title: Type III female genital mutilation: clinical implications and treatment by carbon dioxide laser surgery.
abstract: OBJECTIVE
  The purpose of this study was to examine clinical implications of type III female genital mutilation and to evaluate the use of carbon dioxide laser surgery to restore vulvar opening and to treat associated epithelial inclusion cysts.
  
  
  METHODS
  Twenty-five infibulated patients underwent carbon dioxide laser treatment. Seven of the women (28%) were pregnant, between 10 and 37 weeks of gestation. Vulvar examination revealed five cases of epidermal inclusion cysts. One pregnant patient, with a cyst that was 7 cm in diameter, was at 24 weeks of gestation. Deinfibulation was performed in an outpatient setting with local anesthesia. A colposcopy-guided laser beam was used to create an incision along the fusion midline of the labia majora. In case of vulvar epidermal inclusion cyst, the capsule was opened and emptied of sebaceous contents; the inner surface of the cyst was vaporized completely.
  
  
  RESULTS
  The carbon dioxide laser procedure restored a complete vulvar opening in all 25 patients. The complete vaporization of cyst capsule was possible in all five cases. No case of intraoperative or postoperative complication occurred. The average duration of follow-up was 11 months. Four patients who underwent deinfibulation antenatally had labor with spontaneous vaginal delivery and no evidence of perineal trauma.
  
  
  CONCLUSIONS
  On the basis of the advantages that were observed, deinfibulation treatment must be offered to all infibulated patients. The procedure is particularly appropriate during pregnancy to prevent childbirth complications. Laser carbon dioxide has been proved to be a suitable technique for the treatment of female genital mutilation when inclusion cysts are associated with it.
authors.affiliation: Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Penna
authors.forename: M Grazia
authors.initials: MG
authors.lastname: Fallani
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.forename: Elisa
authors.initials: E
authors.lastname: Zipoli
authors.forename: Mauro
authors.initials: M
authors.lastname: Marchionni
mesh_terms: D000328:Adult; D019093:Circumcision, Female / Q000009:adverse effects*; D004814:Epidermal Cyst / Q000209:etiology / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D053685:Laser Therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D014845:Vulvar Diseases / Q000209:etiology / Q000601:surgery