Reconstructive surgery after Female Genital Mutilation: a multidisciplinary approach

Reconstructive surgery after Female Genital Mutilation: a multidisciplinary approach

Authors

  • Stefano Restaino a:1:{s:5:"en_US";s:124:"Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100, Udine";}
  • Giulia Pellecchia
  • Lorenza Driul
  • Salvatore Alberico

Keywords:

female genital mutilation, deinfibulation, multidisciplinary approach, psychological aspects

Abstract

Background and aim: Female Genital Mutilations (FMGs) are all interventions involving partial or total removal of external female genital apparatus, perpetrated not for therapeutic purposes. This review aims to describe a multidisciplinary approach to clinical management of women with FGM, requiring reconstructive surgery and therapeutic deinfibulation. Furthermore, these traditional procedures are harmful to women's physical integrity, being able to result in severe psychological damage with strong inhibitions in sexual and emotive life. Methods: Clinical management followed internal protocol implemented at the obstetric Pathology of IRCCS Burlo Garofolo of Trieste, in the framework of the regional project "Female genital mutilation and women immigrants: a draft integrated training and support person," supported by Regione Friuli Venezia Giulia, Italy. We have enrolled in our protocol 15 women that came in our Hospital spontaneously. Here, we present a case of a 38-year-old woman, who had undergone ritual FGM type III with a deep groove scar. She had suffered pain and limitations to sexual intercourses. Results: We performed a reconstructive surgery of the mutilated genital tissue and a therapeutic deinfibulation. The deep groove scar was successfully removed with a multidisciplinary approach. We achieved careful evaluation, both clinical and psychological, of the patient, before surgery. Conclusions: Reconstructive surgery for women who suffer sexual consequences from FGM is feasible. It restores women's natural genital anatomy, allowing to improve female sexuality.

References

Mishori R, Warren N, Reingold R. Female Genital Mutilation or Cutting, Am Fam Physician. 2018 Jan 1;97(1):49-52.

Eliminating female genital mutilation. An interagency statement - OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO (2008). http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/

World Health Organization, Department of Reproductive Health and Research, WHO Guidelines on the Management of Health Complications From Female Genital Mutilation. Geneva: WHO; 2016. http://www.who.int/reproductivehealth/topics/fgm/managementhealth-complications-fgm/en/.

A.A. Rouzi, F Alturki, Female genital mutilation/cutting: an update, Clin. Exp. Obstet. Gynecol., XLII, n. 3, 2015.

J. Weston, Female genital mutilation: the law as it relates to children. Arch Dis Child. 2017 Sep;102(9):864-867.

AM. Gibeau, Female genital mutilation: when a cultural practice generates clinical and ethical dilemmas., J Obstet Gynecol Neonatal Nurs. 1998 Jan-Feb;27(1):85-91

J. Rymer, Female genital mutilation. Current Obstetrics & Gynaecology, 2003 Jun;13(3):185-190

FA. Aziz, Gynecologic and obstetric complications of female circumcision., Int J Gynaecol Obstet., 1980 May-Jun;17(6):560-3

G. Davis, J. Jellins, Female genital mutilation: Obstetric outcomes in metropolitan Sydney. Aust N Z J Obstet Gynaecol. 2019 Apr;59(2):312-316.

S. Wuest, L Raio, D Wyssmueller, M D Mueller, W Stadlmayr, D V Surbek, et al., Effects of female genital mutilation on birth outcomes in Switzerland., BJOG. 2009 Aug;116(9):1204-9

TK. Al-Hussaini, Female genital cutting: types, motives and perineal damage in laboring Egyptian women., Med Princ Pract. 2003 Apr-Jun;12(2):123-8

Female Genital Mutilation and its Management, RCOG Green-top Guideline, 2015, No.53

K. Teufel, DM Dörfler, Female genital circumcision/mutilation: implications for female urogynaecological health., Int Urogynecol J., 2013 Dec;24(12):2021-7

RC. Berg, V. Underland, The obstetric consequences of female genital mutilation/cutting: a systematic review and meta-analysis., Obstet Gynecol Int. 2013;2013:496564

A. Frega, G. Puzio, P. Maniglio, A. Catalano, GN Milazzo, D. Lombardi et al., Obstetric and neonatal outcomes of women with FGM I and II in San Camillo Hospital, Burkina Faso., Arch Gynecol Obstet. 2013 Sep;288(3):513-9

G. Cropp, J. Armstrong, Female genital mutilation and reporting duties for all clinical personnel, British Journal of Hospital Medicine, 2016, 77(7).

WHO study group on female genital mutilation and obstetric outcome; E. Banks, O. Meirik, T. Farley, O. Akande, H. Bathija, M. Ali, Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet. 2006 Jun 3;367(9525):1835-41.

