Post-traumatic stress disorder among Iranian women with genital mutilation: a cross-sectional study

The present study aimed to assess the prevalence and severity of PTSD and its associated factors among Iranian women with genital mutilation.

Type of FGM and magnitude of PTSD

The results of the present study indicated that six women (3.9%) had PTSD. The mental health status of 66 circumcised women migrating from Africa to the Netherlands was investigated in a study conducted in 2012 and the results indicated that about 54% of participants had type III FGM, 14% type II and 32% type I. Further, approximately, 16% of circumcised women had the symptoms of PTSD [20]. In another study, 17.5% of African women with genital mutilation had PTSD symptoms [21]. The results of a study performed in Egypt indicated that 19% of women with genital mutilation exhibited symptoms of PTSD [22]. Further, the prevalence of PTSD among circumcised women was reported to be 30.4% in a study conducted in Senegal [23]. In most of studies, the prevalence of PTSD was not reported by the type of FGM/C and only a few studies stratified the results based on FGM/C type [5, 21, 23]. The prevalence of PTSD in the present study is much lower than the prevalence reported in various studies with the same sampling method, which may be due to the high prevalence of type I of FGM/C in the study area. On the other hand, the acceptance of FGM/C among the study population may be acted as a protective factor against PTSD. Early studies also reported that the prevalence of psychological trauma and PTSD increases in societies with low prevalence of FGM/C and its social rejection [14, 22].

In the present study, the mean (SD) score of PTSD symptoms among Kurdish women with type 1 of FGM/C was 27.73 (6.79). In a study performed in north of Iraq [24], sharing borders with Iran, the mean (SD) score of PTSD among circumcised Kurdish girls aged 8–14 years was 44.3 (13.73) and the severity of symptom was very high compared to the findings of the present study, which may be attributed to the low prevalence of FGM/C in the north of Iraq, differences in the age groups, and not stratifying the results based on FGM/C type. The study population in the aforementioned study was single girls with a mean age of 12.2 years and in the present study was married women with a mean age of 31.46 years. Further, in a study conducted in Kenya [25], the mean score of PTSD symptoms among women with genital mutilation migrating from Somalia was 41.16 (16.1), as these refugee women had experienced many difficulties and challenges before, during, and after migration, they were more likely to experience higher levels of PTSD. In the present study, the severity of PTSD among the participants were relatively low, which may be due to convenience sampling of the study, the limited injury in genitalia and the social acceptance of the practice.

Associated factors of PTSD

In the present study, the age at FGM/C was regarded as the predictor of PTSD among the women. Namely, individuals who were older at the time of genital mutilation exhibit more PTSD symptoms. Consistent with the findings of the present study, the results of a study conducted on Somali women revealed a positive relationship between the age at FGM/C and PTSD symptoms [25]. Vloeberghs et al. [20] also reported that the severity of PTSD symptoms was higher among women who were older at the time of genital mutilation.

In addition, the level of education and type of residence were considered as other predictors of PTSD in the present study, so that the severity of PTSD symptoms increased among women with lower level of education and those who live in the house of the father-in-law. In fact, circumcised women with low social and economic status demonstrated more PTSD symptoms. Knipscheer et al. [21] reported that the low economic status was significantly associated with psychological trauma among circumcised girls and women, which is in line with the results of the present study. Further, Vloeberghs et al. [20] addressed that full housewife women experienced more anxiety and depression compared to the employed circumcised women.

Strength and limitation of the study

The strengths of the present study included using standard questionnaire and reporting the results in detail for type 1 FGM. Moreover, the findings of the study provided evidence for planning a future advanced study. The main limitation of study is the use of the convenience sampling method. Also, the results of the present study cannot be generalized to other contexts or cultures, since it was conducted in one geographical area with specific ethnicity.

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