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Try out PMC Labs and tell us what you think. Learn More. Data will not be shared. Most data consist of transcribed in-depth interviews, and, to maintain the anonymity of the persons interviewed, they cannot be shared publicly. However, sufficient anonymous data are presented in the paper to illustrate the findings. A small opening remains for the passage of urine and menstrual blood. This physical closure has to be re-opened—defibulated—later in life. When they marry, a partial opening is made to enable sexual intercourse. The husband commonly uses his penis to create this opening.

In some settings, a circumciser or traditional midwife opens the infibulated Women want sex Edna with a knife or razor blade. In Norway, public health services provide surgical defibulation, which is less risky and painful than traditional forms of defibulation.

This paper explores the perceptions and experiences of surgical defibulation among migrants in Norway and investigates whether surgical defibulation is an accepted medicalization of Women want sex Edna traditional procedure or instead challenges the cultural underpinnings of infibulation. Data derived from in-depth interviews with 36 women and men of Somali and Sudanese origin and with 30 service providers, as well as participant observations in various settings from —15, were thematically analyzed.

The study findings indicate that, despite negative attitudes towards infibulation, its cultural meaning in relation to virility and sexual pleasure constitutes a barrier to the acceptance of medicalized defibulation. As sexual concerns regarding virility and male sexual pleasure constitute a barrier to the uptake of medicalized defibulation, health care providers need to address sexual concerns when discussing treatment for complications in infibulated women.

Furthermore, campaigns and counselling against this practice also need to tackle these sexual concerns. Upon marriage and childbirth, this closure needs to be opened—i. After marrying, the husband traditionally uses his penis or a circumciser uses a knife or razor blade to open this seal sufficiently for sexual intercourse.

In Norway, public health services provide surgical defibulation, which is performed to reduce the pain and risks involved in traditional forms of defibulation and to Women want sex Edna birth complications. This paper explores how Somali and Sudanese migrants in Norway relate to medicalized defibulation offerings. It also investigates whether surgical defibulation is an accepted medicalization of a traditional procedure or instead challenges the cultural underpinnings of infibulation.

A qualitative study, including in-depth interviews with 36 women and men of Somali and Sudanese origin and 30 service providers, as well as participant observations, was conducted from — The study found that, while informants had negative attitudes toward infibulation, many of the associated cultural values were still upheld and constituted a barrier to the uptake of medicalized defibulation. Medicalized defibulation was seen to undermine male virility and masculinity, which was expected to be expressed through penile defibulation.

Furthermore, medicalized defibulation was considered a threat to the tight vaginal opening that was regarded as a prerequisite for male sexual pleasure. In Somalia and the Democratic Republic of Sudan, infibulation is nearly universally practiced and is associated with a complex set of key cultural values. Therefore, in recent decades, numerous interventions have arisen to promote its abandonment [ 78 ]. However, while support for the practice is decreasing, the decrease in the practice itself is less pronounced [ 9 ].

This discrepancy between attitudes and practices might reveal a resistance to change that has been underestimated and, in turn, has not been appropriately addressed. While studies ask whether people have negative or positive attitudes toward the practice [ 11 ], research has shown attitudes to be both complex and fluid [ 14 — 17 ].

Therefore, the key to abandoning this practice involves establishing a t agreement to do so; the social convention will thereby be broken, and the underlying social norms will dissolve. Therefore, this study explores a new avenue for understanding cultural change. It relies on the utilization of medicalized defibulation for those already subjected to the practice rather than on stated attitudes towards the practice or data on its prevalence. Medicalized defibulation reduces the suffering and risk associated with traditional forms of defibulation. Therefore, given the widespread negative attitudes toward infibulation in the diaspora, girls and women subjected to pre-migration infibulation could be expected to eagerly embrace access to clinical defibulation in Norway.

That is, if infibulation is no longer of ificant importance, no cultural convention should require that women refrain from clinical defibulation. Through migration, the practice is now found worldwide. This study focuses on Type III, commonly referred to as infibulation. Type IV comprises any other procedures that can harm the external genitalia but that do not include tissue removal. Approximately 9, girls and women in Norway have been estimated to have undergone pre-migration infibulation [ 26 ]. Infibulation constitutes a densely meaningful symbol that is intrinsically intertwined with the physiological extent of the procedure.

The opening left in the infibulated scar should be sufficiently small to impede sexual intercourse to fulfill its major function of safeguarding and proving virginity [ 2 — 434 ]. Nevertheless, this virtuous closure must later be reopened to fulfill cultural values related to marriage and motherhood. First, a partial opening is made at the time of marriage to enable sexual intercourse and conception. At the time of childbirth, a more substantial opening is needed to provide room for the passage of the baby.

