Clitoral reconstruction/transposition after female genital mutilation/cutting: differences in access, refunding, technique, care and outcomes
Abdulcadir, J1; Petignat, P1
1: Geneva University Hospitals, Switzerland
Objective(s): To review the evidence on access, care, surgical techniques, practices and outcomes of clitoral surgery, called reconstruction or transposition, after female genital mutilation/cutting (FGM/C).
Material and Method(s): Review and analysis of the published/grey literature and current practices.
Result(s): Two systematic reviews on harms and benefits for chronic pain/dyspareunia, sexual pleasure and clitoral appearance concluded that the evidence on safety and efficacy of clitoral surgery after FGM/C is inconclusive. A systematic review on surgical and non surgical treatments for pain after FGM/C did not find any result. Because of lacking evidence, the guidelines for the management of complications of FGM/C of the Royal College of Obstetricians and Gynaecologists and of the World Health Organization did not emit a recommendation in favour of clitoral reconstruction/transposition. Four different more or less invasive surgical techniques are described in three different specializations: urology (Foldès), gynaecology (Ouedraogo), plastic surgery (O’Dey and Chang et al.). A scoping review on interventions to address sexual function after FGM/C and four case series show that when multidisciplinary care is available, only 16 to 20% of women initially requesting the surgery, finally undergo it. Women’s needs are met by non surgical treatments including information on clitoral anatomy and function and psychosexual therapy. Current indications for clitoral reconstruction vary from improving sexual function, reducing dyspareunia or chronic pain and regaining an uncut genital appearance and female gender identity. Clitoral surgery after FGM/C is not refunded and accessible in many high and low income countries and training on the technique is scarce. In countries like Belgium, the access to the surgery is highly regulated and clitoral surgery is refunded only in two national and multidisciplinary referral centres, where women receive both surgical and non surgical treatments. Elsewhere, such as in France or Switzerland, any trained surgeon can perform clitoral surgery, in public and private clinics, with or without offering psychosexual therapy.
Conclusion(s): Women who request clitoral reconstruction/transposition should be informed about the scarcity of available evidence and the efficacy of non surgical treatments associated with or without surgery. Multidisciplinary care should precede and be associated to the surgery. Additional multicentre and inter-professional research is needed on the surgical and non surgical cares offered to improve the treatments and information offered to women. We suggest to name the surgery clitoral re-exposition instead of reconstruction/transposition to clarify to clients that the clitoris is present under the scar of FGM/C and the surgery un-buries it.
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