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Christopher AN, Othman S, Morris MP, Broach RB, Percec I. Clinical and Patient-Reported Outcomes of 19 Patients Undergoing Clitoral and Labial Reconstruction After Female Genital Mutilation/Cutting. Aesthetic Plast Surg 2022; 46:468-477. [PMID: 34729638 DOI: 10.1007/s00266-021-02648-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is the intentional alteration, removal, or injury of female genitalia for non-medical reasons. Approximately 200 million females have been victims of FGM/C, and genital reconstructive procedures are increasing in demand. OBJECTIVES The objectives of this study were to assess clinical and patient-reported outcomes after FGM/C reconstruction to help guide treatment practices. METHODS Adult patients undergoing anatomic reconstruction after FGM/C were retrospectively identified. Outcomes included clitoral, labial, and donor site surgical site occurrences (SSO) and the need for revision operations. Patient-reported outcomes were assessed using an adapted version of the Female Sexual Function Index (FSFI), a validated outcomes instrument that assesses sexual function through 6 domains, with each domain having a maximum score of 6. RESULTS Nineteen patients were identified in our review. Patients presented for reconstruction due to dyspareunia, inability to orgasm, chronic infections, to normalize appearance, and/or to "feel normal." There were no SSOs and two revision operations for adhesions. 74% of patients completed the FSFI postoperatively. Despite most patients seeking repair for inability to orgasm and/or dyspareunia, the median scores for these domains were 4.6 and 5.2. Patients' desire to engage in sexual activity scored lowest (3.9), and patients reported concerns over the appearance of their genitalia (50%) that affected self-confidence (85.7%). CONCLUSION FGM/C reconstruction is safe and contributes to improvements in physical sexual health. Psychological trauma may contribute to lessened sexual desire and self-confidence even after reconstruction. Multidisciplinary treatment is important to address the long-term psychological effects of this practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Chappell AG, Soriano AJ, Percec I. The Role of Plastic Surgeons in Female Genital Mutilation Reconstructive Surgery. World J Plast Surg 2021; 10:104-107. [PMID: 33833961 PMCID: PMC8016383 DOI: 10.29252/wjps.10.1.104] [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] [Indexed: 11/01/2022] Open
Abstract
The World Health Organization defines female genital mutilation (FGM) as any procedure involving partial or total removal of female external genitalia or other injury to genital organs for non-medical indications. Despite prohibitory legislation in the United States and significant morbidity related to FGM procedures, the practice continues throughout the globe with three million women at risk annually. Surgical care for women with FGM has historically been in the hands of obstetrician and Gynaecologists (OB GYNs), and mainly focused to help safe labor and delivery. Recent awareness of the need for improved reconstructive surgical care for FGM has developed in the plastic surgical literature. This Current Opinion article highlights the historical surgical care for FGM and the opportunity for plastic surgeons to get more involved in the multidisciplinary care of these patients.
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Affiliation(s)
- Ava G Chappell
- Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA.,Institute of Global Health, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Alex J Soriano
- Division of Urogynecology, Department of Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ivona Percec
- Department of Plastic and Reconstructive Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Sow A, Diagne G, Keita Y, Sow O, Ndiath A, Ouattara A, Sarr ML, Sylla A, Moreira C. [Fatal female genital mutilation in a 10-year-old girl]. Arch Pediatr 2017; 24:991-994. [PMID: 28870818 DOI: 10.1016/j.arcped.2017.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/24/2016] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
Abstract
Female genital mutilation (FGM) comprises all procedures involving partial or total removal of the external genitalia and/or any other procedures affecting the female genitalia, for cultural or religious reasons or for nontherapeutic purposes in general. FGM is responsible for a number of short-, medium-, and long-term complications that can engage the vital and functional prognosis, especially in African countries. We report on a case in a 10-year-old girl who underwent genital mutilation, a traditional type of total excision during the neonatal period. She was followed for urethral meatus stenosis, which then was complicated by obstructive chronic kidney failure and urinary sepsis, whose progression was fatal.
