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von Fritschen U, Strunz C, Scherer R, Fricke A. Sensitivity after Clitoral Reconstruction in Patients with Female Genital Mutilation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5851. [PMID: 38881961 PMCID: PMC11177814 DOI: 10.1097/gox.0000000000005851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/08/2024] [Indexed: 06/18/2024]
Abstract
Background In the past decades, reconstructive choices after female genital mutilation extended beyond de-infibulation and scar release. The current trend to expand techniques addressing sexual and aesthetic aspects by reconstructing the clitoris and prepuce, and dissecting the clitoral nerves raises concern, as there is a paucity of evidence on the functional outcomes and suspected iatrogenic lacerations. Methods A total of 128 female genital mutilation patients were included in the study. To evaluate clitoral sensitivity after elevation, the Semmes-Weinstein-monofilament test was performed before and after genital reconstruction. Results Preoperatively, patients with a visually intact clitoris showed significantly better sensitivity compared with patients with a mutilated clitoris or infibulation (P < 0.0001). Surgery was performed in 84 patients. After clitoral reconstruction (CR), 70 of 73 patients were able to perceive 2.83 monofilaments (95.9%), whereas three perceived 3.61. Patients with a visually intact clitoris served as control, and 95.0% perceived 2.83 monofilaments. We showed a significant improvement of clitoral sensitivity (P = 0.0020) in the subgroup consisting of patients with a mutilated clitoris in whom the test was performed before and after reconstruction. Conclusions Clitoral sensitivity improves significantly after CR. Seventy of 73 patients attained the same sensitivity as unharmed women. No patient showed a decreased sensitivity compared with their preoperative findings. Therefore, our study supports the argument that CR offers sufficient improvement of objective clitoral sensitivity without additionally addressing clitoral nerves.
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Affiliation(s)
- Uwe von Fritschen
- From the Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Berlin, Germany
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - Cornelia Strunz
- Desert Flower Center, Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Berlin, Germany
| | - Roland Scherer
- Desert Flower Center, Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Berlin, Germany
| | - Alba Fricke
- From the Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Berlin, Germany
- Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg, Freiburg, Germany
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Albert J, Wells M, Spiby H, Evans C. Examining the key features of specialist health service provision for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North: a scoping review. Front Glob Womens Health 2024; 5:1329819. [PMID: 38840583 PMCID: PMC11150566 DOI: 10.3389/fgwh.2024.1329819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
Background Health care for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North is often described as sub-optimal and focused on maternity care. Specialist FGM/C services have emerged with little empirical evidence informing service provision. The objective of this scoping review is to identify the key features of FGM/C specialist care. Methods The review was conducted in accordance with JBI methodology. Participants: organisations that provide specialist FGM/C care. Concept: components of specialist services. Context: high-income OECD countries. Eligibility criteria included primary research studies of any design from 2012 to 2022, providing a comprehensive description of specialist services. Seven bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Cochrane Library and MIC). The components of "specialist" (as opposed to "generalist") services were defined and then applied to an analysis of FGM/C specialist care. FGM/C specialist provision was categorised into primary (essential) and secondary features. Data were extracted and analysed descriptively through charting in tables and narrative summary. Results Twenty-five papers described 20 unique specialist services across eleven high income countries. Primary features used to identify FGM/C specialist care were:-(i) Named as a Specialist service/clinic: 11/20 (55%); (ii) Identified expert lead: 13/20, (65%), either Midwives, Gynaecologists, Urologist, or Plastic Surgeons; (iii) Offering Specialist Interventions: surgical (i.e., reconstruction and/or deinfibulation) and/or psychological (i.e., trauma and/or sexual counselling); and (iv) Providing multidisciplinary care: 14/20 (70%). Eleven services (in Spain, Sweden, Switzerland, Germany, Italy, Netherlands, France, Belgium, and USA) provided reconstruction surgery, often integrated with psychosexual support. No services in UK, Norway, and Australia offered this. Six services (30%) provided trauma therapy only; 25% sexual and trauma therapy; 15% sexual therapy only; 30% did not provide counselling. Secondary features of specialist care were subdivided into (a) context of care and (b) the content of care. The context related to concepts such as provision of interpreters, cost of care, community engagement and whether theoretical underpinnings were described. Content referred to the model of care, whether safeguarding assessments were undertaken, and health education/information is provided. Conclusion Overall, the features and composition of FGM/C specialist services varied considerably between, and sometimes within, countries. Global guidelines advocate that specialist care should include access to deinfibulation, mental health support, sexual counselling, and education and information. The review found that these were rarely all available. In some high-income countries women cannot access reconstruction surgery and notably, few services for non-pregnant women mentioned safeguarding. Furthermore, services for pregnant women rarely integrated trauma therapy or psychosexual support. The review highlights a need for counselling (both trauma and psychosexual) and culturally-appropriate sensitive safeguarding assessments to be embedded into care provision for non-pregnant as well as pregnant women. Further research is needed to extract the features of specialist services into a comprehensive framework which can be used to examine, compare, and evaluate FGM/C clinical specialist care to determine which clinical features deliver the best outcomes. Currently a geographical lottery appears to exist, not only within the UK, but also across the Global North.
