Tag Archives: Gynecologic Surgical Procedures

Surgery performed on the female genitalia.

Reasons for and Experiences With Surgical Interventions for Female Genital Mutilation/Cutting (FGM/C): A Systematic Review

J Sex Med. 2017 Aug;14(8):977-990. doi: 10.1016/j.jsxm.2017.05.016. Epub 2017 Jun
27.

Reasons for and Experiences With Surgical Interventions for Female Genital Mutilation/Cutting (FGM/C): A Systematic Review

Berg RC, Taraldsen S, Said MA, Sørbye IK, Vangen S

ABSTRACT

BACKGROUND: Because female genital mutilation/cutting (FGM/C) leads to changes in normal genital anatomy and functionality, women are increasingly seeking surgical interventions for their FGM/C-related concerns. AIM: To conduct a systematic review of empirical quantitative and qualitative research on interventions for women with FGM/C-related complications. METHODS: We conducted systematic searches up to May 2016 in 16 databases to obtain references from different disciplines. We accepted all study designs consisting of girls and women who had been subjected to FGM/C and that examined a reparative intervention for a FGM/C-related concern. We screened the titles, abstracts, and full texts of retrieved records for relevance. Then, we assessed the methodologic quality of the included studies and extracted and synthesized the study data. OUTCOMES: All outcomes were included. RESULTS: Of 3,726 retrieved references, 71 studies including 7,291 women were eligible for inclusion. We identified three different types of surgical intervention: defibulation or surgical separation of fused labia, excision of a cyst with or without some form of reconstruction, and clitoral or clitoral-labial reconstruction. Reasons for seeking surgical interventions consisted of functional complaints, sexual aspirations, esthetic aspirations, and identity recovery. The most common reasons for defibulation were a desire for improved sexual pleasure, vaginal appearance, and functioning. For cyst excision, cystic swelling was the main reason for seeking excision; for reconstruction, the main reason was to recover identity. Data on women’s experiences with a surgical intervention are sparse, but we found that women reported easier births after defibulation. Our findings also suggested that most women were satisfied with defibulation (overall satisfaction = 50-100%), typically because of improvements  in their sexual lives. Conversely, the results suggested that defibulation had low social acceptance and that the procedure created distress in some women who disliked the new appearance of their genitalia. Most women were satisfied with clitoral reconstruction, but approximately one third were dissatisfied with or perceived a worsening in the esthetic look. CLINICAL TRANSLATION: The information health care professionals give to women who seek surgical interventions for FGM/C should detail the intervention options available and what women can realistically expect from such interventions. STRENGTHS AND LIMITATIONS: The systematic review was conducted in accordance with guidelines, but there is a slight possibility that studies were missed. CONCLUSION: There are some data on women’s motivations for surgery for FGM/C-related concerns, but little is known about whether women are satisfied with the surgery, and experiences appear mixed.

This article is available in this LINK

Missed opportunities for diagnosis of female genital mutilation.

Int J Gynaecol Obstet. 2014 Mar 5. pii: S0020-7292(14)00114-3. doi: 10.1016/j.ijgo.2013.11.016. [Epub ahead of print]

Missed opportunities for diagnosis of female genital mutilation.

Abdulcadir J, Dugerdil A, Boulvain M, Yaron M, Margairaz C, Irion O, Petignat P.

ABSTRACT

OBJECTIVE: To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

METHODS: In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification.

RESULTS: In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis.

CONCLUSION: Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.

This article can be accessed in this LINK.

Female genital mutilation, cutting, or circumcision.

Obstet Gynecol Int. 2013;2013:240421. doi: 10.1155/2013/240421. Epub 2013 Nov 27.FREE

Female genital mutilation, cutting, or circumcision.

Sundby J(1), Essén B(2), Johansen RE(3).

Author information: (1)Institute of Health and Society, University of Oslo, Norway. (2)Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Sweden. (3)Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Norway.

EXTRACT

Female genital mutilation (FGM), female genital cutting, or female circumcision of women, the theme addressed in this special issue has many terms. The short form acronym FGM is understood by most, and it does contain the notion that we are talking about a traditional practice that is harmful. The practice affects women in diaspora as well as African countries, and men are involved as decision makers and attitude changers. Cutting is a neutral term, and circumcision is a more traditional terminology. Each term carries a certain value. But the practice is the same regardless of name.