H. Smith, K. Stein, Surgical or medical interventions for female genital mutilation. Int J Gynaecol Obstet. 2017 Feb;136 Suppl 1:43-46.

J. Young, NM Nour, RC Macauley, SK Narang, C. Johnson-Agbakwu, SECTION ON GLOBAL HEALTH; COMMITTEE ON MEDICAL LIABILITY AND RISK MANAGEMENT; COMMITTEE ON BIOETHICS., Diagnosis, Management and Treatment of Female Genital Mutilation or cutting in girls, American Academy of Paediatrics.2020 Aug;146:2

B. O. Okusanya, O. Oduwole, N. Nwachuku, MM Meremikwu, Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta‐analysis, Int J Gynecol Obstet 2017; 136 (Suppl. 1): 13–20

Kaplan A, M Forbes, I Bonhoure, M Utzet, M Martín, M Manneh, et al., Female genital mutilation/cutting in The Gambia: long-term health consequences and complications during delivery and for the newborn., Int J Womens Health 2013;5:323–31

H. Smith, K. Stein, Health information interventions for female genital mutilation. Int J Gynaecol Obstet. 2017 Feb;136 Suppl 1:79-82.

V. Auricchio, S. Garzon, P Pomini, AS Laganà, J Casarin, A. Cromi, et al., Clitoral reconstructive surgery after female genital mutilation: A systematic review, Sexual & Reproductive Healthcare, 29 (2021) 100619

CS Chang, DW Low, I Percec, Female Genital Mutilation Reconstruction: A Preliminary Report. Aesthet Surg J 2017;37(8):942–6.

P Fold`es, B Cuzin, A Andro, Reconstructive surgery after female genital mutilation: a prospective cohort study. Lancet Lond Engl 2012;380(9837):134–41.

L. Berman, J. Berman, M Miles, D Pollets, JA Powell, Genital self-image as a component of sexual health: relationship between genital self-image, female sexual function, and quality of life measures. J Sex Marital Ther 2003;29(Suppl 1):11–21.

H. Smith, K. Stein, Psychological and counselling interventions for female genital mutilation. Int J Gynaecol Obstet. 2017 Feb;136 Suppl 1:60-64.

Royal College of Obstetricians and Gynaecologists. Female genital mutilation and its management. Green-top guideline no. 53. July 2015. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-53- fgm.pdf. 2017

ACOG. Female Genital Cutting Clinical Management of Circumcised Women. Jan2007

RANZCOG. Female Genital Mutilation (FGM). Nov2013

MH El-Defrawi, G Lotfy, K F Dandash, A H Refaat, M Eyada, Female genital mutilation and its psychosexual impact., J Sex Marital Ther., 2001 Oct-Dec;27(5):465-73.

V Berggren, S Musa Ahmed, Y Hernlund, E Johansson, B Habbani, A K Edberg, Being victims or beneficiaries? Perspectives on female genital cutting and reinfibulation in Sudan. Afr J Reprod Health. 2006 Aug;10(2):24-36.

L. Morison, C Scherf, G Ekpo, K Paine, B West, R Coleman et al., The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey., Trop Med Int Health., 2001 Aug;6(8):643-53.

F. Okonofua, U Larsen, F Oronsaye, R C Snow, T E Slanger, The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria. BJOG. 2002 Oct;109(10):1089-96.

A. Behrendt, S. Moritz, Posttraumatic stress disorder and memory problems after female genital mutilation. Am J Psychiatry 2005;162:1000–2.

E. K. Ameyaw, JK Tetteth, EK Armah-Ansah, K Aduo-Adea, A Sena-Iddrisu, Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters? BMC International Health and Human Rights (2020) 20:19

Lightfoot-Klein MA., The sexual experience and marital adjustment of genital circumcised and infibulated females in the Sudan. The Journal of Sex Research, 26, 375 – 392.

NM Nour, KB Michels, AE Bryant, Deinfibulation to treat female genital cutting: effect on symptoms and sexual function. Obstet Gynecol. 2006 Jul;108(1):55-60.

E Leye, NV Eekert, S Shamu, T Esho, H Barrett & ANSER Reproductive, Debating medicalization of Female Genital Mutilation/Cutting (FGM/C): learning from (policy) experiences across countries, Reproductive Health (2019) 16:158.

Downloads

Published

29-06-2022

Issue

Section

Case Reports: General Surgery and Miscellanea

How to Cite

1.
Restaino S, Pellecchia G, Driul L, Alberico S. Reconstructive surgery after Female Genital Mutilation: a multidisciplinary approach. Acta Biomed [Internet]. 2022 Jun. 29 [cited 2024 Jul. 13];93(S1):e2022118. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/11765