Cliroral Reconstruction After Female Genital Mutilation: A New Labial Sensate Technique
Purpose: Female Genital Mutilation remains endemic in many parts of the world with more than 200 million women with FGM alive today. Regrettably, immigrants to the Western world might continue that practice in their new habitat. Published treatment techniques remain few, and have focused on clitoral reconstruction by liberating the remnants of the clitoris and releasing the scar tissue. None have addressed the sensory issue of the neo-clitoris, and while they might restore the appearance of the clitoris, the concomitant sensory deficit was not tackled.
Methods: Sixty patients presenting to Cairo University Hospitals with FGM related sexual problems were enlisted in this study. Following psychological counseling, genital examination and Female Sexual Functional Index (FSFI) and Female Genital Self Image Scale (FGSIS) scores, patients were randomly divided into two equal groups: Group I (Control) had clitoral reconstruction by previously described techniques, and Group II had additional sensory coverage of the new clitoris by a sensate mucosal pedicled flap rotated from the inner surface of the Labia Minora.
Results: All patients had a viable clitoris after the surgery. On weeks 4, 6 and 12, patients had sensory testing for the neo-clitoris and repeat of the psychological examination, FSFI and FGSIS testing. Group II had a statistically significant improvement in sexual function when compared with Group I, with more erotic stimulation and significantly higher FSFI and FGSIS scores.
Conclusion- Use of a sensate flap significantly improved the functional outcome of clitoral reconstruction and improved the FSFI scoring and FGSIS scales in the patients.
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