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Affiliation(s)
- A Sow
- Service de pédiatrie, centre hospitalier universitaire (CHU) Aristide le Dantec, BP 3001, Dakar-Fann, Sénégal.
| | - G Diagne
- Service de pédiatrie, centre hospitalier universitaire (CHU) Aristide le Dantec, BP 3001, Dakar-Fann, Sénégal
| | - Y Keita
- Service de pédiatrie, centre hospitalier universitaire (CHU) Aristide le Dantec, BP 3001, Dakar-Fann, Sénégal
| | - O Sow
- Service d'urologie de l'hôpital Aristide le Dantec, Dakar-Fann, Sénégal
| | - A Ndiath
- Service d'urologie de l'hôpital Aristide le Dantec, Dakar-Fann, Sénégal
| | - A Ouattara
- Service de pédiatrie, centre hospitalier universitaire (CHU) Aristide le Dantec, BP 3001, Dakar-Fann, Sénégal
| | - M-L Sarr
- Service de pédiatrie, centre hospitalier universitaire (CHU) Aristide le Dantec, BP 3001, Dakar-Fann, Sénégal
| | - A Sylla
- Service de pédiatrie, centre hospitalier universitaire (CHU) Aristide le Dantec, BP 3001, Dakar-Fann, Sénégal
| | - C Moreira
- Service de pédiatrie, centre hospitalier universitaire (CHU) Aristide le Dantec, BP 3001, Dakar-Fann, Sénégal
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Ziyada MM, Norberg-Schulz M, Johansen REB. Estimating the magnitude of female genital mutilation/cutting in Norway: an extrapolation model. BMC Public Health 2016; 16:110. [PMID: 26837303 PMCID: PMC4739093 DOI: 10.1186/s12889-016-2794-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background With emphasis on policy implications, the main objective of this study was to estimate the numbers of two main groups affected by FGM/C in Norway: 1) those already subjected to FGM/C and therefore potentially in need for health care and 2) those at risk of FGM/C and consequently the target of preventive and protective measures. Special attention has been paid to type III as it is associated with more severe complications. Methods Register data from Statistics Norway (SSB) was combined with population-based survey data on FGM/C in the women/girls’ countries of origin. Results As of January 1st 2013, there were 44,467 first and second-generation female immigrants residing in Norway whose country of origin is one of the 29 countries where FGM/C is well documented. About 40 pct. of these women and girls are estimated to have already been subjected to FGM/C prior to immigration to Norway. Type III is estimated in around 50 pct. of those already subjected to FGM/C. Further, a total of 15,500 girls are identified as potentially at risk, out of which an approximate number of girls ranging between 3000 and 7900 are estimated to be at risk of FGM/C. Conclusion Reliable estimates on FGM/C are important for evidence-based policies. The study findings indicate that about 17,300 women and girls in Norway can be in need of health care, in particular the 9100 who are estimated to have type III. Preventive and protective measures are also needed to protect girls at risk (3000 to 7900) from being subjected to FGM/C. Nevertheless, as there are no appropriate tools at the moment that can single these girls out of all who are potentially at risk, all girls in the potentially at risk group (15,500) should be targeted with preventive measures.
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Affiliation(s)
- Mai M Ziyada
- Norwegian Centre for Violence and Traumatic Stress Studies, P.b. 181 Nydalen, 0409, Oslo, Norway
| | - Marthe Norberg-Schulz
- Samfunnsøkonomisk analyse (Formerly DAMVAD Norge AS), Olavsvei 112, 1450, Nesoddtangen, Norway
| | - R Elise B Johansen
- Norwegian Centre for Violence and Traumatic Stress Studies, P.b. 181 Nydalen, 0409, Oslo, Norway.