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Affiliation(s)
- Juliet Albert
- University of Nottingham and Division of Womens, Children and Clinical Support, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom
| | - Mary Wells
- Nursing Directorate, Department of Surgery and Cancer, Imperial College Healthcare NHS Trust (ICHNT), Imperial College London, London, United Kingdom
| | - Helen Spiby
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Catrin Evans
- The Nottingham Centre for Evidence Based Healthcare, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Correa-Ventura N, Mahtani-Chugani V, Báez-Quintana D. Female genital mutilation in the Canary Islands: A qualitative study on the perspectives of women and healthcare professionals. Heliyon 2023; 9:e16223. [PMID: 37274704 PMCID: PMC10238863 DOI: 10.1016/j.heliyon.2023.e16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Migration to Western countries is associated with social and health challenges that are difficult to manage. Female genital mutilation (FGM) is a harmful practice that still occurs in the 21st century. According to the World Health Organization, FGM is a ritual procedure involving the partial or total removal of the external female genitalia for non-therapeutic reasons. Objectives (I) To explore the experiences of women residing in the Canary Islands, in Spain, who had suffered FGM, and their assessment of the healthcare received. (II) To explore the perspectives of healthcare professionals who had attended to these cases, care pathways, and prevention. Methods A qualitative study, phenomenologically oriented based on a pragmatic perspective, was conducted. We conducted open in-person interviews, and written documents were sent via email for data collection. Purposeful and snowball sampling methods were used to select women who had undergone FGM and healthcare providers who had attended to such patients. Nine participants were recruited, five health professionals and four women. Although the sample size was not very large, the data had enough depth and richness to meet the goals of the study. The data were analyzed using the thematic analysis technique. Results Six main themes emerged, including the "meaning of FGM," "health consequences," "benefits of treatments," "knowledge about FGM," "experiences of professionals and with professionals," and "recommendations of professionals in improving care." Conclusions Professionals and women identified the lack of training to address this problem, and both parties perceived FGM as a negative practice. The women lack knowledge about the relationship between some health problems they suffer and FGM, which poses a challenge for accurate diagnosis and treatment. Therefore, professionals need to know in detail all health conditions related to FGM to diagnose and treat these women more accurately. When affected women arrive in Western countries and receive correct information on the consequences of FGM, they are more likely to reject this practice. The identification of cases of FGM in women born in the Canary Islands urges the need to develop strategies to avoid such situations.
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Affiliation(s)
| | - Vinita Mahtani-Chugani
- Research Unit of Hospital Nuestra Señora de la Candelaria, Tenerife, Spain
- Management Office for Primary Healthcare of Tenerife, Tenerife, Spain
| | - Delia Báez-Quintana
- University of La Laguna (ULL), Tenerife, Spain
- Hospital Universitario de Canarias (HUC), Obstetrics and Gynecology Department, Tenerife, Spain
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New Challenges in Sexuality and Sexual Dysfunction. J Clin Med 2022; 12:jcm12010203. [PMID: 36615004 PMCID: PMC9821202 DOI: 10.3390/jcm12010203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Human sexuality constitutes not only a basic need but also a right that significantly enriches interpersonal relationships, providing mutual satisfaction and pleasure [...].
