Tag Archives: Reconstructive surgical procedures

Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures.

Clitoral keloids after female genital mutilation/cutting.

FREETurk J Obstet Gynecol. 2016 Sep;13(3):154-157. doi: 10.4274/tjod.32067. Epub 2016 Sep 15.

Clitoral keloids after female genital mutilation/cutting.

Birge Ö, Akbaş M, Özbey EG, Adıyeke M.

ABSTRACT

We aimed to describe the presentation of long-term complications of female genital mutilation/cutting and the surgical management of clitoral keloids secondary to female genital mutilation/cutting. Twenty-seven women who underwent surgery because of clitoral keloid between May 2014 and September 2015 in Sudan Nyala Turkish Hospital were evaluated in this retrospective descriptive case series study. The prevalence of type 1, type 2, and type 3 female genital mutilation/cutting were 3.7%, 22.2%, and 74.1%, respectively (type 1: 1/27, type 2: 6/27, and type 3: 20/27). All patients had long-term health problems (dysuria, chronic pelvic pain, vaginal discharge, and chronic pruritus) and sexual dysfunction. Keloids were removed by surgical excision. There were no postoperative complications in any patient. Although clitoral keloid lesions can be seen after any type of female genital mutilation/cutting, they usually develop after type 3 female genital mutilation/cutting. Most of these keloids were noticed after menarche. Keloids can be removed by surgical excision and this procedure can alleviate some long-term morbidities of female genital mutilation/cutting.

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Management of painful clitoral neuroma after female genital mutilation/cutting. 

FREEReprod Health. 2017 Feb 8;14(1):22. doi: 10.1186/s12978-017-0288-3.

Management of painful clitoral neuroma after female genital mutilation/cutting.

Abdulcadir J, Tille JC, Petignat P.

ABSTRACT

BACKGROUND: Traumatic neuromas are the result of regenerative disorganized proliferation of the proximal portion of lesioned nerves. They can exist in any anatomical site and are responsible for neuropathic pain. Post-traumatic neuromas of the clitoris have been described as an uncommon consequence of female genital mutilation/cutting (FGM/C). FGM/C involves partial or total removal of the female genital organs for non-therapeutic reasons. It can involve cutting of the clitoris and can cause psychological, sexual, and physical complications. We aimed to evaluate the symptoms and management of women presenting with a clitoral neuroma after female genital mutilation/cutting (FGM/C). METHODS: We identified women who attended our specialized clinic for women with FGM/C who were diagnosed with a traumatic neuroma of the clitoris between April 1, 2010 and June 30, 2016. We reviewed their medical files and collected socio-demographic, clinical, surgical, and histopathological information. RESULTS: Seven women were diagnosed with clitoral neuroma. Six attended our clinic to undergo clitoral reconstruction, and three of these suffered from clitoral pain. The peri-clitoral fibrosis was removed during clitoral reconstruction, which revealed neuroma of the clitoris in all six subjects. Pain was ameliorated after surgery. The seventh woman presented with a visible and palpable painful clitoral mass diagnosed as a neuroma. Excision of the mass ameliorated the pain. Sexual function improved in five women. One was not sexually active, and one had not yet resumed sex. CONCLUSION: Post-traumatic clitoral neuroma can be a consequence of FGM/C. It can cause clitoral pain or be asymptomatic. In the case of pain symptoms, effective treatment is neuroma surgical excision, which can be performed during clitoral reconstruction. Surgery should be considered as part of multidisciplinary care. The efficacy of neuroma excision alone or during clitoral reconstruction to treat clitoral pain should be further assessed among symptomatic women.

This article is available in this LINK

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.

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Technique opératoire: la transposition clitoridienne [Article in French]

J Gynecol Obstet Biol Reprod (Paris). 2015 Mar 24. pii: S0368-2315(15)00074-5. doi: 10.1016/j.jgyn.2015.02.013

Technique opératoire: la transposition clitoridienne [Article in French]

Chevrot A, Lousquy R, Arfi A, Haddad B, Paniel BJ, Touboul C

ABSTRACT

Female sexual mutilations result in an important physical and mental suffering. A large number of women have been affected and require a global management, including surgical clitoral transposition. This surgical technique is allowing a rapid improvement of clinical symptoms. In this article, we will describe the indications and operative technique of the clitoral transposition.

This article can be accessed in this LINK

A systematic review of the evidence on clitoral reconstruction after female genital mutilation/cutting

Int J Gynaecol Obstet. 2015 Jan 15. pii: S0020-7292(15)00002-8. doi: 10.1016/j.ijgo.2014.11.008. [Epub ahead of print]

A systematic review of the evidence on clitoral reconstruction after female genital mutilation/cutting

Abdulcadir J, Rodriguez MI, Say L

ABSTRACT

BACKGROUND: Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C).

OBJECTIVES: To review evidence on the safety and efficacy of clitoral reconstruction.

