Understanding Women’s Responses to Sexual Pain After Female Genital Cutting: An Integrative Psychological Pain Response Model

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14 Scopus citations


The World Health Organization estimates that over 200 million women and girls have experienced female genital cutting (FGC). Many women and girls who have undergone FGC have migrated to areas of the world where providers are unfamiliar with the health needs associated with FGC. Both providers in Western healthcare systems and female immigrant and refugee patients report communication difficulties leading to distrust of providers by women who have experienced FGC. Sexual pain is one common problem requiring discussion with healthcare providers and possible intervention. Yet, existing clinical and research literature provides little guidance for assessment and intervention when sexual pain is a result of FGC. Several conceptual frameworks have been developed to conceptualize and guide treatments for other types of pain, such as back pain and headaches. In this article, we integrate four prominent models—the fear avoidance model, eustress endurance model, distress endurance model, and pain resilience model—to conceptualize sexual pain in women who have experienced FGC. The resulting integrative psychological pain response model will aid in providing culturally responsive clinical management of sexual pain to women who have experienced FGC. This integrative model also provides a theoretical foundation for future research in this population.

Original languageEnglish (US)
Pages (from-to)1859-1869
Number of pages11
JournalArchives of sexual behavior
Issue number5
StatePublished - Apr 22 2019

Bibliographical note

Funding Information:
The writing of this article was partially supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (R01HD091685-01A1) and the Department of Family Medicine and Community Health, University of Minnesota Medical School. We would like to acknowledge and thank Heidi Fall for her assistance in manuscript preparation and Dr. Bernie Harlow for comments on early versions of the conceptual model. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.


  • Female genital cutting
  • Immigrant women’s health
  • Pain models
  • Refugee women’s health
  • Sexual pain


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