However, 56 observational studies reported on eight main types of immediate medical harms (bleeding, shock, genital tissue swelling, fever, infections and problems with urination and wound healing) on 133 515 females of various ages and types of FGM/C. The rate of immediate complications varied greatly across the studies. There were strong indications of under-reporting selleckchem Imatinib Mesylate of immediate complications from the procedure, with some studies reporting that 90% of the girls undergoing FGM/C experienced no bleeding at all.30 64 However, representative studies (ie, where the participants can be assumed to represent the larger population) of moderate

and high methodological quality indicated that the most common immediate complications were: excessive bleeding (median 32%, range 5–62%), urine retention (median 31%, range 8–53%), genital tissue swelling (median 15%, range 2–27%), problems with wound healing (13%) and pain (11%).30 73 74 Girls generally suffered more than one immediate complication. We identified three clinical reports on deaths directly attributed to FGM/C.75–77 Fourteen studies reported the number of events for different types of FGM/C separately, allowing us to estimate differences in risk

across exposure groups.30 45 64 65 78–87 Our results indicated that there might be a greater risk of immediate harms with FGM/C type III relative to types I–II. We found few, and small, differences in risk of immediate complications with FGM/C types I–II compared to type IV (generally ‘nick’). Genitourinary problems With respect to the genitourinary sequelae of FGM/C, reported years and sometimes decades following the procedure, we identified 17 comparative studies.21 27 29–33 37 43 45 46 54 55 57 60 64 65 In total, the studies included 38 390

women. The most frequently measured outcomes were genital tissue damage, vaginal discharge and itching, urological complications and infections. Many sequelae were examined in only one or a few studies and/or they were relatively rare events, such as keloids and abscesses. Analyses were thus often unable to establish whether there were statistically significant differences between the groups being compared and the CIs were wide. As a result, there was insufficient information available from the studies to assess difference Drug_discovery in risk relative to FGM/C exposure. The results were inconclusive with respect to: scarring, keloids, abscesses, fistulae, damaged tissue (perineum, anal sphincter), disfigurement, vaginal obstruction and cysts. According to four cross-sectional studies (n=3657), there was a trend for a greater risk of vaginal discharge and itching with FGM/C (adjusted ORs (AOR) from 0.94 to 2.81).33 54 57 60 Urological long-term complications were reported in four comparative studies (n=3611), none of which could establish a statistically significant difference, either in unadjusted analyses (RRs from 0.85 to 1.78) or in adjusted analyses (AORs from 0.80 to 1.