These opening procedures are not only a technical necessity but also highly ificant cultural, symbolical and personal experiences. Through defibulation, a girl is transformed from a single virginal girl to a mature woman—married and ready for motherhood. It also provides her husband with access to her sexual and reproductive powers and services [ 435 ]. Furthermore, a small, only partially open vaginal orifice is considered essential for male sexual pleasure and, in turn, fertility and marital stability [ 34 ].

Traditional defibulation at the time of marriage is performed in one of two ways. First, in Sudan and southern Somalia, the bridegroom is expected to defibulate his bride through penile penetration [ 43436 ]. To ensure a sufficient opening, the man is expected to put sufficient pressure on the infibulation seal, causing it to tear. This practice is painful for both women [ 3537 — 39 ] and men [ 341840 ]. Occasionally, men are said to use tools, such as knives or razor blades, if penile pressure proves insufficient [ 36 ].

In northern Somalia, an excisor circumciser is commonly called on to cut open the infibulation [ 2 ].

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However, whether the opening is ensured through penile penetration or the use of a cutting tool, the couple have to engage in regular sexual intercourse during the following weeks to prevent the infibulation from healing, thus recreating infibulation and closing the vulva [ 3537 ]. Many women describe the defibulation procedure as equally painful as the original infibulation [ 1838 ]. In preparation for childbirth, a further opening is necessary to make room for the passage of the. After childbirth, the cut edges are treated in different ways.

In Sudan, reinfibulation, whereby the two sides of the labia are re-sutured, is a routine post-delivery procedure [ 4142 ]. This closure al-adil commonly goes beyond merely closing what was opened during delivery and includes cutting or scraping new tissue to recreate a vaginal orifice similar to that of an unmarried woman [ 34142 ]. In such cases, a new process of defibulation for sexual intercourse is necessary, leading women to go through repeated closure and openings throughout their childbearing years [ 40 — 44 ]. Less is known about post-delivery care procedures in Somali.

No clear evidence has shown that reinfibulation is common there, although one study from Kenya has suggested such practices [ 36 ]. To ease access to these services, some clinics accept women who seek help directly. Others require referrals, which are easy to access and are accepted from various service providers. The cost is also low at approximately 34 Euro NOKas medicalized defibulation is offered as part of public health care services. Finally, travel time and cost is also low for most women, as the clinics are located in major cities with the highest concentrations of affected migrant groups [ 49 ].

Medicalized defibulation differs from traditional defibulation modes in several ways. First, medicalized defibulation is performed clinically, with pain relief and sterile instruments. The Norwegian guidelines advise sufficient defibulation to uncover the urethra [ 46 ]. This is expected to ease daily functioning of urination and menstruation and to facilitate eventual medical examinations and childbirth. The cut edges are sutured to each side to prevent regrowth and re-closure. Furthermore, couples are advised to refrain from sexual intercourse until the wounds heal.

Compared with traditional procedures, medicalized defibulation likely reduces pain, risk of infection, and Women want sex Edna complications ificantly.

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It also reduces the need for further defibulation when women give birth. If not done before, defibulation is a necessity in childbirth to avoid uncontrolled tearing, though occasionally health care providers have preferred to carry out multiple episiotomies instead, though they are more invasive procedures [ 18 ]. Given these benefits, infibulated women and their male partners can be expected to prefer medicalized defibulation over painful and time-consuming traditional practices.

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However, no accurate data report an uptake of medicalized defibulation to support this assumed preference. Given that more than 9, women in Norway most likely have undergone infibulation, an underutilization of such services can be inferred. Does this limited uptake indicate a resistance to medicalized defibulation? This study thus seeks to explore the factors that encourage and hinder women and girls from seeking medicalized defibulation. A deeper understanding of these factors can improve our understanding of health-seeking behavior, the utilization of medicalized defibulation and the acceptance of these services.

A qualitative study, including interviews and participant observations in Somali and Sudanese communities was conducted in the period — Efforts were made to recruit informants from diverse backgrounds. Informants were recruited from across the country—approximately half from Oslo and the remainder from eight other towns and villages. In-depth interviews with key informants were conducted with 23 women and 13 men of Somali and Sudanese origin. Twenty-two were of Somali origin, and 14 were of Sudanese origin. Snow-ball sampling through different starting points was used to recruit 24 informants who had lived more than a year in Norway, and four key informants were recruited through the services in which they worked.

In addition, eight newly arrived Somali quota refugees were included in the study. The recruitment strategies that were selected to include informants with various lengths of stay and migration routes thus resulted in two informant groups: long-term residents and newly arrived refugees. The contacts who assisted in the initial recruitment of Women want sex Edna informants had high levels of education and long-term residence in Norway.

This bias was also evident among the informants who they recruited, of whom the majority had higher levels of education beyond primary school and employment than the average Somali and Sudanese migrants in Norway. This bias was particularly pronounced among the Sudanese, several of whom had studied at the university level, both in Sudan and Norway. The settled informants thus differed ificantly from the average Somali and Sudanese migrant in sense of higher education and level of employment.

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