In order to understand the tradition, assist women who have undergone it, and promote action against it, it is important to have solid knowledge. This knowledge is partly medical and partly social. Thus, research based on a multitude of methods is warranted. This special issue is indeed a combination of social science and medical research on different aspects of the practice, that is also a genital health hazard for women….

This article can be downloaded in this LINK

Perron et al.: Female genital cutting.

J Obstet Gynaecol Can. 2013 Nov;35(11):1028-45.

Female genital cutting.

Perron L, Senikas V, Burnett M, Davis V; Social Sexual Issues Committee, Burnett M, Aggarwal A, Bernardin J, Clark V, Davis V, Fisher W, Pellizzari R, Polomeno V, Rutherford M, Sabourin J; Ethics Committee, Shapiro J, Akhtar S, Camire B, Christilaw J, Corey J, Nelson E, Pierce M, Robertson D, Simmonds A.

Ottawa ON.

ABSTRACT

Objective: To strengthen the national framework for care of adolescents and women affected by female genital cutting (FGC) in Canada by providing health care professionals with: (1) information intended to strengthen their knowledge and understanding of the practice; (2) directions with regard to the legal issues related to the practice; (3) clinical guidelines for the management of obstetric and gynaecological care, including FGC related complications; and (4) guidance on the provision of culturally competent care to adolescents and women with FGC. Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library in September 2010 using appropriate controlled vocabulary (e.g., Circumcision, Female) and keywords (e.g., female genital mutilation, clitoridectomy, infibulation). We also searched Social Science Abstracts, Sociological Abstracts, Gender Studies Database, and ProQuest Dissertations and Theses in 2010 and 2011. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. Female genital cutting is internationally recognized as a harmful practice and a violation of girls’ and women’s rights to life, physical integrity, and health. (II-3) 2. The immediate and long-term health risks and complications of female genital cutting can be serious and life threatening. (II-3) 3. Female genital cutting continues to be practised in many countries, particularly in sub-Saharan Africa, Egypt, and Sudan. (II-3) 4. Global migration patterns have brought female genital cutting to Europe, Australia, New Zealand, and North America, including Canada. (II-3) 5. Performing or assisting in female genital cutting is a criminal offense in Canada. (III) 6. Reporting to appropriate child welfare protection services is mandatory when a child has recently been subjected to female genital cutting or is at risk of being subjected to the procedure. (III) 7. There is concern that female genital cutting continues to be perpetuated in receiving countries, mainly through the act of re-infibulation. (III) 8. There is a perception that the care of women with female genital cutting is not optimal in receiving countries. (III) 9. Female genital cutting is not considered an indication for Caesarean section. (III)

Recommendations 1. Health care professionals must be careful not to stigmatize women who have undergone female genital cutting. (III-A) 2. Requests for re-infibulation should be declined. (III-B) 3. Health care professionals should strengthen their understanding and knowledge of female genital cutting and develop greater skills for the management of its complications and the provision of culturally competent care to adolescents and women who have undergone genital cutting. (III-A) 4. Health care professionals should use their knowledge and influence to educate and counsel families against having female genital cutting performed on their daughters and other family members. (III-A) 5. Health care professionals should advocate for the availability of and access to appropriate support and counselling services. (III-A) 6. Health care professionals should lend their voices to community-based initiatives seeking to promote the elimination of female genital cutting. (III-A) 7. Health care professionals should use interactions with patients as opportunities to educate women and their families about female genital cutting and other aspects of women’s health and reproductive rights. (III-A) 8. Research into female genital cutting should be undertaken to explore women’s perceptions and experiences of accessing sexual and reproductive health care in Canada. (III-A) The perspectives, knowledge, and clinical practice of health care professionals with respect to female genital cutting should also be studied. (III-A). 9. Information and guidance on female genital cutting should be integrated into the curricula for nursing students, medical students, residents, midwifery students, and students of other health care professions. (III-A) 10. Key practices in providing optimal care to women with female genital cutting include: a. determining how the woman refers to the practice of female genital cutting and using this terminology throughout care; (III-C) b. determining the female genital cutting status of the woman and clearly documenting this information in her medical file; (III-C) c. ensuring the availability of a well-trained, trusted, and neutral interpreter who can ensure confidentiality and who will not exert undue influence on the patient-physician interaction when providing care to a woman who faces language challenges; (III-C) d. ensuring the proper documentation of the woman’s medical history in her file to minimize the need for repeated medical histories and/or examinations and to facilitate the sharing of information; (III-C) e. providing the woman with appropriate and well-timed information, including information about her reproductive system and her sexual and reproductive health; (III-C) f. ensuring the woman’s privacy and confidentiality by limiting attendants in the room to those who are part of the health care team; (III-C) g. providing woman-centred care focused on ensuring that the woman’s views and wishes are solicited and respected, including a discussion of why some requests cannot be granted for legal or ethical reasons; (III-C) h. helping the woman to understand and navigate the health system, including access to preventative care practices; (III-C) i. using prenatal visits to prepare the woman and her family for delivery; (III-C) j. when referring, ensuring that the services and/or practitioners who will be receiving the referral can provide culturally competent and sensitive care, paying special attention to concerns related to confidentiality and privacy. (III-C).

