Jasmine Abdulcadir

Care of women with female genital mutilation/cutting.

In multi-ethnic European society medical professionals are faced with an increasing number of women originating from countries where female genital mutilations/cuttings (FGM/C) are practised. Recent studies, however, emphasise the lack of knowledge on this subject. This review article aims to present FGM/C as a complex socio-healthcare and multidisciplinary issue, outlining the definition, classification, epidemiology and anthropologico-legal aspects of FGM/C. It explains the approach to be adopted to FGM/C women, focusing on defibulation, clitoral restoration/repair and re-infibulation. Finally, it reports on the discussions surrounding pricking/nicking and the proposals for alternative rituals in recent years.

Seven Things to Know about Female Genital Surgeries in Africa

HASTINGS CENTER REPORT 19 Starting in the early 1980s, media coverage of customary African genital surgeries for females has been problematic and overly reliant on sources from within a global activist and advocacy movement opposed to the practice, variously described as female genital mutilation, female genital cutting, or female circumcision. Here, we use the more neutral expression female genital surgery. In their passion to end the practice, antimutilation advocacy organizations often make claims about female genital surgeries in Africa that are inaccurate or overgeneralized or that don’t apply to most cases. The aim of this article—which we offer as a public policy advisory statement from a group of concerned research scholars, physicians, and policy experts—is not to take a collective stance on the practice of genital surgeries for either females or males. Our main aim is to express our concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of littleknown others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates. In effect, the statement is an invitation to actually have that debate, with all sides of the story fairly represented. Some of the signatories of this policy statement support efforts to promote voluntary abandonment of all practices of genital surgery on children. Other signatories wish to allow parents to continue to circumcise males, but not females. Still other signatories seek to preserve the right of parents to carry forward their religious and cultural traditions and Seven Things to Know about Female Genital Surgeries in Africa

Research gaps in the care of women with female genital mutilation: an analysis

Female genital mutilation (FGM) includes procedures involving the partial or total removal of the external female genitals for non‐therapeutic reasons. They can have negative psychosexual and health consequences that need specific care. In this paper, we review some key knowledge gaps in the clinical care of women with FGM, focusing on obstetric outcomes, surgical interventions (defibulation and clitoral reconstruction), and the skills and training of healthcare professionals involved in the prevention and management of FGM. We identify research priorities to improve the evidence necessary to establish guidelines for the best multidisciplinary care, communication, and prevention, and to improve health‐promotion measures for women with FGM.

A systematic review of the evidence on clitoral reconstruction after female genital mutilation/cutting

Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C).

Clitoral neuroma after female genital mutilation/cutting: a rare but possible event

INTRODUCTION Female genital mutilation/cutting (FGM/C), in particular, type III, also called infibulation, can cause various long-term complications. However, posttraumatic neuroma of the clitoris is extremely rare; only one case was previously reported in the literature. AIM The aim of this study was to describe the case of a patient presenting a clitoral neuroma post-FGM/C in detail and her successful multidisciplinary treatment. METHODS We report the case of a 24-year-old woman originating from Somalia presenting a type III a-b FGM/C who attended our outpatient clinic at the Geneva University Hospitals complaining of primary dysmenorrhea and a post-mutilation painful clitoral mass. The mass was clinically diagnosed as a cyst and surgically removed. Histopathological analysis revealed that it was a posttraumatic neuroma and a foreign body granuloma around the ancient surgical thread. Our patient was also offered a multidisciplinary counseling by a specialized gynecologist on FGM/C, a sexologist, and a reproductive and sexual health counselor. RESULTS One month after surgical treatment, the vulvar pain was over. CONCLUSIONS This is the second case of clitoral neuroma after FGM/C reported and the first with complete clinical, as well as histopathological documentation and multidisciplinary care. Considering the high frequency of clitoral cysts in case of infibulation, clitoral neuroma should be considered in the differential diagnosis. In this case, if symptomatic, the treatment should be surgery, clinical follow-up, and counseling. If necessary, appropriate sexual therapy should be offered too.

Clitoral Reconstruction after Female Genital Mutilation/Cutting: Case Studies

INTRODUCTION Clitoral reconstruction following female genital mutilation/cutting (FGM/C) is a new surgical technique reported to be a feasible and effective strategy to reduce clitoral pain, improve sexual pleasure, and restore a vulvar appearance similar to uncircumcised women. However, data on safety, care offered, and evaluation of sexual and pain outcomes are still limited. AIMS This study aims to present the care offered and clinical outcomes of two women who received multidisciplinary care, including psychosexual treatment, with clitoral reconstruction. We report their long-term outcomes, and the histology of the removed periclitoral fibrosis. METHODS We report the cases of two women with FGM/C types II and III who requested clitoral reconstruction for different reasons. One woman hoped to improve her chronic vulvar pain, as well as improve her sexual response. The other woman requested surgery due to a desire to reverse a procedure that was performed without her consent, and a wish to have a genital appearance similar to non infibulated women. They both underwent psychosexual evaluation and therapy and surgery. The histology of the periclitoral fibrosis removed during surgery was analyzed. RESULTS At 1-year postoperatively, the first woman reported complete disappearance of vulvar pain and improved sexual pleasure, including orgasm. Our second patient also described improved sexuality at 1-year follow-up (increased sexual desire, lubrication, vulvar pleasure, and sensitiveness), which she attributed to a better self body image and confidence. Both women reported feeling satisfied, happy, and more beautiful. CONCLUSION We show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery.

Reconstructive surgery for female genital mutilation

The main role of imaging is to provide a description of the appearance, size, and location of adnexal lesions and associated abnormalities. In some circumstances, the aggressive potential of an adnexal lesion may be suggested on the basis of the imaging findings, the age of the patient, and the clinical data.

Missed opportunities for diagnosis of female genital mutilation

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

Overactive bladder after female genital mutilation/cutting (FGM/C) type III

A 27-year-old Somali woman with type III a–b female genital mutilation/cutting, consulted because of slow micturition, voiding efforts, urgency and urge incontinence (overactive bladder). She also referred primary dysmenorrhoea and superficial dyspareunia making complete sexual intercourses impossible. We treated her by defibulation and biofeedback re-educative therapy. We also offered a multidisciplinary counselling. At 5 months follow-up, urgency and urge incontinence had resolved and she became pregnant.

Female Genital Mutilation: A Visual Reference and Learning Tool for Health Care Professionals

Female genital mutilation comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs for nonmedical reasons. Health care providers for women and girls living with female genital mutilation have reported difficulties in recognizing, classifying, and recording female genital mutilation, which can adversely affect treatment of complications and discussions of the prevention of the practice in future generations. According to the World Health Organization, female genital mutilation is classified into four types, subdivided into subtypes. An agreed-upon classification of female genital mutilation is important for clinical practice, management, recording, and reporting, as well as for research on prevalence, trends, and consequences of female genital mutilation. We provide a visual reference and learning tool for health care professionals. The tool can be consulted by caregivers when unsure on the type of female genital mutilation diagnosed and used for training and surveys for monitoring the prevalence of female genital mutilation types and subtypes.