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Birge Ö, Serin AN, Bakır MS. Female genital mutilation/cutting in sudan and subsequent pelvic floor dysfunction. BMC Womens Health 2021; 21:430. [PMID: 34961500 PMCID: PMC8713407 DOI: 10.1186/s12905-021-01576-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background We aimed to evaluate the socio-demographic characteristics of women with female genital mutilation/cutting (FGM/C) and the results of FGM/C due to pelvic floor dysfunction. Results The prevalence of FGM/C was 87.2% in Sudan and Type 3 (50.4%) was the most prevalent, followed by Type 2 (35%) and Type 1 (8.5%). In the multinominal logistic regression analysis performed to show the effect of FGM/C on pelvic organ prolapse (POP), it was observed that FGM/C frequency in POP group 2 was statistically similar when POP group 1 was taken as reference category. In the evaluation for symptomatic POP (POP group 3), risk of developing POP in patients without FGM/C was significantly lower than patients with type 3 FGM/C with a rate of 82.9% (OR(odds ratio): 0.171 (p: 0.002), (Confidence Interval (CI) %95; 0.058–0.511). Risk of developing POP rate in patients with type 1 FGM/C was 75% (OR:0.250 (p: 0.005), CI %95; 0.094–0.666) and in patients with type 2 FGM/C was 78.4% (OR:0.216 (p: 0.0001), CI%95; 0.115–0.406). In the multinominal logistic regression analysis including other variables affecting POP, when group 1 was taken as the reference category, it was found that the possibility of developing mild POP (group 2) decreased in FGM/C type 1 and 2 compared to FGM/C type 3 but it was not statistically significant. However, the evaluation for the symptomatic POP group showed up a significantly lower risk of developing POP in patients with type 2 FGM/C compared to patients with type 3 FGM/C, with a rate of 58.4%. (OR:0.419 (p: 0.016), CI%95; 0.206–0.851) (Table 3). In addition, older age was found to be significant risk factor for increasing symptomatic POP (p: 0.003). Conclusions Type 2 and 3 FGM/C continues to be an important health problem in terms of complications that may develop in advanced ages as well as many short-term complications as a result of mechanical or physiological deterioration of the female genital anatomy.
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Navarro-Sánchez A, Luri-Prieto P, Compañ-Rosique A, Navarro-Ortiz R, Berenguer-Soler M, Gil-Guillén VF, Cortés-Castell E, Navarro-Cremades F, Gómez-Pérez L, Pérez-Tomás C, Palazón-Bru A, Montejo AL, Pérez-Jover V. Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case-Control Study. J Clin Med 2021; 10:jcm10194401. [PMID: 34640419 PMCID: PMC8509279 DOI: 10.3390/jcm10194401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022] Open
Abstract
Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case–control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention.
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Affiliation(s)
- Antonio Navarro-Sánchez
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (A.N.-S.); (M.B.-S.); (V.P.-J.)
| | - Paloma Luri-Prieto
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
| | - Antonio Compañ-Rosique
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Ramón Navarro-Ortiz
- Orthopedic Surgery and Traumatology Service, Torrevieja University Hospital, 03186 Torrevieja, Spain;
| | - María Berenguer-Soler
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (A.N.-S.); (M.B.-S.); (V.P.-J.)
| | - Vicente F. Gil-Guillén
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Ernesto Cortés-Castell
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Felipe Navarro-Cremades
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Luis Gómez-Pérez
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Carla Pérez-Tomás
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
| | - Antonio Palazón-Bru
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
- Department of Psychiatry, Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-63-9754-620
| | - Virtudes Pérez-Jover
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (A.N.-S.); (M.B.-S.); (V.P.-J.)