There is no LINK to view this article online.

Interventions for improving outcomes for pregnant women who have experienced genital cutting.

Cochrane Database Syst Rev. 2013 Feb 28;2:CD009872. doi: 10.1002/14651858.CD009872.pub2.

Interventions for improving outcomes for pregnant women who have experienced genital cutting.

Balogun OO, Hirayama F, Wariki WM, Koyanagi A, Mori R.

Department of Social and Preventive Epidemiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

BACKGROUND: Female genital cutting (FGC) refers to all procedures that involve the partial or total removal of the external female genitalia, or other injury to the female genital organs for cultural or other non-therapeutic reasons. There are no known medical benefits to FGC, and it can be potentially dangerous for the health and psychological well-being of women and girls who are subjected to the practice resulting in short- and long-term complications. Health problems of significance associated with FGC faced by most women are maternal and neonatal mortality and morbidity, the need for assisted delivery and psychological distress. Under good clinical guidelines for caring for women who have undergone genital cutting, interventions could provide holistic care that is culturally sensitive and non-judgemental to improve outcomes and overall quality of life of women. This review focuses on key interventions carried out to improve outcome and overall quality of life in pregnant women who have undergone FGC.

OBJECTIVES: To evaluate the impact of interventions to improve all outcomes in pregnant women or women planning a pregnancy who have undergone genital cutting. The comparison group consisted of those who have undergone FGC but have not received any intervention.

SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (31 December 2012) and organisations engaged in projects regarding FGC.

SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-randomised trials or quasi-RCTs with reported data comparing intervention outcomes among pregnant women or women planning a pregnancy who have undergone genital cutting compared with those who did not receive any intervention.

DATA COLLECTION AND ANALYSIS: We did not identify any RCTs, cluster-randomised trials or quasi-RCTs.

MAIN RESULTS: There are no included studies.

AUTHORS’ CONCLUSIONS: FGC research has focused mainly on observational studies to describe the social and cultural context of the practice, and we found no intervention trials conducted to improve outcomes for pregnant women presenting with complications of FGC. While RCTs will provide the most reliable evidence on the effectiveness of interventions, there remains the issue of what is considered ethically appropriate and the willingness of women to undergo randomisation on an issue that is enmeshed in cultural traditions and beliefs. Consequently, conducting such a study might be difficult.

This review can be accessed in this LINK

The Impact of Female Genital Cutting on First Delivery in Southwest Nigeria

Stud Fam Plann. 2002 June 33(2):173–184

The Impact of Female Genital Cutting on First Delivery in Southwest Nigeria

Slanger TE, Snow RC, Okonofua FE

ABSTRACT

To date, data linking obstetric morbidity to female genital cutting in populations with less severe types of cutting have been limited to case reports and speculation. In this cross-sectional study, 1,107 women at three hospitals in Edo State, Nigeria, reported on their first-delivery experiences. Fifty-six percent of the sample had undergone genital cutting. Although univariate analyses suggest that genital cutting is associated with delivery complications and procedures, multivariate analyses controlling for sociodemographic factors and delivery setting show no difference between cut and noncut women’s likelihood of reporting first-delivery complications or procedures. Whereas a clinical association between genital cutting and obstetric morbidity may occur in populations that have undergone more severe forms of cutting, in this setting, apparent associations between cutting and obstetric morbidity appear to reflect confounding by social class and by the conditions under which delivery takes place.

