A Norwegian group recently performed a meta-analysis of studies of surgical interventions to address complications of FGM. 71 studies met criteria for inclusion, and the total number of subjects was 7,291. Three procedures predominated: deinfibulation, excision of cystic inclusions +/- a reconstructive procedure, and clitoral or clitoral-labial reconstruction. Reasons for seeking these interventions ranged from treatment of sexual pain and dysfunction, restoration of anatomy, and to re-establish a sense of femininity. Most of the articles were contemporary series dating from 2010-2016.
In their discussion of the findings, the authors comment on the lack of surgical detail in the literature. Outcome data are also rare and not rigorously reported. Further, long-term data regarding success of the various interventions are not available. Although patient satisfaction was reported in some studies, quality of life evaluations after reparative procedures was sparse. What little information was available suggested that up to one-third of women who underwent reconstruction were ultimately dissatisfied with the appearance of their genitalia. This likely resulted from a number of factors including cultural esthetics and unrealistic expectations. Given the complexity of each woman’s situation, more in-depth study of not only the anatomical sequelae of FGM, but of patients’ motivations, expectations and experiences surrounding genital reconstruction is necessary to provide optimal care. Indeed, the authors’ primary objective in performing this analysis was to establish protocols for evaluating and treating these patients, but they found that the available data were inadequate to the task. So, one may surmise that, although the physical scarring produced by FGM can often be repaired, the psychological and emotional scars are not often addressed. Therefore, further attention to the invisible consequences of FGM are essential to providing the all-encompassing care those subjected to GM deserve.
Interested in ethical issues surrounding FGM and other types of genital surgery? If so, please participate in the free Ethics Committee workshop at 1630 on 13 September in Room Spadolini G.
Berg RC, Taraldsen S, Said MA, Sorbye IK, and Vangen S. Reasons for and experiences with surgical interventions for female genital mutilation/cutting (FGM/C):a systematic review. J Sex Med 2017;14:977-990
ICS core curriculum (free): the ethics of female genital mutilation (FGM) and other urogenital interventions: an interactive workshop