Autologous Platelet-Rich Plasma for Clitoral Reconstruction: A Case Study

Clitoral reconstruction after female genital mutilation/cutting (FGM/C) is associated with significant post-operative pain and months-long recovery. Autologous platelet-rich plasma (A-PRP) reduces the time of healing and pain in orthopedic and burn patients and could also do so in clitoral reconstruction. In the present case, a 35-year-old Guinean woman who had undergone FGM/C Type IIb presented to our clinic for clitoral reconstruction. Her request was motivated by low sexual satisfaction and body image. We surgically reconstructed the clitoris using the Foldès method and applied plasma and glue of A-PRP. The patient was highly satisfied with the procedure. Two months post-operatively, her pain had ceased entirely and re-epithelialization was complete. We conclude that A-PRP may improve pain and healing after clitoral reconstruction. Extensive studies investigating long-term outcomes are needed.

Swedish healthcare for women subjected to Female Genital Mutilation/Cutting (FGM/C)

Background: FGM/C can lead to a number of health complications, such as pain during intercourse or childbirth, psychological problems, and postpartum complications. This study seeks to describe and assess Swedish healthcare for women subjected to FGM/C.Methods: This aim encompasses three research foci: (1) to inventory Swedish regional healthcare guidelines and policies for care for women who have undergone FGM/C, (2) to map healthcare consumption among women who have undergone FGM/C, and (3) to map the type of care measures and treatment they have been offered in the Swedish healthcare system. A questionnaire was sent to healthcare regional managers and a database study was conducted.Results: The inventory of the healthcare regions' guidelines shows that five of 21 had no guidelines. The number of women who have been subjected to FGM/C and sought care has increased steadily between 2012 and 2018. Women who have been subjected to FGM/C seek care mostly in connection with pregnancy and childbirth.Conclusions: The type of care that should be offered to women who have been subjected to FGM/C vary depending on individual needs. Care may include surgical procedures in the form of defibulation, clitoral reconstruction, or removal of cysts, as well as psychosexual care. Existing treatment options in surgical care, together with psychosexual treatment, are the care measures that seem to be helpful for some women who have undergone FGM/C, but not for all. Communication and treatment are of great importance in order to be able to offer care to women who have undergone FGM/C.

The benefits and disappointments following clitoral reconstruction after female genital cutting: A qualitative interview study from Sweden

Female genital cutting or mutilation refers to the cutting of girls’ external genitalia. Due to migration from contexts where female genital cutting is common, it is estimated that around 38 000 cut women and girls live in Sweden. Clitoral reconstruction, a relatively new form of surgical healthcare offered to women with female genital cutting, was established in Sweden in 2014. This surgery aims at restoring clitoral function and anatomy, but there is yet a dearth of evidence demonstrating the effects of the surgery. The aim of this study was to explore how women undergoing clitoral reconstruction in Sweden between 2016 and 2019 experienced the surgical process and its aftereffects from a physical, sexual and psychosocial perspective. Eighteen women who had undergone clitoral reconstruction at a university hospital in Sweden agreed to participate in the study. The women were interviewed using semi-structured interviews, which were recorded, transcribed and analysed using thematic analysis. The results, based on self-categorization and labelling theory, demonstrated both benefits and disappointments following the surgery. Several women reported positive outcomes in terms of sexual, psychosocial and aesthetic terms. They experienced reduced genital pain, improvements in their sex lives, and a sense of feeling more empowered and at ease in their bodies. Yet, some women reported aesthetic, functional and process-related disappointment related to clitoral reconstruction. Nonetheless, the women expressed gratitude for the possibility of undergoing the surgery. In conclusion, the women reported that they experienced physical, sexual and psychosocial benefits of the surgery.

Novel Clitoral Reconstruction and Coverage With Sensate Labial Flaps: Potential Remedy for Female Genital Mutilation

Background Clitoral reconstruction after female genital mutilation (FGM) could help alleviate complications caused by FGM, such as clitoral pain, reduced sensation, diminished sexual function, as well as improving aesthetics of the genitalia and restoring anatomy. Objectives Create sensate labial flaps to cover the neo-clitoris and assess its outcome. Methods Between December 2018 and July 2020, forty patients with FGM underwent clitoral reconstruction and coverage with sensate labial flaps donated by the remnant of the labia minora and were followed prospectively. Flaps were mapped on the less mutilated labia minora, based on recent description of arterial anatomy and innervation. Before the surgery, the patients’ clitoral sensation was assessed on a 6 point scale and they were also given the Female Sexual Functional Index (FSFI) to complete. Eight and twenty four weeks postoperatively, the same assessment was repeated and the data compared. Results The mean preoperative FSFI was 11.64 (range 2.8-25.6) and post-operatively was 29.14 (range 12.8-35.4), demonstrating a significant increase. Similarly, the Clitoral sensation increased from 2.35 (range 1-4) before the surgery to 4.9 (range 2-6) after the surgery, demonstrating a significant increase. In total, 95% of patients benefited from the surgery. Conclusions Clitoral reconstruction after FGM using sensate labial flaps resulted in significant improvement of sexual function, clitoral sensation, genital aesthetics and self-esteem.