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Wenzel T, Kizilhan JI, Alksiri R, Dörfler D, Messerschmidt EJ, Chen AF. FGM and Restorative Justice-A Challenge for Developing Countries and for Refugee Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178913. [PMID: 34501503 PMCID: PMC8430822 DOI: 10.3390/ijerph18178913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
Female Genital Mutilation (FGM) has been identified as one of the most serious human rights violations women are exposed to in many countries, in spite of national and international efforts. The actual implementation of preventive strategies and support of victims faces a number of challenges that can only be addressed by an interdisciplinary approach integrating public health and legal considerations. FGM in the context of women as refugees who left their country to escape FGM has rarely been covered in this context. This article summarizes the most important international standards and initiatives against FGM, highlights the medical, legal, and psychological factors identified so far, and explores the interdisciplinary considerations in changing a country and society to permit safe return of those escaping FGM to third countries and support public health in the country.
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Affiliation(s)
- Thomas Wenzel
- World Psychiatric Association Scientific Section on Psychological Aspects of Persecution and Torture, 1226 Geneva, Switzerland; (R.A.); (A.F.C.)
- CEHRI, The Centre for the Enforcement of Human Rights International, Schwarzspanierstraße 15/1/17, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-37230
| | - Jan Ilhan Kizilhan
- Duale Hochschule Baden-Württemberg, 78054 Villingen-Schwenningen, Germany;
- University of Dohuk, AJ Duhok 1006, Iraq
| | - Reem Alksiri
- World Psychiatric Association Scientific Section on Psychological Aspects of Persecution and Torture, 1226 Geneva, Switzerland; (R.A.); (A.F.C.)
- CEHRI, The Centre for the Enforcement of Human Rights International, Schwarzspanierstraße 15/1/17, 1090 Vienna, Austria
| | - Daniela Dörfler
- Department Gynaecology, Medical University of Vienna, 1090 Vienna, Austria;
| | | | - Anthony Fu Chen
- World Psychiatric Association Scientific Section on Psychological Aspects of Persecution and Torture, 1226 Geneva, Switzerland; (R.A.); (A.F.C.)
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Tirado-González S, Navarro-Sánchez A, Compañ-Rosique A, Luri-Prieto P, Rodríguez-Marín J, Van-der Hofstadt-Román CJ, Berenguer Soler M, Navarro-Cremades F, Gil-Guillén VF, Navarro Ortiz R, Montejo AL, Pérez-Jover V. Validation of the Center of Applied Psychology Female Sexuality Questionnaire (CAPFS-Q). J Clin Med 2021; 10:jcm10122686. [PMID: 34207115 PMCID: PMC8235656 DOI: 10.3390/jcm10122686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
Instruments for the measurement of human sexuality include self-report measures used to assess sexual functioning, but many of them have not yet been validated. The Center of Applied Psychology Female Sexual Questionnaire (CAPFS-Q) is an original self-report instrument. It has been developed for the study of sexuality in specific non-clinical populations, such as female university students of Medicine and other Health Sciences. The CAPFS-Q includes 26 items, organized as follows: sociodemographic and relevant data (four items); aspects of sexual relations with partner (five items); sexual practices (12 from 13 items); and dysfunctional aspects of sexual relations (four items). CAPFS-Q validity and reliability were examined in a sample of Spanish female university students of Health Sciences. Exploratory and confirmatory factor analysis (FA) showed a four-factor structure which explained 71.6% of the variance. This initial version of the CAPFS-Q is a reliable measure of women's sexual behavior, with a dimensionality that replicates the initial theoretical content and with adequate indicators of internal consistency, validity, and test-retest reliability. It is easy to administer and to complete.
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Affiliation(s)
- Sonia Tirado-González
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Antonio Navarro-Sánchez
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Antonio Compañ-Rosique
- San Juan University Hospital, Miguel Hernández University, Ctra N-332, s/n, 03550 Sant Joan d’Alacant, Spain; (A.C.-R.); (P.L.-P.)
