Management of painful clitoral neuroma after female genital mutilation/cutting.
BACKGROUND
Traumatic neuromas are the result of regenerative disorganized proliferation of the proximal portion of lesioned nerves. They can exist in any anatomical site and are responsible for neuropathic pain. Post-traumatic neuromas of the clitoris have been described as an uncommon consequence of female genital mutilation/cutting (FGM/C). FGM/C involves partial or total removal of the female genital organs for non-therapeutic reasons. It can involve cutting of the clitoris and can cause psychological, sexual, and physical complications. We aimed to evaluate the symptoms and management of women presenting with a clitoral neuroma after female genital mutilation/cutting (FGM/C).


METHODS
We identified women who attended our specialized clinic for women with FGM/C who were diagnosed with a traumatic neuroma of the clitoris between April 1, 2010 and June 30, 2016. We reviewed their medical files and collected socio-demographic, clinical, surgical, and histopathological information.


RESULTS
Seven women were diagnosed with clitoral neuroma. Six attended our clinic to undergo clitoral reconstruction, and three of these suffered from clitoral pain. The peri-clitoral fibrosis was removed during clitoral reconstruction, which revealed neuroma of the clitoris in all six subjects. Pain was ameliorated after surgery. The seventh woman presented with a visible and palpable painful clitoral mass diagnosed as a neuroma. Excision of the mass ameliorated the pain. Sexual function improved in five women. One was not sexually active, and one had not yet resumed sex.


CONCLUSIONS
Post-traumatic clitoral neuroma can be a consequence of FGM/C. It can cause clitoral pain or be asymptomatic. In the case of pain symptoms, effective treatment is neuroma surgical excision, which can be performed during clitoral reconstruction. Surgery should be considered as part of multidisciplinary care. The efficacy of neuroma excision alone or during clitoral reconstruction to treat clitoral pain should be further assessed among symptomatic women.
Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Bld de la Cluse, 30 Bld de la Cluse, 1211, Geneva, Switzerland. jasmine.abdulcadir@hcuge.ch.|Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1205, Geneva, Switzerland. jasmine.abdulcadir@hcuge.ch.
Jasmine
J
Abdulcadir
Division of Clinical Pathology, Geneva University Hospitals, Rue Michel Servet 1, 1205, Geneva, Switzerland.
Jean-Christophe
JC
Tille
Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Bld de la Cluse, 30 Bld de la Cluse, 1211, Geneva, Switzerland.
Patrick
P
Petignat
D000328:Adult; D019093:Circumcision, Female / Q000009:adverse effects / Q000534:rehabilitation*; D002987:Clitoris / Q000293:injuries / Q000601:surgery*; D019468:Disease Management; D005260:Female; D006801:Humans; D008875:Middle Aged; D009463:Neuroma / Q000209:etiology / Q000601:surgery*; D010146:Pain / Q000150:complications; D059408:Pain Management; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D055815:Young Adult
Clitoral reconstruction; Clitoris; FGC; FGM; FGM/C; Female genital cutting; Female genital mutilation; Neuroma