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From body to brain: considering the neurobiological effects of female genital cutting.

Perspect Biol Med. 2008 Winter;51(1):84-97. doi: 10.1353/pbm.2008.0012.

From body to brain: considering the neurobiological effects of female genital cutting.

Einstein G.

Department of Psychology, University of Toronto, Ontario, Canada. gillian.einstein@utoronto.ca

ABSTRACT

Female genital cutting (FGC) is an ancient tradition unbounded by religion and practiced primarily in Africa and the regions to which Africans have immigrated. All types of FGC involve cutting neural innervation to the vulva: the clitoris, labia majora and minora. Most types include excision of the clitoris. Since the tissue of the vulva is highly innervated by nerves and their endings, I postulate here that the brain and spinal cord will respond to FGC as it would to any loss of neural targets or inputs: by rearranging neural networks. This, in turn, would affect neural signaling to target structures and modify sensory perception. Most scientific investigations of FGC have focused on its reproductive consequences. To fully appreciate its effects on the lives of women, however, an understanding beyond the reproductive system is necessary. Exploring the potential neural changes of FGC may help explain the mixed responses of the women themselves and identify new directions for research to understand their lives. A neurobiological analysis may also help us understand how cultural practices inscribe meaning on central nervous system structures, affecting mind as well as body.

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[Three cases of epidermal cyst of vulva following female genital mutilation]

Gynecol Obstet Fertil. December 2002 30(12): 958–960

Trois cas de kystes épidermiques de la vulve après mutilations génitales féminines

[Three cases of epidermal cyst of vulva following female genital mutilation] [Article in French]

Moreira P.M., Moreira I.V., Faye E.H.O, Cisse L, Mendes V, Diadhiou F

ABSTRACT

We report three cases of tumors of the vulva following an Excision during childhood, in patients aged 22 to 25. The achieved surgical removal gave correct aesthetic and functional results. Histological examination of these tumors revealed epidermal cyst containing keratin. Because of clinical, psychological and social impact of female excision, steps should be taken against such traditional practices.

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Circumcision Revisited

Hastings Center Report. March-April 1997 27(2) 4–5

Circumcision Revisited

No abstract is available for this article.

This article can be purchased in this LINK

 

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Labia reduction for non-therapeutic reasons vs. female genital mutilation: contradictions in law and practice in Britain.

Reprod Health Matters. 2010 May;18(35):106-10.

Labia reduction for non-therapeutic reasons vs. female genital mutilation: contradictions in law and practice in Britain.

Berer M.

Reproductive Health Matters, London, UK. mberer@rhmjournal.org.uk

“…In the 26 May 2007 edition of the British Medical Journal (BMJ), two British psychologists reported that the numbers of requests from women for surgery to alter the appearance of their genitals, especially the labia, were increasing.1 In examining this phenomenon, the authors asked: how should health care providers respond to requests for this surgery? From this and other literature on this subject, a picture emerges of a growing number of women, many of them very young, who have been led to believe something is wrong with their genitals. According…”

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Genital trauma in prepubertal girls and adolescents.

Curr Opin Obstet Gynecol. 2011 Oct;23(5):307-14. doi: 10.1097/GCO.0b013e32834ab544.

Genital trauma in prepubertal girls and adolescents.

Merritt DF.

Department of Obstetrics and Gynecology, Pediatric and Adolescent Gynecology, Washington University School of Medicine, Barnes Jewish Hospital, St Louis Children’s Hospital and Missouri Baptist Medical Center, St Louis, Missouri 63110, USA. merrittd@wustl.edu

PURPOSE OF REVIEW: To look critically at recent research articles that pertain to children and adolescents who present with genital injuries. RECENT FINDINGS: Emerging evidence supports links to long-term psychological sequelae of child sexual abuse. Parents should be educated to instruct their children regarding types of child abuse and prevention. ‘Medicalization’ of female genital mutilation (FGM) by health providers, including ‘cutting or pricking’, is condemned by international organizations. SUMMARY: Genital injuries whether accidental or intentional need to be reported with standardized terminology to allow for comparisons between reported outcomes. Motor vehicle accidents associated with pelvic fractures may result in bladder or urethral trauma. Adverse long-term psychosocial behaviors may be sequelae of child sexual abuse. FGM is willful damage to healthy organs for nontherapeutic reasons, and a form of violence against girls and women. Healthcare providers should counsel women suffering from the consequences of FGM, advise them to seek care, counsel them to resist reinfibulation, and prevent this procedure from being performed on their daughters.

This article can be purchased in this LINK

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Exploring the psychosexual drive, before genital cosmetic surgery.

Eur J Obstet Gynecol Reprod Biol. 2011 Oct;158(2):369-70. Epub 2011 Jun 12.

Exploring the psychosexual drive, before genital cosmetic surgery.

Mahran MA, Rashid M, Leather A.

No abstract is available.

This article can be purchased in this LINK.

