title: Using the Female Sexual Function Index (FSFI) to evaluate sexual function in women with genital mutilation undergoing surgical reconstruction: a pilot prospective study.
abstract: OBJECTIVE
  Few prospective studies have evaluated sexual function in women with female genital mutilation by cutting (FGM/C) before and after clitoral reconstructive surgery, and none used a validated questionnaire. A validated questionnaire, the Female Sexual Function Index (FSFI) was used for the first time, to assess the impact of reconstructive surgery on sexual function in women with female genital mutilation/cutting (FGM/C) before and after clitoral reconstructive surgery.
  
  
  METHODS
  Women with FGM/C consulting at the Nantes University Hospital for clitoral reconstruction between 2013 and 2014 were prospectively included. All patients completed a questionnaire at inclusion, describing their social, demographic, and FGM/C characteristics. They were also asked to complete the FSFI as well as a questionnaire about clitoral sensations, symptoms of depression or anxiety, and self-esteem before and 3 and 6 months after the surgery. Paired Wilcoxon and McNemar tests were used to compare data.
  
  
  RESULTS
  Of the 12 women included, 9 (75%) had type II mutilations. Results showed a global sexual dysfunction (median FSFI summary score=17) before surgery. Clitoral sensations were absent in 8 women (67%). Six months after surgery, all FSFI dimensions except lubrication had improved significantly (median FSFI summary score=29, P=0.009). Ten women had clitoral sensations, and 11 (92%) were satisfied with their surgery.
  
  
  CONCLUSIONS
  This study shows that 6 months after clitoral reconstructive surgery, women reported a multidimensional positive improvement in their sexual function. The FSFI is a promising tool for routine standardized assessment of the sexual function of women with FGM/C for determining appropriate management and assessing it. Larger studies with validated questionnaires assessing self-esteem, depression, and body image are also needed to develop an integrative approach and to provide evidence-based recommendations about management of these women.
authors.affiliation: Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Vital
authors.affiliation: INSERM CIC 1413, Nantes University Hospital, Nantes, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: de Visme
authors.affiliation: INSERM CIC 1413, Nantes University Hospital, Nantes, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Hanf
authors.affiliation: Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France.
authors.forename: Henri-Jean
authors.initials: HJ
authors.lastname: Philippe
authors.affiliation: Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France.
authors.forename: Norbert
authors.initials: N
authors.lastname: Winer
authors.affiliation: Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France. Electronic address: sophie.wylomanski@gmail.com.
authors.forename: Sophie
authors.initials: S
authors.lastname: Wylomanski
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D019093:Circumcision, Female / Q000009:adverse effects*; D002987:Clitoris / Q000601:surgery*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007989:Libido / Q000502:physiology*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012649:Self Concept; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology
keywords: Clitoral surgical reconstruction; Female Sexual Function Index; Female genital mutilation/cutting; Orgasm; Sexual well-being