Female genital mutilation reversal: a general approach

• Published in: International Urogynecology Journal Vol. 25; no. 7; pp. 985 - 986
• Main Authors: Anand, Mallika, Stanhope, Todd J., Occhino, John A.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-07-2014; Springer Nature B.V
• Subjects: Adult; Circumcision, Female - classification; Female; Gynecologic Surgical Procedures - methods; Gynecology; Humans; IUJ Video; Medicine; Medicine & Public Health; Reconstructive Surgical Procedures - methods; Urology; Vagina - surgery; Vulva - surgery; Female genital mutilation; Circumcision reversal; Defibulation
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-013-2299-0

Introduction and hypothesis
Female genital mutilation (FGM) is a violation of human rights; yet, more than 100 million females are estimated to have undergone the procedure worldwide. There is an increased need for physician education in treating FGM. Female pelvic surgeons have a unique opportunity to treat this population of patients. Here, we depict the classification of FGM and a general approach to FGM reversal. We specifically address the procedure of type III FGM reversal, or defibulation.
Methods
In this video, we first highlight the importance of the problem of FGM. Next, we present the classification of FGM using an original, simple, schematic diagram highlighting they key anatomic structures involved in the four types of FGM. We then present a simple case of reversal of type III FGM, a procedure also known as defibulation. After depicting the surgical procedure, we discuss clinical results and summarize key principles of the defibulation procedure.
Results
Our patient was a 25-year-old woman who had undergone type III FGM as a child in Somalia. She desired restoration of vaginal function. We performed a reversal, and her postoperative course was uncomplicated. By 6 weeks postoperatively, she was able to engage in sexual intercourse without dyspareunia.
Conclusion
FGM is a problem at the doorsteps of female pelvic medicine and reconstructive surgery. Our video demonstrates a basic surgical approach that can be applied to simple cases of type III FGM presenting to the female pelvic surgeon.