SEARCH STRATEGY: PubMed and Cochrane databases were searched for articles published in any language from database inception until May 2014. Search terms related to FGM/C and clitoral reconstruction were used in various combinations.

SELECTION CRITERIA: Studies of any design that reported on safety or clinical outcomes (e.g. appearance, pain, sexual response, or patient satisfaction) associated with clitoral reconstruction after FGM/C were included.

DATA COLLECTION AND ANALYSIS: Evidence was summarized and systematically assessed via a standard data abstraction form.

MAIN RESULTS: Four of 269 identified articles were included. They were fair to poor in quality. Summary measures could not be computed owing to heterogeneity. The studies reported on immediate surgical complications, clitoral appearance, dyspareunia or chronic pain, and clitoral function postoperatively via non-standardized scales.

CONCLUSIONS: Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify both long-term outcomes and which women might benefit.

This article can be accessed in this LINK

Female genital cutting

J Obstet Gynaecol Can. 2014 Aug;36(8):671-2.FREE

Female genital cutting

Kotaska A, Avery L

Comment in J Obstet Gynaecol Can. 2014 Aug;36(8):672.

EXTRACT

Female genital cutting (FGC) is unethical. It causes physical, psychological, and emotional harm, and is rarely performed with consent. SOGC Clinical Practice Guideline no. 299 on FGC outlines this argument well.1 However, re-infibulation is inappropriately bundled together with FGC. Re-infibulation is fundamentally different, surgically and ethically, from FGC. The two need to be examined independently, particularly since the guideline prohibits re-infibulation…

This article can be accessed in this LINK

First UK prosecution for female genital mutilation raises concerns among doctors.

BMJ. 2014 Mar 27;348:g2424. doi: 10.1136/bmj.g2424.

First UK prosecution for female genital mutilation raises concerns among doctors.

Dyer C.

EXTRACT

Obstetricians have said that the first prosecution for female genital mutilation (FGM) in the United Kingdom could lead doctors to fear criminal charges if they carry out repairs to stop post-birth bleeding in women who have previously been subjected to the illegal procedure, which has been a specific crime in the UK since 1985.

The first prosecution for the offence has been launched against a doctor who, the Crown Prosecution Service alleges, “repaired FGM that had previously been performed on the patient, allegedly carrying out FGM himself,”1 after a patient had given birth…

This article can be accessed in this LINK

Increasing certified nurse-midwives’ confidence in managing the obstetric care of women with female genital mutilation/cutting.

J Midwifery Womens Health. 2013 Jul;58(4):451-6. doi: 10.1111/j.1542-2011.2012.00262.x.

Increasing certified nurse-midwives’ confidence in managing the obstetric care of women with female genital mutilation/cutting.

Jacoby SD, Smith A.

INTRODUCTION: In response to an increase in the number of women who immigrate to the United States from countries that practice female genital mutilation/cutting (FGM/C; infibulation), US clinicians can expand their knowledge and increase confidence in caring for women who have experienced infibulation. This article describes a comprehensive education program on FGM/C and the results of a pilot study that examined its effect on midwives’ confidence in caring for women with infibulation.

METHODS: An education program was developed that included didactic information, case studies, a cultural roundtable, and a hands-on skills laboratory of deinfibulation and repair. Eleven certified nurse-midwives (CNMs) participated in this pilot study. Participants completed a measure-of-confidence survey tool before and after the education intervention.

RESULTS: Participants reported increased confidence in their ability to provide culturally competent care to immigrant women with infibulation when comparisons of preeducation and posteducation survey confidence logs were completed.

DISCUSSION: Following the education program and the knowledge gained from it, these midwives were more confident about their ability to perform anterior episiotomy and to deliver necessary care to women with FGM/C in a culturally competent context. This education program should be expanded as more women who have experienced infibulation immigrate to the United States.

This article can be accessed in this LINK.

Surgical techniques: defibulation of Type III female genital cutting

J Sex Med. 2007 Nov;4(6):1544-7.

Surgical techniques: defibulation of Type III female genital cutting.

Johnson C, Nour NM.

Obstetrics & Gynecology, Robert Wood Johnson Clinical Scholar, Division General Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

There is no abstract available for this article.

This article can be accessed in this LINK.

Female circumcision: double standards.

Pract Midwife. 2012 Dec;15(11):27-8.

Female circumcision: double standards.

Adikibi A.

Salford University.

ABSTRACT

Female circumcision is an emotive subject condemned by all and thought to be practised by less developed countries than the United Kingdom (UK) and United States of America (USA). However, this is now a growing business among western cosmetic surgeons as these two nations become entangled in the search for ‘the perfect body’. The difference lies only in the who, why, where and by whom the operations are performed in these two distinct worlds. The most frightening observation is the rate at which this business is growing in the National Health Service (NHS) and public sector.

There is no LINK to view this article online.