Twenty peer-reviewed articles were included in our analysis. Nine were quantitative surveys [22–30], ten used qualitative interviews [31–40] and one was a mixed qualitative and quantitative study . The settings included 15 countries, i.e. Egypt, Yemen, Oman, Nigeria, North Sudan, Senegal, Guinea, Somalia, Gambia, Sierra Leone, Ghana, USA, Norway, Sweden and Spain.
Three main themes in regards to men’s attitudes, beliefs and behaviours to support continuation or abandonment of FGM and its prevention emerged. These were (1) men’s perceptions of FGM, (2) FGM as an issue for men, and (3) influence of socio-demographic factors. A synthesis of the available data revealed ambiguity of men’s wishes in regards to the continuation of FGM. Many men wished to abandon this practice because of the physical and psychosexual complications to both women and men. The silent culture between the sexes was posited as a major obstacle for change , as was the entrenched sense of social obligation [31, 35, 37].
Men’s perception of FGM
A study of fathers in Egypt showed that they believed uncut women to be promiscuous . FGM was deemed important for good marriage opportunities and to ensure fidelity in marriage . In this respect, FGM helped men maintain polygamy in some communities . Men in Guinea considered FGM to reduce the likelihood of premarital sex . In a study of Somali men, however, they were divided on whether FGM prevented premarital sex, marital infidelity and preserved the dignity of girls .
Men acknowledged and complained about the negative impact of FGM on marital sexual relationships, and found the lack of sexual response of their wives disturbing or inconvenient [31, 33]. Almost all 99 men and religious leaders, Muslims and Christians, in a study in rural communities in Egypt acknowledged women’s equal right to enjoy sex . Nevertheless, for some men these concerns and beliefs were overridden by their wish to ensure their wives’ fidelity in marriage  or their fear of loss of control over the sexual relationship .
FGM as an issue for men
Interviews with men in Northern Sudan revealed that men did not accurately understand FGM, as it was not until they were newly married that they experienced the irrevocable consequences of their wives’ FGM . Men felt they, too, were victims of the consequences of FGM. Almost all men stated they did not want their daughters to undergo FGM and believed it would become less common as men had started to prefer women who had not been cut . Men described their own complications, including male sexual dissatisfaction, compassion for female suffering and perceived challenges to their masculinity [32, 33].
Factors that influence men’s support for continuation or abandonment of FGM
Somali men in Oslo acknowledged that men in Somalia disliked the practice but that it continued due to social obligation . Men agreed to it so as not to upset their mothers . Somali men in Norway no longer felt social pressure to perform FGM. In fact, they maintained that it was prestigious for a woman not to have been cut .
Fathers in Egypt acknowledged the wish to abandon FGM and a longing for change . They cited social pressure and fear of rejection from the community as significant barriers to the abandonment process. The entrenched sense of social obligation was stronger than the belief that FGM was against their religion .
Education, urban living, religion and ethnicity
The level of education of men, urban living and wealth are associated with disapproval of FGM [24, 26, 29, 30]. Evaluation of DHS data in Guinea from 1999 revealed that 51 % of men wanted FGM to continue, whilst 38 % were against it . Each additional year of schooling substantially increased the odds of favouring the discontinuation of the practice .
A school-based study of adolescent boys in Oman revealed that they were more likely to support FGM if they lived in rural areas and their parents had lower level of education . Eighty percent of the boys considered FGM to be important and necessary.
The analysis of the DHS of Guinea showed that if FGM was considered to be accepted by religion, men were more likely to be supportive of the practice . In two studies in Somalia, almost all men supported the continuation of FGM and 96 % preferred to marry women who had been cut, even though 90 % were aware of its complications [25, 34]. Men supported the “lesser” Sunna type, i.e. types I and II, because they believed it not to have any negative health effects, unlike the Pharaonic type, i.e. type III or infibulation . Ninety-six percent of men believed FGM to be a religious requirement.
Prevalence of FGM varied amongst Muslims with different ethnic backgrounds from 12 % to 98 % in a study of 993 men in Gambia . The Serer and Wolof communities that were Muslim but traditionally non-practising, had the lowest prevalence. Wolof men also had the highest awareness of complications of FGM . Similarly, male healthcare workers in Gambia belonging to traditionally practising communities were more likely to support the continuation and medicalisation of FGM, and intended to cut their daughters .
Knowledge of complications of FGM
Intervention studies involving men had an important positive effect on men’s attitudes towards abandonment of this practice. In a study of men (n = 4488) and women (n = 5041) in Nigeria , a greater proportion of men (54 %) than women (44 %) did not want FGM stopped prior to the intervention of health education on FGM and its complications over ten days. There was a statistically significant decrease in this attitude to 25 % amongst men in the post-intervention stage.
A six months Village Empowerment Program was conducted by TOSTAN in Senegal on human rights, problem-solving process, basic hygiene, and women’s health . The change in the intention to cut their daughters amongst men was greatest among program participants (66 to 13 %) and least in the control group (78 to 56 %). Twenty percent of men as participants and 63 % in the comparison groups preferred a women who had been cut. Most participant men (75 %) indicated their support for the abandonment of FGM. Only 30 % in the comparison group expressed the same.
In a study of 993 men in Gambia, 72 % did not know FGM had a negative impact on health . As compared to older men, younger men had a better understanding of the health problems and were less supportive of the practice, had lower intention to cut their daughters, and had higher willingness for men to participate in prevention programs .
There are three studies that examined the attitudes of men from Somalia in Norway  and the USA , and from Ethiopia and Eritrea in Sweden . In contrast to findings from countries where FGM is prevalent, almost all men strongly rejected this practice [35–37]. Men had very good knowledge of the complications of FGM [35–37] and understood that it reduced female sexual pleasure [35, 36]. They considered it devoid of meaning within the context of a cultural practice and that it had no religious mandate [35, 36]. One man had believed it was done to girls to prevent sexual violence .
Even living in another African country had a positive effect on attitudes of men. Eighty-nine percent of Somali male refugees in Ethiopia positively viewed the usefulness of anti-FGM interventions .