Addressing Female Genital Mutilation/Cutting (FGM/C) in the Era of Clitoral Reconstruction: Plastic Surgery

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Abstract

Purpose of the Review

The aim of this review is to give an overview of the recent evidence on clitoral reconstruction and other relevant reconstructive plastic surgery measures after female genital mutilation/cutting (FGM/C).

Recent Findings

Recent publications present refinements and modifications of the surgical technique of clitoral reconstruction along with reconstruction of the labia majora and clitoral hood. Novel approaches with reposition of the clitoral nerve, anchoring of the labia majora, fat grafting, and full thickness mucosa grafts have been introduced. The current evidence on outcomes of clitoral reconstruction shows potential benefits. However, there is a risk of postoperative complications and a negative outcome. Experts in the field advocate for a multidisciplinary approach including psychosexual counseling and health education with or without subsequent clitoral reconstructive surgery.

Summary

The evolution of reconstructive treatment for women with FGM/C is expanding, however at a slow rate. The scarcity of evidence on clitoral reconstruction halters availability of clinical guidelines and consensus regarding best practice. Clitoral reconstruction should be provided by multidisciplinary referral centers in a research setting with long-term follow-up on outcomes of postoperative morbidity and possible benefits.

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Most cited references 46

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Up-to-date approach to manage keloids and hypertrophic scars: a useful guide.

Anna I Arno, Gerd Gauglitz, Juan P Barret … (2014)

Keloids and hypertrophic scars occur anywhere from 30 to 90% of patients, and are characterized by pathologically excessive dermal fibrosis and aberrant wound healing. Both entities have different clinical and histochemical characteristics, and unfortunately still represent a great challenge for clinicians due to lack of efficacious treatments. Current advances in molecular biology and genetics reveal new preventive and therapeutical options which represent a hope to manage this highly prevalent, chronic and disabling problem, with long-term beneficial outcomes and improvement of quality of life. While we wait for these translational clinical products to be marketed, however, it is imperative to know the basics of the currently existing wide array of strategies to deal with excessive scars: from the classical corticotherapy, to the most recent botulinum toxin and lasers. The main aim of this review paper is to offer a useful up-to-date guideline to prevent and treat keloids and hypertrophic scars.

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Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges.

Clinton Enos, Alon Mantel, Valerie M. Harvey … (2016)

Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized.

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Pleasure and orgasm in women with Female Genital Mutilation/Cutting (FGM/C).

Jasmine Abdulcadir, L Catania, Omar Abdulcadir … (2007)

Female genital mutilation/cutting (FGM/C) violates human rights. FGM/C women's sexuality is not well known and often it is neglected by gynecologists, urologists, and sexologists. In mutilated/cut women, some fundamental structures for orgasm have not been excised. The aim of this report is to describe and analyze the results of four investigations on sexual functioning in different groups of cut women. semistructured interviews and the Female Sexual Function Index (FSFI). 137 adult women affected by different types of FGM/C; 58 young FGM/C ladies living in the West; 57 infibulated women; 15 infibulated women after the operation of defibulation. The group of 137 women, affected by different types of FGM/C, reported orgasm in almost 86%, always 69.23%; 58 mutilated young women reported orgasm in 91.43%, always 8.57%; after defibulation 14 out of 15 infibulated women reported orgasm; the group of 57 infibulated women investigated with the FSFI questionnaire showed significant differences between group of study and an equivalent group of control in desire, arousal, orgasm, and satisfaction with mean scores higher in the group of mutilated women. No significant differences were observed between the two groups in lubrication and pain. Embryology, anatomy, and physiology of female erectile organs are neglected in specialist textbooks. In infibulated women, some erectile structures fundamental for orgasm have not been excised. Cultural influence can change the perception of pleasure, as well as social acceptance. Every woman has the right to have sexual health and to feel sexual pleasure for full psychophysical well-being of the person. In accordance with other research, the present study reports that FGM/C women can also have the possibility of reaching an orgasm. Therefore, FGM/C women with sexual dysfunctions can and must be cured; they have the right to have an appropriate sexual therapy.

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Author and article information

Contributors

Hannes Sigurjonsson: 0046 733 947391 , hannes.sigurjonsson@sll.se

Journal

Journal ID (nlm-ta): Curr Sex Health Rep

Journal ID (iso-abbrev): Curr Sex Health Rep

Title: Current Sexual Health Reports

Publisher: Springer US (New York )

ISSN (Print): 1548-3584

ISSN (Electronic): 1548-3592

Publication date (Electronic): 27 April 2018

Publication date PMC-release: 27 April 2018

Publication date (Print): 2018

Volume: 10

Issue: 2

Pages: 50-56

Affiliations

[1 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Department of Plastic and Reconstructive Surgery, , Karolinska University Hospital, ; 171 76 Stockholm, Sweden

[2 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Medicine, , Karolinska Institute, ; Stockholm, Sweden

[3 ]ISNI 0000 0004 1936 9457, GRID grid.8993.b, Center for Gender Research, , Uppsala University, ; Uppsala, Sweden

Article

Publisher ID: 147

DOI: 10.1007/s11930-018-0147-4

PMC ID: 5937872

PubMed ID: 29755298

SO-VID: db559f52-8be6-4dd6-ad90-d4872bebd874

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Funding

Funded by: Karolinska Institute

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Keywords: clitoris,clitoral reconstruction,multi-disciplinary approach,female genital mutilation,female genital cutting, reconstructive plastic surgery

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Keywords: clitoris, clitoral reconstruction, multi-disciplinary approach, female genital mutilation, female genital cutting, reconstructive plastic surgery

Addressing Female Genital Mutilation/Cutting (FGM/C) in the Era of Clitoral Reconstruction: Plastic Surgery

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Abstract

Purpose of the Review

Recent Findings

Summary

Related collections

UCL: UN SDG 05 Gender Equality

Most cited references 46

Up-to-date approach to manage keloids and hypertrophic scars: a useful guide.

Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges.

Pleasure and orgasm in women with Female Genital Mutilation/Cutting (FGM/C).

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