Anatomical Reconstruction following Female Genital Mutilation/Cutting (FGM/C)

Abstract

Background: International migration from high-prevalence regions has increasingly confronted non-endemic countries with female genital mutilation/cutting (FGM/C). Correspondingly, Western-based health care providers have seen a greater demand for surgical reconstruction of female anatomical units. We introduce novel surgical techniques developed by the first author for clitoral and vulvovestibular reconstruction and examine operative outcomes. Methods: We performed a retrospective cohort study of operative outcomes of the Omega-Domed (OD) flap, Neurotizing and Molding of the Clitoral Stump (NMCS procedure) and anterior Obturator Artery Perforator (aOAP) flap for preputial, clitoral and vulvovestibular reconstruction respectively. Between 2014 and 2021 we treated patients with all types of FGM/C and analyzed various data, including demographics, clitoral sensation, and symptoms such as dysmenorrhea, dysuria, dyspareunia, and anorgasmia. We aimed to examine the efficacy and safety of these techniques in improving clitoral sensation and reducing symptoms. Results: A total of 119 women (mean age of 31.0 ± 10.4) were included. We performed the OD-flap (85%), the NMCS procedure (82%) and the aOAP-flap (36%) and had a 1-year follow-up period which was attended by 94.1% of patients. Patients significantly reported post-operative reduction of dysmenorrhea, dysuria, and dyspareunia as well as significant improvement of clitoral sensation and ability to achieve orgasm (p<0.001). There was one major complication (loss of flap) to report. Secondary ambulatory interventions were performed in 10 patients (8.4%). Conclusions: By allowing for safe and effective anatomical reconstruction of the female genitalia, the described surgical techniques represent a new stage of treatment possibilities for women affected by FGM/C.