title: Clitoral reconstruction after female genital mutilation/cutting: case studies.
abstract: BACKGROUND
  Clitoral reconstruction following female genital mutilation/cutting (FGM/C) is a new surgical technique reported to be a feasible and effective strategy to reduce clitoral pain, improve sexual pleasure, and restore a vulvar appearance similar to uncircumcised women. However, data on safety, care offered, and evaluation of sexual and pain outcomes are still limited.
  
  
  OBJECTIVE
  This study aims to present the care offered and clinical outcomes of two women who received multidisciplinary care, including psychosexual treatment, with clitoral reconstruction. We report their long-term outcomes, and the histology of the removed periclitoral fibrosis.
  
  
  METHODS
  We report the cases of two women with FGM/C types II and III who requested clitoral reconstruction for different reasons. One woman hoped to improve her chronic vulvar pain, as well as improve her sexual response. The other woman requested surgery due to a desire to reverse a procedure that was performed without her consent, and a wish to have a genital appearance similar to non infibulated women. They both underwent psychosexual evaluation and therapy and surgery. The histology of the periclitoral fibrosis removed during surgery was analyzed.
  
  
  RESULTS
  At 1-year postoperatively, the first woman reported complete disappearance of vulvar pain and improved sexual pleasure, including orgasm. Our second patient also described improved sexuality at 1-year follow-up (increased sexual desire, lubrication, vulvar pleasure, and sensitiveness), which she attributed to a better self body image and confidence. Both women reported feeling satisfied, happy, and more beautiful.
  
  
  CONCLUSIONS
  We show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery.
authors.affiliation: Department of Obstetrics and Gynaecology, Geneva University Hospitals, Geneva, Switzerland; Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Abdulcadir
authors.forename: Maria I
authors.initials: MI
authors.lastname: Rodriguez
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
authors.forename: Lale
authors.initials: L
authors.lastname: Say
mesh_terms: D000328:Adult; D001828:Body Image / Q000523:psychology*; D019093:Circumcision, Female / Q000523:psychology / Q000534:rehabilitation*; D002987:Clitoris / Q000503:physiopathology / Q000601:surgery*; D015928:Cognitive Behavioral Therapy; D037001:Directive Counseling; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007989:Libido; D009948:Orgasm; D010146:Pain; D010348:Patient Care Team; D017060:Patient Satisfaction; D057181:Pleasure; D019651:Plastic Surgery Procedures / Q000379:methods / Q000523:psychology*; D012725:Sexual Behavior; D016896:Treatment Outcome
keywords: Clitoral Reconstruction; Clitoris; FGC; FGM; FGM/C; Female Genital Cutting; Female Genital Mutilation; Female Genital Mutilation/Cutting