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Paloma Luri-Prieto
- San Juan University Hospital, Miguel Hernández University, Ctra N-332, s/n, 03550 Sant Joan d’Alacant, Spain; (A.C.-R.); (P.L.-P.)
| | - Jesús Rodríguez-Marín
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Carlos J. Van-der Hofstadt-Román
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - María Berenguer Soler
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Felipe Navarro-Cremades
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Vicente F. Gil-Guillén
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Ramón Navarro Ortiz
- Torrevieja University Hospital, Carretera CV 95, s/n, 03186 Torrevieja, Spain;
| | - Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
- Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-63-9754-620
| | - Virtudes Pérez-Jover
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
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Auricchio V, Garzon S, Pomini P, Laganà AS, Casarin J, Cromi A, Ghezzi F, Vigato E, Franchi M. Clitoral reconstructive surgery after female genital mutilation: A systematic review. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100619. [PMID: 33845447 DOI: 10.1016/j.srhc.2021.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To summarize available evidence on clitoral reconstruction after Female genital mutilations/cut (FGM/C). STUDY DESIGN Systematic review of the literature to identify studies on clitoral reconstruction after previous FGM/C with at least 6 months of follow-up. The literature search was performed in the following databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. The period considered was from the database inception to June 30th, 2020. MAIN OUTCOME MEASURES Post-operative vulvar pain or dyspareunia, changes in sexual activity or orgasm, and the impact on self-image. RESULTS We identified 8 studies; four used the same "Foldès technique", and four adopted similar techniques based on the downward mobilization of the clitoral stump, with different reconstructions of glans and prepuce. The postoperative complication rate was reported at 5.3%. Sexual function is the only outcome investigated by all studies, which consistently suggest that clitoral reconstruction appear effective to improve clitoral pleasure/orgasm. Almost all studies assessed self-image, which appears improved. Only 2 studies provided data about pain and/or dyspareunia, which were improved by clitoral reconstruction. However, the risk of bias is high. Most patients were lost at follow-up, and validated instruments to assess outcomes were used only in a minority of studies. CONCLUSIONS Although clitoral reconstructive surgery for FGM/C appears safe and effective, caution is required to interpret available evidence due to significant limitations. Further studies are required to compare the proposed techniques and to confirm the effectiveness in terms of vulvar pain and/or dyspareunia, sexual activity and/or orgasm, and self-image improvement.
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Affiliation(s)
- Valeria Auricchio
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, VR, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, VR, Italy.
| | - Paola Pomini
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, VR, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, VR, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, VR, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, VR, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, VR, Italy
| | - Enrico Vigato
- Department of Plastic and Reconstructive Surgery, AOUI Verona, University of Verona, Verona, VR, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, VR, Italy
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Effects of clitoral reconstruction for female genital mutilation on perinatal outcomes: A retrospective case-control study. J Gynecol Obstet Hum Reprod 2020; 50:101954. [PMID: 33080401 DOI: 10.1016/j.jogoh.2020.101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the perinatal outcomes of women with a history of female genital mutilation (FGM) who underwent clitoral reconstruction (CR) compared with women with FGM who did not undergo CR. MATERIAL AND METHODS Retrospective case-control study at Angers University Hospital, between 2005 and 2017. INCLUSION CRITERIA pregnant women >18 years who underwent CR after FGM. Only the first subsequent delivery after CR was included. Each woman with CR was matched for age, ethnicity, FGM type, parity, and gestational age at the time of delivery with two women with FGM who did not undergo CR during the same period of time. At birth, the main outcomes were the need for episiotomy and having an intact perineum after delivery. RESULTS 84 women were included (28 in the CR group; 56 in the control group). In the CR group, patients required significantly fewer episiotomies (5/17[29.4 %]) compared to the control group (28/44[63.6 %], p = 0.02), even after excluding operative vaginal deliveries (2/13[15.4 %] vs 21/36[58.3], p < 0.01). CR reduces the risk of episiotomy (aOR = 0.15, 95 %CI [0.04-0.56]; p < 0.01) after adjusting on the infant weight and the need for instrumental delivery. In the CR group, 47 % of the patients had an intact perineum after delivery, compared to 20.4 % in the control group (p = 0.04). CR increases the odds of having an intact perineum at birth by 3.46 times (CI95 %[1.04-11.49]; p = 0.04). CONCLUSION CR after FGM increases the chances of having an intact perineum after delivery by 3.46 times and reduces the risk of episiotomy by 0.15 times compared to women with FGM who did not underwent CR.
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