Female Genital Mutilation Reconstruction for Plastic Surgeons

A Call to Arms

Takintope Akinbiyi, MD, MSc; Emily Langston; Ivona Percec, MD, PhD

Disclosures

Plast Reconstr Surg Glob Open. 2018;6(11):e1945 

In This Article

Conclusions

The clitoris has been described as being essential to female sexual arousal and function and the outer appearance of the female genitalia is heavily tied to female sexuality.[2,3] The practice of FGM, defined as the mutilation of the clitoris and vulva to varying degrees for completely nonmedical reasons, has been divided into 4 overlapping classifications by the WHO. There is a long list of short- and long-term complications including infertility, recurrent infections, and infant and maternal mortality in the extreme case. Many of the victims are too young to be able to fully understand the procedure, let alone give their consent. Finally, the conditions under which the procedures occur are inhumane. As such, there is a growing global outcry at the practice and many initiatives are underway to reduce and eventually eliminate its occurrence. In short, the act of FGM is a gross violation of human rights.

Even with the most aggressive forms of FGM, only the superficial aspect of the clitoris, the glans, is usually damaged.[5] Therefore, the possibility exists to restore some, or possibly all, of the clitoral function. Many authors have described techniques and their initial results with vulva reconstruction. However, additional work on how best to treat victims of FGM and the optimal method of reconstruction is still required. It is essential to increase education of both the public and medical professionals, especially those practicing in primary care, pediatrics, and obstetrics and gynecology fields who will often be the first to encounter FGM victims and potentially intervene on those at risk of becoming future victims.

Although plastic and reconstructive surgeons are traditionally at the forefront of innovating reconstructive therapies and techniques, most of the early work and advancements in vulvar reconstruction after FGM has been by urologists and obstetrician-gynecologists. Plastic and reconstructive surgeons have been markedly absent from the discussion, as evidenced by only one article on the subject published in Plastic and Reconstructive Surgery over 10 years ago.[32] Although some information can be extrapolated from the labiaplasty and transgender transformation publications, which are both discussed more frequently in the plastics literature, the paucity of FGM data represent a tremendous opportunity for plastic surgeons to engage this population suffering from anatomical disfigurement and to use our wealth of reconstructive knowledge to provide restoration of form and function to FGM victims. As such, it behooves us to begin to develop multidisciplinary treatment programs for women suffering the repercussions of FGM procedures, much like we have developed for other complicated conditions.

Before we begin to seek out the victims of the FGM and try to heal them, however, we must educate ourselves about the cultural beliefs that perpetuate this practice, and understand the broad physical and psychological repercussions. Only then can plastic surgeons fully engage with FGM victims and provide them with comprehensive therapeutic options. The victims of FGM represent a very vulnerable and potentially isolated population of women. However, those appropriate for vulvar reconstruction may experience tremendous increases in their quality of life and should be offered the opportunity for reconstruction.

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