Cargando…

Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation

Background: Reconstruction after female genital mutilation (FGM) has developed from being merely a therapy for complications to addressing body perception and sexuality. However, evidence regarding a direct correlation between FGM and sexual dysfunction is scarce. The present WHO classification prov...

Descripción completa

Detalles Bibliográficos
Autores principales: von Fritschen, Uwe, Strunz, Cornelia, Scherer, Roland, von Fritschen, Marisa, Fricke, Alba
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10002091/
https://www.ncbi.nlm.nih.gov/pubmed/36901456
http://dx.doi.org/10.3390/ijerph20054439
_version_ 1784904305426300928
author von Fritschen, Uwe
Strunz, Cornelia
Scherer, Roland
von Fritschen, Marisa
Fricke, Alba
author_facet von Fritschen, Uwe
Strunz, Cornelia
Scherer, Roland
von Fritschen, Marisa
Fricke, Alba
author_sort von Fritschen, Uwe
collection PubMed
description Background: Reconstruction after female genital mutilation (FGM) has developed from being merely a therapy for complications to addressing body perception and sexuality. However, evidence regarding a direct correlation between FGM and sexual dysfunction is scarce. The present WHO classification provides an imprecise grading system, which makes it difficult to compare present studies with treatment outcomes. The aim of this study was to develop a new grading system based on a retrospective study of Type III FGM, evaluating operative time and postoperative results. Methods: The extent of clitoral involvement, operative time of prepuce reconstruction and lack of prepuce reconstruction, and postoperative complications of 85 patients with FGM-Type III were retrospectively analyzed at the Desert Flower Center (Waldfriede Hospital, Berlin). Results: Even though universally graded by the WHO, large differences in the degree of damage were found after deinfibulation. In only 42% of patients, a partly resected clitoral glans was found after deinfibulation. There was no significant difference in operative time when comparing patients who required prepuce reconstruction and patients who did not (p = 0.1693). However, we found significantly longer operative time in patients who presented with a completely or partly resected clitoral glans when compared to patients with an intact clitoral glans underneath the infibulating scar (p < 0.0001). Two of the 34 patients (5.9%) who had a partly resected clitoris required revision surgery, while none of the patients in whom an intact clitoris was discovered under the infibulation required revision. However, these differences in the complication rates between patients with and without a partly resected clitoris were not statistically significant (p = 0.1571). Conclusions: A significantly longer operative time was found in patients who presented with a completely or partly resected clitoral glans when compared with patients with an intact clitoral glans underneath the infibulating scar. Furthermore, we found a higher, though not significantly significant, complication rate in patients with a mutilated clitoral glans. In contrast to Type I and II mutilations, the presence of an intact or mutilated clitoral glans underneath the infibulation scar is not addressed in the present WHO classification. We have developed a more precise classification, which may serve as a useful tool when conducting and comparing research studies.
format Online
Article
Text
id pubmed-10002091
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-100020912023-03-11 Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation von Fritschen, Uwe Strunz, Cornelia Scherer, Roland von Fritschen, Marisa Fricke, Alba Int J Environ Res Public Health Article Background: Reconstruction after female genital mutilation (FGM) has developed from being merely a therapy for complications to addressing body perception and sexuality. However, evidence regarding a direct correlation between FGM and sexual dysfunction is scarce. The present WHO classification provides an imprecise grading system, which makes it difficult to compare present studies with treatment outcomes. The aim of this study was to develop a new grading system based on a retrospective study of Type III FGM, evaluating operative time and postoperative results. Methods: The extent of clitoral involvement, operative time of prepuce reconstruction and lack of prepuce reconstruction, and postoperative complications of 85 patients with FGM-Type III were retrospectively analyzed at the Desert Flower Center (Waldfriede Hospital, Berlin). Results: Even though universally graded by the WHO, large differences in the degree of damage were found after deinfibulation. In only 42% of patients, a partly resected clitoral glans was found after deinfibulation. There was no significant difference in operative time when comparing patients who required prepuce reconstruction and patients who did not (p = 0.1693). However, we found significantly longer operative time in patients who presented with a completely or partly resected clitoral glans when compared to patients with an intact clitoral glans underneath the infibulating scar (p < 0.0001). Two of the 34 patients (5.9%) who had a partly resected clitoris required revision surgery, while none of the patients in whom an intact clitoris was discovered under the infibulation required revision. However, these differences in the complication rates between patients with and without a partly resected clitoris were not statistically significant (p = 0.1571). Conclusions: A significantly longer operative time was found in patients who presented with a completely or partly resected clitoral glans when compared with patients with an intact clitoral glans underneath the infibulating scar. Furthermore, we found a higher, though not significantly significant, complication rate in patients with a mutilated clitoral glans. In contrast to Type I and II mutilations, the presence of an intact or mutilated clitoral glans underneath the infibulation scar is not addressed in the present WHO classification. We have developed a more precise classification, which may serve as a useful tool when conducting and comparing research studies. MDPI 2023-03-02 /pmc/articles/PMC10002091/ /pubmed/36901456 http://dx.doi.org/10.3390/ijerph20054439 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
von Fritschen, Uwe
Strunz, Cornelia
Scherer, Roland
von Fritschen, Marisa
Fricke, Alba
Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation
title Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation
title_full Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation
title_fullStr Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation
title_full_unstemmed Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation
title_short Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation
title_sort postoperative course of reconstructive procedures in fgm type iii-proposal for a modified classification of type iii female genital mutilation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10002091/
https://www.ncbi.nlm.nih.gov/pubmed/36901456
http://dx.doi.org/10.3390/ijerph20054439
work_keys_str_mv AT vonfritschenuwe postoperativecourseofreconstructiveproceduresinfgmtypeiiiproposalforamodifiedclassificationoftypeiiifemalegenitalmutilation
AT strunzcornelia postoperativecourseofreconstructiveproceduresinfgmtypeiiiproposalforamodifiedclassificationoftypeiiifemalegenitalmutilation
AT schererroland postoperativecourseofreconstructiveproceduresinfgmtypeiiiproposalforamodifiedclassificationoftypeiiifemalegenitalmutilation
AT vonfritschenmarisa postoperativecourseofreconstructiveproceduresinfgmtypeiiiproposalforamodifiedclassificationoftypeiiifemalegenitalmutilation
AT frickealba postoperativecourseofreconstructiveproceduresinfgmtypeiiiproposalforamodifiedclassificationoftypeiiifemalegenitalmutilation