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Théra T, Kouma A, Touré M, Coulibaly A, Sima M, Ongoiba I, Sagara A, Maiga B. [Obstetrical complications of genital mutilation in Malian rural environment]. ACTA ACUST UNITED AC 2014; 44:276-9. [PMID: 24461341 DOI: 10.1016/j.jgyn.2013.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 11/24/2013] [Accepted: 12/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe maternal and fetal complications during delivery of mutilated women. MATERIALS AND METHODS It was a case study, witnesses with matching going from February 1st, 2008 till January 31st, 2009 which took place in Mopti's region. We compared maternal and fetal complications of mutilated and non-mutilated women. Using statistical tests were Chi(2) (P<0.05), Odd-Ratio (OR) and its 95% confident interval (CI95%). RESULTS We recorded 410 deliveries among which 280 mutilated women (68%). One hundred and forty excised women were included. There is a significant difference between duration of eviction>30 mm (RC=8.27 [4.66-14.76], P<0.001); simple perennials lacerations (RC=14.54 [4.79-49.56], P<0.001) and full perennials lacerations (RC=8.90 [1.91-57.23], P<0.001) in the two groups. The scores of morbid Apgar (RC=9.70 [4.35-22,29], P<0.001) were more important in groups of cases. Moreover, we recorded 3 neonatal deaths and 4 complicated perennials lacerations in the group of cases only. CONCLUSION Maternal and fetal complications are significantly more important for the excised woman's than for the not excised women.
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Affiliation(s)
- T Théra
- Service de gynécologie-obstétrique, CHU du Point G, Bamako, Mali.
| | - A Kouma
- Service de gynécologie-obstétrique, CHU de Kati, Kati, Mali
| | - M Touré
- Service de gynécologie-obstétrique, hôpital du Mali, Bamako, Mali
| | - A Coulibaly
- Service de gynécologie-obstétrique, CHU du Point G, Bamako, Mali
| | - M Sima
- Service de gynécologie-obstétrique, CHU du Point G, Bamako, Mali
| | - I Ongoiba
- Service de gynécologie-obstétrique, CHU du Point G, Bamako, Mali
| | - A Sagara
- Service de gynécologie-obstétrique, CHU du Point G, Bamako, Mali; Service de gynécologie-obstétrique, CHU de Kati, Kati, Mali; Service de gynécologie-obstétrique, hôpital du Mali, Bamako, Mali
| | - B Maiga
- Service de gynécologie-obstétrique, CHU du Point G, Bamako, Mali
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Mseddi M, Bouassida S, Turki H. [Female genital mutilation]. Ann Dermatol Venereol 2007; 134:500-1. [PMID: 17507859 DOI: 10.1016/s0151-9638(07)89228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- M Mseddi
- Service de Dermatologie, CHU H. Chaker, 3029 Sfax, Tunisie.
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Millogo-Traore F, Kaba STA, Thieba B, Akotionga M, Lankoande J. [Maternal and foetal prognostic in excised women delivery]. ACTA ACUST UNITED AC 2007; 36:393-8. [PMID: 17418983 DOI: 10.1016/j.jgyn.2007.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 01/17/2007] [Accepted: 03/01/2007] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The female circumcision constitutes by their frequency and complications a real problem of public health. MATERIAL AND METHOD Our study aims at comparing the maternal land fetal complications of the spontaneous vaginal delivery in the excised women and non-excised. We led a comparative survey case witness implying 227 excised pregnant women at the maternity in CHU YO of Ouagadougou. RESULTS The prevalence of the excision from January 1st to July 31, 2006 was 72.86%. The distribution of female genital mutilations in this population is the following: type I=27.75%, type II=69.61%, type III=2.64%. The middle age was 25 years and 79.30% of women were aged less than 30 years. Islam appeared like a factor of exposure to the practice of the excision with 67.40% of women excised that practise it against 41.90% at the non-excised group (P<0,0001). The maternal complications were dominated by the duration of fetal expulsion prolonged and perineal tears. The duration of fetal expulsion was superior to 30 minutes for 34.56% of excised woman childbirths 9 times more frequently than women non-excised (P=0.001). The frequency of perineal tears was 10.13% in the group of women excised against 5.73% in the group of the non-excised (P=0.008). These perineal lesions were more frequent with the primiparae and women excised at the 2nd and 3rd degree. The neobirth asphyxia affected 4.4% of newborns from mother excised against 0.2% in the non-excised group (RR=5.18; P=0.006). In the group of excised them the rate of mortinatality was 22.03 for 1000 births, against 8.81 for 1000 births in the group of the non-excised (P=0.22). CONCLUSION The prevention of these complications with the excised woman rests on the episiotomy and the instrumental extraction in the FGM of type III.
