Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique

Botter, Charles; Sawan, Dana; SidAhmed-Mezi, Mounia; Spanopoulou, S; Luchian, S; Méningaud, Jean-Paul; Hersant, Barbara

doi:10.1016/j.jsxm.2021.02.010

Cited by 13 publications

(12 citation statements)

References 32 publications

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“…The clitoris is innervated by analogous nerves and generally has one main function, which is to create erogenous sensation during sexual arousal and activity. Like penile erection during sexual arousal, the clitoris becomes engorged or “erect.” 19 For TGNB patients wishing to undergo penile transplantation GAS, there remains a concern regarding whether female vascular anatomy can provide sufficient blood flow for a full penile erection. The female internal pudendal artery (IPA) is determined to have a smaller luminal diameter, wall thickness, and wall-to-lumen ratio compared with that of the male IPA.…”

Section: Discussionmentioning

confidence: 99%

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Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study

Lopez

Yusuf

Girard

et al. 2023

J Reconstr Microsurg

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Background It can be argued that individuals in the transgender and gender non-binary (TGNB) community suffer from a similar impact on quality of life in the face of gender dysphoria, with psychosocial and physical consequences. Indications for penile allotransplantation for patients wishing to undergo gender affirmation surgery have yet to be elucidated, but technical lessons for feasibility can be gleaned from penis transplants that have already been performed on cisgender males to date. Methods This study investigates the theoretical feasibility for penile-to-clitoral transplantation, prior penile transplants, and current multidisciplinary gender affirmation healthcare modalities. Results Penile allotransplantation offers a potential solution for individuals in the TGNB community for a more aesthetic penis, improved erectile function without the need of a prosthesis, optimal somatic sensation, and improved urethral outcomes. Conclusion Questions remain about ethics, patient eligibility, and immunosuppressive sequelae. Before these issues are addressed, feasibility of this procedure must be established.

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Section: Discussionmentioning

confidence: 99%

“…The DDV of the clitoris is the main vessel that provides venous drainage of the area. 19 In terms of penile transplantation, the DPA/DDV is critical for optimal graft perfusion and drainage. Notably, the DPA is the sole supplier to the penile glans and is essential to prevent distal graft necrosis.…”

Section: Vascular Anastomosismentioning

confidence: 99%

Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study

Lopez

Yusuf

Girard

et al. 2023

J Reconstr Microsurg

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“…Various publications have demonstrated a benefit of surgical clitoral reconstruction [12][13][14][15][16]. However, systematic reviews of studies evaluating safety and clinical outcomes illustrate that these studies provide a very low level of evidence, limited by incomplete follow-up, small sample size, non-validated scales, and various confounding factors [4,[17][18][19][20][21][22][23]. In particular, these studies do not allow for the pre-selection of appropriate patients for a specific therapy.…”

Section: Introductionmentioning

confidence: 99%

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

Fritschen

Strunz

Scherer

et al. 2023

IJERPH

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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.

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“…(Hersant et al, 2016). A-PRP has been suggested for use in clitoral reconstruction (Seifeldin, 2018) and to decrease postoperative pain (Botter et al, 2021). Given its potential to expedite healing and mitigate pain, as well as its safety in peri-and intra-clitoral injections, we decided to use liquid A-PRP and A-PRP glue for the present case.…”

Section: Introductionmentioning

confidence: 99%

“…Clitoral reconstruction for women with FGM/C has become increasingly common since it was first described by Thabet and Thabet ( 2003 ) and studied on a large scale by Foldès et al ( 2012 ). Since then, seven distinct techniques have been developed to improve outcomes of pain, recovery time, wound dehiscence, hematoma, and esthetic clitoral appearance (Botter et al, 2021 ; Sharif Mohamed et al, 2020 ; Wilson & Zaki, 2021 ). However, due to inconclusive evidence on safety and efficacy, particularly long term, clitoral reconstruction is not yet recommended by any professional organization, including the WHO.…”

Section: Introductionmentioning

confidence: 99%

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

Manin

Taraschi

Berndt³

et al. 2021

Arch Sex Behav

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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.

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Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique

Cited by 13 publications

References 32 publications

Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study

Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study

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

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

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