There were 13 studies from click this the Middle East, 43 from a Western country, and 129 from Africa. Twenty different African countries were represented. The FGM/C participants in studies from a Western country originated in the majority of cases from Somalia, and in the remaining cases they originated from another African country where FGM/C is commonly practised. Overall, the 185 studies involved 3.17 million female participants, from infants to women in their 70s, with a mean age

of approximately 30. With respect to the FGM/C characteristics, the majority of women had genital alteration that involved the cutting and removal of portions of the external female genitalia, without stitching, corresponding to either type I or type II. The procedure had in the absolute majority of cases been undertaken in early childhood, usually before the age of 10, by a traditional circumciser. A total of 75 different outcomes were extracted. In this overview, we present key physical health complications of FGM/C in a

life course perspective. Except for some immediate outcomes, these key outcomes derive from comparative studies, that is, women with FGM/C are compared to women without FGM/C with respect to an outcome in a cohort, case–control or cross-sectional study (table 1). We prioritise the presentation of studies with clinically measured and adjusted outcome data, but note also the best available

evidence for additional key outcomes, largely immediate complications. Table 1 shows the 57 studies with the best available evidence regarding the physical health sequelae of FGM/C (comparative cohort, case–control, cross-sectional studies).19–72 About 40% of the outcomes were self-reported primarily by adult women, although the great majority of the obstetric and some genitourinary outcomes were clinically measured. The meta-analytical results that are based on unadjusted estimates are presented in figure 3, and those based on adjusted estimates are shown in figure 4. Table 1 Summary of included comparative studies (N=57) Figure 3 Meta-analyses of urinary tract infection, dyspareunia, Cilengitide sexually transmitted infections, episiotomy (unadjusted effect estimates). Figure 4 Meta-analyses of bacterial vaginosis, HIV, prolonged labour, obstetric tears, caesarean section, instrumental delivery, obstetric haemorrhage, difficult delivery (adjusted effect estimates). Immediate complications In most cases of FGM/C, a girl’s clitoris and labia are cut away, often with a crude unsterile instrument and without anaesthetics by a traditional practitioner who has little knowledge of female anatomy.2 Thus, it is reasonable to assume that physiological harms such as bleeding ensue during the cutting process and the short-term postprocedure period.