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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.

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Female genital mutilation: Experience in a West London clinic.

J Obstet Gynaecol. 2007 May;27(4):416-9.

Female genital mutilation: Experience in a West London clinic.

Gordon H, Comerasamy H, Morris NH.

ABSTRACT

The Wellwoman African Clinic, Central Middlesex Hospital, London, UK. z.whitlock@imperial.ac.uk In 1997, a new clinic was established at the Central Middlesex Hospital to serve the needs of a mainly Somali population who had suffered genital mutilation in childhood. Between June 1997 and January 2005, 4,125 clinic attendances were recorded. A total of 215 reversals of circumcision were carried out (FGM 3), all on a day-care basis. In the majority of cases, an intact and undamaged clitoris was found under the scar tissue. The clinic staff were able to draw attention to cultural and religious issues which proved important in the medical management of these women. The experience of this clinic has shown that where there is a large immigrant population of women from the Horn of Africa, clinics such as this are efficient and cost-effective and encourage women to attend with a variety of health concerns. The clinic also encourages these women to take their health concerns seriously.

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[Epithelial inclusion cyst of the clitoris as a late complication of childhood female circumcision]

Ugeskr Laeger. 2008 Jan 7;170(1):59.

[Epithelial inclusion cyst of the clitoris as a late complication of childhood female circumcision]. [Article in Danish]

Kristensen IB.

Baagøes Allé 8A, 2. th, DK-5700 Svendborg. idabk@dadlnet.dk.

ABSTRACT

Two cases of epithelial inclusion cyst as a late complication of childhood female circumcision in patients aged 39 and 27 years are reported. Symptoms were interference with sexual intercourse and discomfort during sitting. Surgical treatment of the condition is known to be effective with few complications and gave correct aesthetic and functional results. Histology confirmed the diagnosis of epithelial inclusion cyst.

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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.

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Lower genital tract lesions requiring surgical intervention in girls: perspective from a developing country

J Paediatr Child Health. 2009 Oct;45(10):610-3. doi:10.1111/j.1440-1754.2009.01574.x. Epub 2009 Sep 14.

Lower genital tract lesions requiring surgical intervention in girls: perspective from a developing country.

Ekenze SO, Mbadiwe OM, Ezegwui HU.

Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria. sebekenze@gmail.com

ABSTRACT

AIM: To determine the spectrum, outcome of treatment and the challenges of managing surgical lesions of lower genital tract in girls in a low-resource setting. METHOD: Retrospective study of 87 girls aged 13-years and younger, with lower genital tract lesions managed between February 2002 and January 2007 at the University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Clinical charts were reviewed to determine the types, management, outcome of treatment and management difficulties. RESULTS: The median age at presentation was 1 year (range 2 days-13 years). Congenital lesions comprised 67.8% and acquired lesions 32.2%. The lesions included: masculinized external genitalia (24), vestibular fistula from anorectal malformation (23), post-circumcision labial fusion (12), post-circumcision vulval cyst (6), low vaginal malformations (6), labial adhesion (5), cloacal malformation (3), bifid clitoris (3) urethral prolapse (3), and acquired rectovaginal fistula (2). Seventy-eight (89.7%) had operative treatment. Procedure related complications occurred in 19 cases (24.4%) and consisted of surgical wound infection (13 cases), labial adhesion (4 cases) and urinary retention (2 cases). There was no mortality. Overall, 14 (16.1%) abandoned treatment at one stage or another. Challenges encountered in management were inadequate diagnostic facilities, poor multidisciplinary collaboration and poor patient follow up. CONCLUSION: There is a wide spectrum of lower genital lesion among girls in our setting. Treatment of these lesions may be challenging, but the outcome in most cases is good. High incidence of post-circumcision complications and poor treatment compliance may require more efforts at public enlightenment.

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