone.0356761.ref015","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1192\/pb.bp.114.047944","article-title":"Mental health problems associated with female genital mutilation","volume":"39","author":"J Knipscheer","year":"2015","journal-title":"BJPsych Bull"},{"issue":"1","key":"pone.0356761.ref016","doi-asserted-by":"crossref","first-page":"19489","DOI":"10.1038\/s41598-025-03878-9","article-title":"Mental health outcomes and post-traumatic stress disorder associated with female genital mutilation","volume":"15","author":"E Keles","year":"2025","journal-title":"Sci Rep"},{"issue":"9","key":"pone.0356761.ref017","doi-asserted-by":"crossref","first-page":"4993","DOI":"10.3390\/ijerph19094993","article-title":"Cognitive-Emotional Aspects of Post-Traumatic Stress Disorder in the Context of Female Genital Mutilation","volume":"19","author":"N Wulfes","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"pone.0356761.ref018","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1176\/appi.ajp.162.5.1000","article-title":"Posttraumatic stress disorder and memory problems after female genital mutilation","volume":"162","author":"A Behrendt","year":"2005","journal-title":"Am J Psychiatry"},{"key":"pone.0356761.ref019","doi-asserted-by":"crossref","first-page":"1242270","DOI":"10.3389\/fpubh.2023.1242270","article-title":"Serious life events and associated PTSD in Gambian girls exposed to female genital cutting","volume":"11","author":"T Heir","year":"2023","journal-title":"Front Public Health"},{"key":"pone.0356761.ref020","doi-asserted-by":"crossref","first-page":"03011","DOI":"10.7189\/jogh.15.03011","article-title":"The psychological impact of displacement and female genital mutilation\/cutting","volume":"15","author":"SK Virk","year":"2025","journal-title":"J Glob Health"},{"issue":"4","key":"pone.0356761.ref021","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2019-001553","article-title":"Is female genital mutilation\/cutting associated with adverse mental health consequences? 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Auricchio","year":"2021","journal-title":"Sex Reprod Healthc"},{"issue":"2","key":"pone.0356761.ref025","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ijgo.2014.11.008","article-title":"A systematic review of the evidence on clitoral reconstruction after female genital mutilation\/cutting","volume":"129","author":"J Abdulcadir","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"issue":"10","key":"pone.0356761.ref026","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1111\/j.1471-0528.2002.01550.x","article-title":"The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria","volume":"109","author":"FE Okonofu","year":"2002","journal-title":"BJOG"},{"issue":"2","key":"pone.0356761.ref027","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-1012","article-title":"Diagnosis, management, and treatment of female genital mutilation or cutting in girls","volume":"146","author":"J Young","year":"2020","journal-title":"Pediatrics"},{"issue":"2","key":"pone.0356761.ref028","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.jsxm.2015.12.023","article-title":"Sexual anatomy and function in women with and without genital mutilation: a cross-sectional study","volume":"13","author":"J Abdulcadir","year":"2016","journal-title":"J Sex Med"},{"issue":"3","key":"pone.0356761.ref029","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/s41443-022-00661-6","article-title":"Health outcomes and female genital mutilation\/cutting: how much is due to the cutting itself?","volume":"35","author":"CE Johnson-Agbakwu","year":"2023","journal-title":"Int J Impot Res"},{"issue":"13","key":"pone.0356761.ref030","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1111\/j.1471-0528.2012.03481.x","article-title":"The association between female genital mutilation and intimate partner violence","volume":"119","author":"HM Salihu","year":"2012","journal-title":"BJOG"},{"issue":"10","key":"pone.0356761.ref031","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1111\/jsm.12249","article-title":"Chronic stress and sexual function in women","volume":"10","author":"LD Hamilton","year":"2013","journal-title":"J Sex Med"},{"issue":"1","key":"pone.0356761.ref032","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s12888-018-1757-0","article-title":"Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations","volume":"18","author":"A K\u00f6bach","year":"2018","journal-title":"BMC Psychiatry"},{"issue":"2","key":"pone.0356761.ref033","first-page":"94","article-title":"The effect of education on sexual health of women with hypoactive sexual desire disorder: a randomized controlled trial","volume":"2","author":"M Kaviani","year":"2014","journal-title":"Int J Community Based Nurs Midwifery"},{"issue":"3","key":"pone.0356761.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0211829","article-title":"Crossing cultural divides: A qualitative systematic review of factors influencing the provision of healthcare related to female genital mutilation from the perspective of health professionals","volume":"14","author":"C Evans","year":"2019","journal-title":"PLoS One"},{"issue":"3","key":"pone.0356761.ref035","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-039809","article-title":"Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations","volume":"11","author":"S Dixon","year":"2021","journal-title":"BMJ Open"},{"issue":"2","key":"pone.0356761.ref036","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/AOG.0000000000001835","article-title":"Posttraumatic Stress Disorder Relapse and Clitoral Reconstruction After Female Genital 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WHO guideline on the prevention of female genital mutilation and clinical management of complications: web annex B: evidence-to-decision tables. https:\/\/www.who.int\/publications\/i\/item\/WHO-RHR-22.12. 2023."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356761","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:25:42Z","timestamp":1789665942000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356761"}},"subtitle":[],"editor":[{"given":"Adewale Olufemi","family":"Ashimi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0356761","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}