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      The lived experience of female genital cutting (FGC) in Somali-Canadian women’s daily lives

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          Abstract

          Many of the Somali women who have immigrated to other countries, including Canada, have experienced Female Genital Circumcision/ Mutilation/ Cutting (FGC). While there is literature on the medical aspects of FGC, we were interested in understanding the daily life experiences and bodily sensations of Somali-Canadian women in the context of FGC. Fourteen women living in the Greater Toronto Area were interviewed. Interview data were analyzed using a phenomenological approach. We found that the memory of the ceremonial cutting was vivid but was frequently described with acceptance and resignation–as something that just is; that was normal given the particular context, familial and cultural, and their young age. Most of the women recounted experiencing pain and discomfort throughout their adult lives but were intent on not noticing or giving the pain any power; they considered themselves healthy. The following themes emerged from our interviews: Every Body Had It: Discussing FGC, I’m Normal Aren’t I?, and Feeling in My Body–all themes that work at normalizing their bodies in a society that they know views them as different. They dealt with both pain and pleasure in the context of their busy lives suggesting resilience in spite of the day-to-day difficulties of daily life.

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          Sex differences in pain.

          Are there sex differences in pain? For experimentally delivered somatic stimuli, females have lower thresholds, greater ability to discriminate, higher pain ratings, and less tolerance of noxious stimuli than males. These differences, however, are small, exist only for certain forms of stimulation and are affected by many situational variables such as presence of disease, experimental setting, and even nutritive status. For endogenous pains, women report more multiple pains in more body regions than men. With no obvious underlying rationale, some painful diseases are more prevalent among females, others among males and, for many diseases, symptoms differ between females and males. Sex differences in attitudes exist that affect not only reporting, coping, and responses to treatment, but also measurement and treatment. So many variables are operative, however, that the most striking feature of sex differences in reported pain experience is the apparent overall lack of them. On the other hand, deduction from known biological sex differences suggests that these are powerful sex differences in the operation of pain mechanisms. First, the vaginal canal provides an additional route in women for internal trauma and invasion by pathological agents that puts them at greater risk for developing hyperalgesia in multiple body regions. Second, sex differences in temporal patterns are likely to give rise to sex differences in how pain is "learned" and stimuli are interpreted, a situation that could lead to a greater variability and wider range of pains without obvious peripheral pathology among females. Third, sex differences in the actions of sex hormones suggest pain-relevant differences in the operation of many neuroactive agents, opiate and nonopiate systems, nerve growth factor, and the sympathetic system. Thus, while inductive analysis of existing data demonstrate more similarities than differences in pain experience between females and males, deductive analysis suggests important operational sex differences in its production.
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            Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review

            Background Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health. Objective To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this. Search strategy A systematic search of eight electronic databases was undertaken in 2015 using the terms “Roma” and “maternity care”. A broad search for grey literature included the websites of relevant agencies. Data extraction and synthesis Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature. Results Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature. Conclusions There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0263-4) contains supplementary material, which is available to authorized users.
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              Gender variations in clinical pain experience.

              A Unruh (2015)
              This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate or severe pains from menstruation, pregnancy and childbirth. In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men. Women may be at greater risk for pain-related disability than men but women also respond more aggressively to pain through health related activities. Women may be more vulnerable than men to unwarranted psychogenic attributions by health care providers for pain. Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.
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                Author and article information

                Contributors
                Role: Formal analysisRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysis
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: ValidationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Formal analysis
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                6 November 2018
                2018
                : 13
                : 11
                : e0206886
                Affiliations
                [1 ] Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
                [2 ] Institute of Medical Sciences, University of Toronto, Toronto, Canada
                [3 ] Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
                [4 ] Department of Psychology, University of Toronto, Toronto, Canada
                [5 ] Department of Family & Community Medicine, University of Toronto, Toronto, Canada
                Migration Institute of Finland, FINLAND
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7792-8099
                Article
                PONE-D-17-32024
                10.1371/journal.pone.0206886
                6219790
                30399181
                e6c4c8ca-9b71-48d3-b10d-b8cf3e715d5f
                © 2018 Jacobson et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 August 2017
                : 21 October 2018
                Page count
                Figures: 0, Tables: 0, Pages: 24
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000029, Institute of Gender and Health;
                Award ID: RN86248 - 221534
                Award Recipient :
                Funded by: Wilfred and Joyce Posluns Chair in Women's Brain Health and Aging
                Award Recipient :
                This work was supported by a grant (RN86248 - 221534) from the Canadian Institutes of Health Research, Institute of Gender and Health ( http://www.cihr-irsc.gc.ca/e/8673.html) and by the Wilfred and Joyce Posluns Chair in Women's Brain Health and Aging to GE. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Ethnicities
                African People
                Somalian People
                Biology and Life Sciences
                Physiology
                Sensory Physiology
                Somatosensory System
                Pain Sensation
                Medicine and Health Sciences
                Physiology
                Sensory Physiology
                Somatosensory System
                Pain Sensation
                Biology and Life Sciences
                Neuroscience
                Sensory Systems
                Somatosensory System
                Pain Sensation
                Social Sciences
                Sociology
                Culture
                Social Sciences
                Anthropology
                Cultural Anthropology
                Religion
                Social Sciences
                Sociology
                Religion
                People and Places
                Population Groupings
                Families
                Fathers
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                People and places
                Geographical locations
                North America
                Canada
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Reproductive System Procedures
                Circumcision
                Custom metadata
                All relevant data are within the paper. This is a qualitative study of only a few participants in a highly connected community. In order to maintain the anonymity of the participants, it is necessary to not include more data than are in the paper, itself. This is based on ethical concerns for the participant's confidentiality. The data within the paper, comprising of all anonymized excerpts, includes all the data necessary to support the study's findings. The full transcripts can not be made available by request. This is because this qualitative study focuses on participants who are a part of a small and highly connected community. Despite the participants being anonymous within the transcripts, the complete details of their lives may make them identifiable. In order to maintain the anonymity of the participants, it is necessary to not include more data from the full transcripts than are in the paper, itself. This is based on ethical concerns for the participant's confidentiality and the recommendation of The University of Toronto Research Ethics Board.

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