Project Summary/Abstract The National Pain Strategy notes the importance of addressing pain in minority populations to reduce health disparities. One such population is female refugees who have been victim to female genital cutting (FGC) --- which is known to cause sexual pain. The objective of the proposed research is to collect empirical data to (1) inform the conceptualization of sexual pain and other outcomes among Somali women living in Minnesota who have experienced FGC, (2) promote healthcare practices that minimize sexual pain, and (3) develop decision- making tool(s) and education seminars driven by study findings. The majority of Somali girls undergo infibulation when originally cut, which involves stitching the vaginal opening shut. Deinfibulation (i.e. opening the circumcision/infibulation scar) may decrease pain and is necessary before vaginal birth. It is recommended before labor and delivery; however, many patients wait until labor and delivery to undergo deinfibulation ?thus increasing a risk in tears. Little is known about how sexual pain and sexual function are impacted by the timing of deinfibulation. To better understand sexual pain in relation to FGC, we will rely upon conceptual models that utilize a biopsychosocial approach, integrating biological, psychological, and cultural considerations. These models include fear-avoidance, endurance, and resilience. We will partner with a community-based organization (SoLaHmo) and two large medical clinics serving Somali American women to conduct 75 qualitative interviews, 300 computer assisted surveys of Somali-American married women 18-45 years who have experienced FGC to accomplish the following aims: Aim 1: Qualitatively investigate sexual pain characteristics and meaning ascribed to sexual pain. Aim 2: Establish reference levels using descriptive statistics to quantify sexual pain characteristics (presence, frequency, intensity), sexual function, pain responses (fear avoidance, endurance, resilience), and moderator variables (acculturation and shared decision making) in this population. Aim 3: Among women who have vaginally delivered one or more babies, determine if sexual pain characteristics and sexual function are associated with the timing of deinfibulation with first child. Aim 4: Among women reporting sexual pain in Aim 3, determine if pain responses (fear avoidance, endurance, resilience) are associated with sexual pain and sexual function, and whether these associations are modified by degree of acculturation --- while adjusting for timing of deinfibulation. The long-term goal is to identify mechanisms that will lead to better pain management in this population. Completion of these novel study aims will generate information to develop evidence-based and culturally- sensitive medical and psychological interventions for women who have undergone FGC.