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Kim G, Torbay R, Lawry L. Basic health, women's health, and mental health among internally displaced persons in Nyala Province, South Darfur, Sudan. Am J Public Health 2007; 97:353-61. [PMID: 17138925 PMCID: PMC1781379 DOI: 10.2105/ajph.2005.073635] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed basic health, women's health, and mental health among Sudanese internally displaced persons in South Darfur. METHODS In January 2005, we surveyed 6 registered internally displaced persons camps in Nyala District. Using systematic random sampling, we surveyed 1293 households, interviewing 1 adult female per household (N=1274); respondents' households totaled 8643 members. We inquired about respondents' mental health, opinions on women's rights, and the health status of household members. RESULTS A majority of respondents had access to rations, shelter, and water. Sixty-eight percent (861 of 1266) used no birth control, and 53% (614 of 1147) reported at least 1 unattended birth. Thirty percent (374 of 1238) shared spousal decisions on timing and spacing of children, and 49% (503 of 1027) reported the right to refuse sex. Eighty-four percent (1043 of 1240) were circumcised. The prevalence of major depression was 31% (390 of 1253). Women also expressed limited rights regarding marriage, movement, and access to health care. Eighty-eight percent (991 of 1121) supported equal educational opportunities for women. CONCLUSIONS Humanitarian aid has relieved a significant burden of this displaced population's basic needs. However, mental and women's health needs remain largely unmet. The findings indicate a limitation of sexual and reproductive rights that may negatively affect health.
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Affiliation(s)
- Glen Kim
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Health Care System, Boston, Mass, USA
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Foldes P, Louis-Sylvestre C. Résultats de la réparation chirurgicale du clitoris après mutilation sexuelle: 453 cas. ACTA ACUST UNITED AC 2006; 34:1137-41. [PMID: 17137821 DOI: 10.1016/j.gyobfe.2006.09.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 09/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Ritual excision is responsible for urologic, gynaecologic and obstetrical complications, whose surgical treatment has been fully described. Sexual sequelae deserve the same attention. We describe and analyze the results of a surgical procedure for clitoral rehabilitation. PATIENTS AND METHODS Women requesting this surgery between 1992 and 2005 have been prospectively included in this study. The skin covering the stump was resected and the clitoris identified. The suspensor ligament was sectioned in order to mobilize the stump, the sclerous tissues were removed from the extremity and the neo glans brought to a normal situation. Pre operative pain and clitoral impairment were assessed within five categories. The same was done with anatomical and functional postoperative results at six months. RESULTS Four hundred and fifty-three patients have been completely evaluated. Hospitalisation stay was 24 hours and the procedure never lasted more than 30 minutes. Minor early complications were recorded in 58 patients (hematoma, disrupture of the suture, pain). Four patients reported persisting pain at four months. A visible clitoral massif could be restored in 87% of the cases and a real improvement in clitoral function was obtained in 75% of the patients. DISCUSSION AND CONCLUSION This surgical procedure is easy and reliable. It provides promising cosmetic and functional results with minor complications.
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Affiliation(s)
- P Foldes
- Service de chirurgie, centre hospitalier (CH), 20, rue Armagis, 78100 Saint-Germain-en-Laye, France
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La mutilation génitale féminine. SEXOLOGIES 2006. [DOI: 10.1016/j.sexol.2006.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation. RECENT FINDINGS The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor. Additionally, as people continue to try to eliminate female genital mutilation through human rights campaigns and the legal system, they have also become increasingly aware that understanding the motives behind this traditional practice may be an avenue towards change. SUMMARY The fundamental understanding of female genital mutilation will allow the clinician to address the emotional and physical needs of the children, girls, and women who have undergone this traditional practice or who are at risk for undergoing this practice. This understanding will allow the practitioner to individualize the history and physical examination, and to provide appropriate management with recognition and treatment of complications. Increased knowledge of the laws against female genital mutilation will allow the healthcare provider to educate and advise at-risk girls and women as well as their parents.
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Affiliation(s)
- Elizabeth Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-05267, USA.
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000185331.32574.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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