Decisional Conflict in Regarding Deinfibulation in Female Genital Mutilation/Cutting Patients: A Cross-Sectional Study

Many Somali female migrants experience Female Genital Mutilation/Female Genital Cutting (FGM/C) during childhood, a procedure that involves removal of the external female genitalia for non-medical reasons; most undergo infibulation, which involves narrowing of the vaginal introitus. FGM/C patients commonly undergo deinfibulation, a procedure that reopens the vaginal introitus. This study aimed to analyze factors that contribute to a participant’s decision to undergo deinfibulation using the Decisional Conflict Scale (DCS) and develop recommendations for healthcare providers to ease decisional conflict. This cross-sectional study recruited 300 Minnesotan Somali women with FGM/C. Participants were given a survey including a modified version of the DCS, which aimed to assess the amount and nature of decisional conflict faced by participants regarding deinfibulation. We found that 196 individuals were infibulated, of which 144 individuals (73.0%) were deinfibulated. The total Decisional Conflict Scale results indicated a moderate level of decisional conflict. The largest source of decisional conflict was regarding a lack of comprehensive understanding of the options surrounding deinfibulation. Timing of deinfibulation was found to be associated with DCS total score. The group that never underwent definfibulation had the most overall decisional conflict, while those that deinfibulated during pregnancy/childbirth had the least (p < .001). The results of this study indicate a knowledge gap and lack of health care provider (HCP) support for patients regarding deinfibulation, which contributes to decisional conflict in the population of Somali women considering deinfibulation. Further research on the efficacy of SDM principles on this topic is needed to guide clinical recommendations.