Sexual dysfunction after female genital mutilation/cutting: A retrospective cross-sectional study of associations with organ-specific genital anatomy, trauma history, and psychiatric comorbidity

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-pleasure 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.