Reconstructive surgery after female genital mutilation: A prospective cohort study

摘要

ABSTRACT It is estimated that every year 3 million girls are at risk worldwide of undergoing female genital mutilation. This practice has psychological, psychosexual, and medical consequences. A high number of young girls die following female genital mutilation as a result of life-threatening infections. This practice is widespread in Africa, but also has been reported among immigrant communities in Europe and North America. Reconstructive surgery is now available that can repair the mutilation. It relieves the pain sequelae associated with female genital mutilation and also improves sex life and/or physical appearance. However, women who have undergone female genital mutilation rarely have access to this corrective surgery. Patient outcomes and satisfaction have not been assessed over the long term following reconstructive surgery. This study evaluated both the immediate and long-term outcomes of reconstructive surgery among women with female genital mutilation treated at the Poissy-St Germain Hospital in France. Participants were 2938 women 18 years or older who were treated between 1998 and 2009. The World Health Organization classification was used to prospectively include patients with either type II or type III mutilation (infibulation). The skin covering the distal stump was resected to expose the clitoris. The suspensory ligament was gradually sectioned to mobilize the stump and bring the glans into a normal anatomical position. All women completed a questionnaire at entry on their characteristics and preoperative clitoral pain and clitoral pleasure; their expectations for pain and clitoral pleasure were assessed using a 5-point scale. At the 1-year visit, patients were questioned about clitoris pain and functionality; the group data for year 1 were compared with the total group of patients who had corrective surgery. The mean age of the patients was 29.2 (SD, 7.77) years; age at excision was 6.1 (SD, 3.5) years The main countries of origin for the women were Mali, Senegal, and Ivory Coast, but 564 had undergone female genital mutilation in France. A total of 866 patients (29%) attended the 1 -year follow-up visit. Expectations among women before surgery were recovery of identity for 2933 (>99%), improved sex life for 2378 (81%), and pain reduction for 847 (29%). The 1-year follow-up data showed that 363 of the women (42%) had a hoodless glans, 239 (28%) had a normal clitoris, 210 (24%) had a visible projection, 51 (6%) had a nonvisible but palpable projection, and 3 (<1 %) had no change. An improvement or at least no worsening of pain was reported by 821 (98%) of the patients; clitoral pleasure was reported by 815 (98%). At 1-year follow-up, 430 (51.1%) of the women had orgasms. Immediate complications after surgery included hematoma, suture failure, and moderate fever and occurred in 155 (5%) of the 2938 patients; 108 (4%) were briefly readmitted to hospital. These findings show that reconstructive surgery after female genital mutilation is effective. The surgery reduces pain and restores clitoral pleasure.