Medic recommends clitoral reconstruction for women living with FGM/C

ON the heels of calls by the UN and human rights organizations for complete ban of the practice of Female Genital Mutilation and Cutting, an Obstetrician and Gynaecologist, Dr Jasmine Abdulcadir, of the University Hospitals of Geneva (HUG), Switzerland, says women living with FGM/C should consider undergoing clitoral reconstruction.

Abdulcadir who specializes in providing services for women who have experienced FGM/C,  urges them to consider this surgery for  reasons ranging from reduction of chronic clitoral pain or to improve sexual pleasure. 

For the last two years, she has supported the work of WHO/RHR in development and implementation of a research agenda that aims to address the needs of women and girls who are at risk of and who live with FGM towards improving the evidence-base for effective policies, and their implementation.  Several women that have been cut see clitoral reconstruction as a way to improve their body image and female identity. 

"They may want to reverse a procedure that was performed without their consent or to regain a genital appearance similar to uncut women," she argues.

On what can women expect from the surgery, she says: "When FGM involves the cutting of the clitoris, it affects the clitoral glans (the visible and more external part of the organ). The majority of the clitoris (the body and crura) lies anatomically deeper and is therefore not affected by the procedure. 

"Additional structures responsible for sexual pleasure, such as the bulbs, also remain intact. This explains why women who have undergone FGM, and do not have psychosexual or other long term physical health complications, may still experience orgasm and sexual pleasure."

Abdulcadir describes clitoral reconstruction as a surgery that consists of re-exposing the clitoral body that is hidden beneath the scar tissue and recreating a more accessible clitoral glans, which can facilitate its stimulation.

"Reduction of clitoral pain and improvement of sexual function are chief among reported positive outcomes. However, the surgery is not without its complications: hematoma, wound breakdown, and post-operative decreased sexual function have been reported in the literature. The rate at which these complications occur ranges from 5.3% to 40%.

On implications for women considering clitoral reconstruction and their providers, she says there is still much unknown about the outcomes of clitoral reconstruction and urged health providers to make women who consider the surgery aware of this scarcity of scientific evidence.

"Whether considering the surgery or not, women should be offered comprehensive, multidisciplinary care including health education on female anatomy, physiology and sexuality, as well as psychosexual therapy. 

"Often, adequate psychosexual care and counselling can improve women's sexual function, body-image and identity with no need for more invasive interventions. Female sexual function is multifactorial and depends on more than the genital anatomy."

Abdulcadir says prior to undergoing any surgery, it is crucial to explore women's pre-operative symptoms, expectations, beliefs and misconceptions on the clitoris, their anatomy and sexuality. "Other possible psychological or physical comorbidities that can affect sexual function should also be screened and treated. If possible, partners should also be included in the care.

"Alternative therapies for improving the sexual health and wellbeing of women living with FGM/C

Women with FGM type III (infibulation) can suffer from superficial dyspareunia (pain during intercourse) and should be offered deinfibulation, a procedure to re-open the vaginal opening after infibulation has been performed. 

"This helps facilitate penetration during sexual activity, hence reducing painful intercourse. It also facilitates urination, menstruation and childbirth. Health education focusing on cultural myths on the clitoris, women's anatomy and physiology, and FGM, as well as associated psychosexual therapy are alternative and effective therapies to improve sexual health that can be proposed to women living with FGM and their partners," she argued.