title: Pregnancy with a pinhole introitus: A report of two cases and a review of the literature.
abstract: OBJECTIVE
  As over 125 million women worldwide have undergone female genital mutilation (FGM), 170,000 of whom are estimated to live in the UK alone, obstetricians and gynaecologists need to be aware of the grades and consequences of this devastating condition. Women with type III FGM, even when they are unable to have penetrative intercourse, can conceive, and obstetricians should be aware of this to ensure optimal care of these patients. To determine the most appropriate surgical approach, deinfibulation in pregnancy should follow some basic principles which take into account the psychological needs of women as well as the extent of scarring.
  
  
  METHODS
  We present two cases of women who had never engaged in penetrative intercourse and therefore presented with no knowledge that they were pregnant. They underwent antenatal deinfibulation and subsequent management based on individual request.
  
  
  CONCLUSIONS
  Management in pregnancy can pose particular problems and should be individualised. In all childbearing women with FGM, even where intercourse has not been possible, pregnancy should be considered. Clinicians should be aware of the types of FGM and management should be undertaken by a designated clinician with appropriate expertise. Pregnant women who have undergone FGM should be examined to identify the requirement for antenatal surgical correction.
authors.affiliation: a Department of Urogynaecology , Sheffield Teaching Hospitals , Sheffield , UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Mistry
authors.affiliation: a Department of Urogynaecology , Sheffield Teaching Hospitals , Sheffield , UK.
authors.forename: Swati
authors.initials: S
authors.lastname: Jha
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D019093:Circumcision, Female / Q000009:adverse effects; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D014621:Vagina / Q000601:surgery*
keywords: Childbirth; Coitus interfemoris; Deinfibulation; FGM; Female circumcision; Intercrural sex; Pregnancy; Surgical termination of pregnancy