This article can be purchased in this LINK

Clitoral cyst: not a very rare complication of female genital mutilation

Fertil Steril. 2009 92(3): S118

Clitoral cyst: not a very rare complication of female genital mutilation

Rouzi AA

ABSTRACT

No abstract is available for this article

This article can be purchased in this LINK

[External genital after-effects of excision in national hospital Yalgado Ouedraogo (CHN-YO): epidemiology and surgery]

Gynecol Obstet Fertil. Abril 2001 29(4): 295–300

Séquelles génitales externes de l’excision au centre hospitalier national Yalgado Ouedraogo (CHN-YO) : épidémiologie et traitement chirurgical

[External genital after-effects of excision in national hospital Yalgado Ouedraogo (CHN-YO): epidemiology and surgery] [Article in French]

Akotionga M, Traore O, Lakoande J, Kone B

ABSTRACT

By a prospective study in one year time, the authors noticed that femal genital mutilation complications were 7,3 per cent of external gynecologic consultations and most complications were overdraft between 15 and 24 years old (36 cases out of 49). The main consultation motives were dyspareunia and difficult sexual relationship. Surgery under local anesthetic was very efficient (more than 90 % success) and cheaper than surgery under general anesthetic.

This article can be purchased in this LINK

[Results of surgical clitoral repair after ritual excision: 453 cases]

Gynecol Obstet Fertil. Dec 2006 34(12); 1137–1141

Résultats de la réparation chirurgicale du clitoris après mutilation sexuelle : 453 cas

[Results of surgical clitoral repair after ritual excision: 453 cases] [Article in French]

Foldes P, Louis-Sylvestre C

ABSTRACT

Objective. Ritual excision is responsible for urologic, gynaecologic and obstetrical complications, whose surgical treatment has been fully described. Sexual sequelae deserve the same attention. We describe and analyze the results of a surgical procedure for clitoral rehabilitation.

Patients and methods. Women requesting this surgery between 1992 and 2005 have been prospectively included in this study. The skin covering the stump was resected and the clitoris identified. The suspensor ligament was sectioned in order to mobilize the stump, the sclerous tissues were removed from the extremity and the neo glans brought to a normal situation. Pre operative pain and clitoral impairment were assessed within five categories. The same was done with anatomical and functional postoperative results at six months.

Results. Four hundred and fifty-three patients have been completely evaluated. Hospitalisation stay was 24 hours and the procedure never lasted more than 30 minutes. Minor early complications were recorded in 58 patients (hematoma, disrupture of the suture, pain). Four patients reported persisting pain at four months. A visible clitoral massif could be restored in 87% of the cases and a real improvement in clitoral function was obtained in 75% of the patients.

Discussion and conclusion. This surgical procedure is easy and reliable. It provides promising cosmetic and functional results with minor complications.

This article can be purchased in this LINK

 

[Clitoridal reconstruction after female circumcision].

Ann Chir Plast Esthet. 2011 Feb;56(1):74-9. Epub 2010 Jun 19.

[Clitoridal reconstruction after female circumcision].

[Article in French]

Quilichini J, Burin Des Roziers B, Daoud G, Cartier S.

Service de chirurgie plastique et chirurgie maxillo-faciale, centre hospitalier de Gonesse, 25, rue Pierre-de-Theilley, BP 30071, 95503 Gonesse cedex, France.
julien.quilichini@gmail.com

ABSTRACT

Ritual sexual mutilations affect 140million of women around the world with over three millions new cases per year. France is not spared with 55,000 mutilated women living on our territory. There is a simple, reliable and reproductible reconstructive surgical technique described by the French urologist Pierre Foldès. This technique is still unknown by patients and plastic surgeons. Through a clinical case, the authors discuss the principles, results and key points of this procedure.

This article can be purchased in this LINK