Although most of us have heard of and have an opinion regarding female genital mutilation (FGM), many of us do not have a detailed knowledge of the procedure, its effect on the external female genitalia nor, ultimately, upon the affected woman’s sexual function, though it is generally recognized that the procedure is performed to decrease or eliminate sexual arousal and orgasm and causes subsequent pain with attempts at coitus. A recent study by Abdulcadir and colleagues uses MRI to examine the anatomy of women with and without FGM and psychometric instruments to assess sexual function in the two study groups. The aims of the study were 3-fold: to examine the impact of FGM in the anatomy of the clitoris and the bulbs; to assess differences in sexual function between women with and without FGM; and to determine if changes in anatomy due to FGM correlate with differences in sexual function.
There were 15 subjects each in the FGM and non-FGM groups. MRI studies of the genitalia focusing on the clitoris and bulbs were performed. Imaging showed that women without FGM had a larger volume of the clitoris + bulbs regardless of the technique of FGM. Women who had FGM also registered lower scores in the domains of sexual function and desire on the Sexual Distress Inventory. They also reported more dyspareunia. It was not possible to correlate anatomic changes due to FSM and specific effects on sexual function.
Perhaps the most encouraging finding was that, although the volume of the clitoris and bulbs in women with FGM was smaller than that of women who did not have the procedure, this volumetric change was not statistically significant. Given that the glans is the principal portion excised during the procedure, it appears that less is removed than many had thought. The bulbs appeared largely intact on MRI. Further, the technique of FGM did not affect the findings. The study involved a small sample of women of varied backgrounds and different approaches toward FGM. The authors judiciously try not to make sweeping conclusions on the basis of this study and encourage further investigation into the consequences of FGM on sexual anatomy and function with the goal of optimizing medical, psychosexual and surgical treatment of women affected by FGM. They conclude, “the present study shows that most sexual structures are preserved and normally developed in women with FGM. The assumption that sexual dysfunction is caused by the total absence of genital sexual organs should be abandoned” including the WHO classification indicating that the clitoris is completely removed in FGM.
Article by the Publications and Communications Committee
Abdulcadir J, Botsikas D, Bolmont M, et al. Sexual anatomy and function in women with and without genital mutilation: a cross-sectional study. J Sex Med 2016;13:226-237.