Psychosexual Consequences of Female Genital Mutilation and the Impact of Reconstructive Surgery: A Narrative Review

Abstract

Purpose: We aim to provide a comprehensive overview of the health consequences of female genital mutilation/cutting (FGM/C), with a particular focus on the psychosexual implications of this practice and the overall impact of reconstructive plastic surgery.Methods: A MEDLINE search through PubMed was performed to identify the best quality evidence published studies in English language on long-term health consequences of FGM/C.Results: Women with FGM/C are more likely to develop psychological disorders, such as post-traumatic stress disorder, anxiety, somatization, phobia, and low self-esteem, than those without FGM/C. Most studies showed impaired sexual function in women with FGM/C. In particular, women with FGM/C may be physiologically less capable of becoming sexually stimulated than uncut women. Reconstructive surgery could be beneficial, in terms of both enhanced sexual function and body image. However, prospective studies on the impact of reconstructive surgery are limited, and safety issues should be addressed.Conclusion: Although it is clear that FGM/C can cause devastating immediate and long-term health consequences for girls and women, high-quality data on these issues are limited. Psychosexual complications need to be further analyzed to provide evidence-based guidelines and to improve the health care of women and girls with FGM/C. The best treatment approach involves a multidisciplinary team to deal with the multifaceted FGM/C repercussions.

An Overview of Female Genital Mutilation in Africa: Are the Women Beneficiaries or Victims?

“…Similarly, the reviewed studies equally established that FGM entails psychological, psychosocial, and psychosexual effects, although there is a few quality evidence to adequately back it [49]. Some studies identified effects such as anxiety, post-traumatic disorder, and depression, perhaps as a result of shame arising from social victimization [38].…”

“…This study commensurates the findings from a narrative review of psychosexual consequences and a meta-analysis study on Nigerian women based on their psychosocial analysis. The former posited that women with FGM are more prone to developing psychological disorders such as phobia, anxiety, somatization, self-esteem, and post-traumatic stress disorder and equally physiological problem in respect to being sexually stimulated, while the latter revealed that FGM creates psychological problems, sexual abnormalities, and unhappiness in marriage [48,49].…”

Clinical Features Associated with Female Genital Mutilation/Cutting: A Pilot Longitudinal Study

“…Although many authors uphold the negative sexual and physical impact of FGM/C, research focused on the correlates of psychopathology and FGM/C is still in its nascent stages [17]. Most commonly identified manifestations of psychological impairments include negative self-image, depression, anxiety, somatization, and posttraumatic stress disorder [17][18][19][20][21][22][23][24]. In a recent comprehensive literature review, 14 of the 16 included studies reported an association between FGM/C and at least one adverse mental health outcome [25].…”

“…Different options for reconstruction of the female genital after FGM/C have been proposed, such as defibulation, removal of cysts, reconstruction of clitoris and labia, neuromas, and scar tissue, although clitoral reconstruction (CR) has been the most widely used [24,26]. CR has been shown to improve both genital anatomy and sexual function, including favorable changes in genital self-image [10,[27][28][29][30].…”

“…However, the impact of CRon the psychological and sexual well-being of women with FGM/C is largely uninvestigated. Preliminary studies in this area have reported reduced depression and sexual distress levels and possible improvements in body image after CR [16,24,33]. However, it appears that genital self-image is not significantly improved after CR [16].…”