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[Psychological factors of genital automutilation and medico-ethical interest in emergency vulvoplasty]

Gynecol Obstet Fertil. 2006 Feb;34(2):134-6. Epub 2006 Feb 21.

[Psychological factors of genital automutilation and medico-ethical interest in emergency vulvoplasty]. [Article in French]

Fayad S, Srom V, Delotte J, Bafghi A, Sorci K, Bongain A.

Service de Gynécologie-Obstétrique, Reproduction et Médecine Foetale, Hôpital Archet-II, CHU de Nice-Sophia-Antipolis, BP 3079, 151, route de Saint-Antoine-de-Ginestière, 06202 Nice cedex 03, France.

ABSTRACT

The genital self-mutilation is not rare in women. Risk factors found in these cases are: mood disorders, food behavior anomalies and antecedents of sexual aggression. However, surgical repair is not done in emergency: we find no similar report to our clinical case describing an added up bilateral reduction nymphoplasty carried out in emergency after hemorrhagic genital self-mutilation. We discuss psychological risk factors, psychiatric diagnosis and optimal treatment, studied from medico-ethical point of view, for this surgical emergency.

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Clitoral neuroma after female genital mutilation/cutting: A rare but possible event.

J Sex Med 2012;9:1220–1225.

Clitoral neuroma after female genital mutilation/cutting: A rare but possible event. 

Abdulcadir J, Pusztaszeri M, Vilarino R, Dubuisson JB, and Vlastos A-T.

ABSTRACT

Introduction.  Female genital mutilation/cutting (FGM/C), in particular, type III, also called infibulation, can cause various long-term complications. However, posttraumatic neuroma of the clitoris is extremely rare; only one case was previously reported in the literature.

Aim.  The aim of this study was to describe the case of a patient presenting a clitoral neuroma post-FGM/C in detail and her successful multidisciplinary treatment.

Methods.  We report the case of a 24-year-old woman originating from Somalia presenting a type III a–b FGM/C who attended our outpatient clinic at the Geneva University Hospitals complaining of primary dysmenorrhea and a post-mutilation painful clitoral mass. The mass was clinically diagnosed as a cyst and surgically removed. Histopathological analysis revealed that it was a posttraumatic neuroma and a foreign body granuloma around the ancient surgical thread. Our patient was also offered a multidisciplinary counseling by a specialized gynecologist on FGM/C, a sexologist, and a reproductive and sexual health counselor.

Results.  One month after surgical treatment, the vulvar pain was over.

Conclusions.  This is the second case of clitoral neuroma after FGM/C reported and the first with complete clinical, as well as histopathological documentation and multidisciplinary care. Considering the high frequency of clitoral cysts in case of infibulation, clitoral neuroma should be considered in the differential diagnosis. In this case, if symptomatic, the treatment should be surgery, clinical follow-up, and counseling. If necessary, appropriate sexual therapy should be offered too.

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Clinical characteristics of well women seeking labial reduction surgery: a prospective study

BJOG. 2011 Nov; 118(12): 1507-1510

Clinical characteristics of well women seeking labial reduction surgery: a prospective studyCrouch NS, Deans R, Michala L, Liao L-M, Creighton SM

ABSTRACT

Objective  To assess clinical characteristics and expectations in well women requesting elective labial reduction surgery.

Design  Prospective study of women attending an outpatient gynaecology clinic.

Setting  General gynaecology clinic at a Central London teaching hospital.

Sample  Women requesting labial reduction surgery and referred by their general practitioner.

Methods  The labia minora width and length were measured for all participants for comparison with published normal values. The presenting complaint was recorded, along with demographic details, expectations of surgery and sources of information regarding appearance of the labia.

Main outcome measures  Labial measurements, reported symptoms and expectations of surgery.

Results  The labia of all participants were within normal published limits, with a mean (SD) of 26.9 (12.8) mm (right labia), and 24.8 (13.1) mm (left labia). The majority of complaints were regarding appearance or discomfort. Expectations were to alter the appearance with surgery.

Conclusions  All women seeking surgery had normal-sized labia minora. Clear guidance is needed for clinicians on how best to care for the worried well woman seeking surgery.

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Labial surgery for well women: a review of the literature

BJOG. 2010 Jan; 117(1): 20-25.

Labial surgery for well women: a review of the literature

Liao L-M, Michala L, Creighton SM

ABSTRACT

This review investigates the quality and content of published reports relating to labial surgery for well women. Electronic databases were searched for relevant articles between 1950 and April 2009. Forty articles were identified, 18 of which included patient data. The specification of the study design was unavailable in 15 of the 18 papers; the remaining three were retrospective reports. No prospective, randomised or controlled studies were found. All reports claimed high levels of patient satisfaction and contained anecdotes pertaining to success. Medically nonessential surgery to the labia minora is being promoted as an effective treatment for women’s complaints, but no data on clinical effectiveness exist.

This review can be accessed in this LINK