St Germain Poissy Hospital, St Germain en Laye, France.
Lancet. 2012 Jul 14;380(9837):134-41. doi: 10.1016/S0140-6736(12)60400-0. Epub 2012 Jun 12.
Women who have undergone female genital mutilation rarely have access to the reconstructive surgery that is now available. Our objective was to assess the immediate and long-term outcomes of this surgery.
Between 1998 and 2009, we included consecutive patients with female genital mutilation aged 18 years or older who had consulted a urologist at Poissy-St Germain Hospital, France. We used the WHO classification to prospectively include patients with type II or type III mutilation. The skin covering the stump was resected to reveal the clitoris. The suspensory ligament was then sectioned to mobilise the stump, the scar tissue was removed from the exposed portion and the glans was brought into a normal position. All patients answered a questionnaire at entry about their characteristics, expectations, and preoperative clitoris pleasure and pain, measured on a 5-point scale. Those patients who returned at 1 year for follow-up were questioned about clitoris pain and functionality. We compared data from the 1-year group with the total group of patients who had surgery.
We operated on 2938 women with a mean age of 29·2 (SD 7·77 years; age at excision 6·1, SD 3·5 years). Mali, Senegal, and Ivory Coast were the main countries of origin, but 564 patients had undergone female genital mutilation in France. The 1-year follow-up visit was attended by 866 patients (29%). Expectations before surgery were identity recovery for 2933 patients (99%), improved sex life for 2378 patients (81%), and pain reduction for 847 patients (29%). At 1-year follow-up, 363 women (42%) had a hoodless glans, 239 (28%) had a normal clitoris, 210 (24%) had a visible projection, 51 (6%) had a palpable projection, and three (0·4%) had no change. Most patients reported an improvement, or at least no worsening, in pain (821 of 840 patients) and clitoral pleasure (815 of 834 patients). At 1 year, 430 (51%) of 841 women experienced orgasms. Immediate complications after surgery (haematoma, suture failure, moderate fever) were noted in 155 (5%) of the 2938 patients, and 108 (4%) were briefly re-admitted to hospital.
Reconstructive surgery after female genital mutilation seems to be associated with reduced pain and restored pleasure. It needs to be made more readily available in developed countries by training surgeons.
French Urological Association.
接受过女性生殖器切割的女性很少有机会接受现在可用的重建手术。我们的目的是评估这种手术的即时和长期结果。
1998 年至 2009 年间，我们连续纳入了在法国 Poissy-St Germain 医院就诊的年龄在 18 岁及以上、患有女性生殖器切割的患者。我们使用世界卫生组织分类前瞻性地纳入 II 型或 III 型切割的患者。切除残端覆盖的皮肤，以显露阴蒂。然后切断悬韧带以移动残端，切除暴露部分的疤痕组织，将龟头置于正常位置。所有患者在入组时都通过问卷调查回答了有关其特征、期望以及术前阴蒂快感和疼痛的问题，疼痛采用 5 分制进行评估。那些在 1 年时回来随访的患者被询问了阴蒂疼痛和功能的问题。我们比较了 1 年组与接受手术的所有患者的数据。
我们对 2938 名平均年龄 29.2（SD 7.77 岁；切割年龄 6.1，SD 3.5 岁）的女性进行了手术。马里、塞内加尔和科特迪瓦是主要的原籍国，但 564 名患者在法国接受了女性生殖器切割。866 名患者（29%）参加了 1 年的随访。术前有 2933 名患者（99%）期望恢复身份，2378 名患者（81%）期望改善性生活，847 名患者（29%）期望减轻疼痛。在 1 年随访时，363 名患者（42%）龟头无包皮，239 名患者（28%）阴蒂正常，210 名患者（24%）可见突出，51 名患者（6%）可触及突出，3 名患者（0.4%）无变化。大多数患者报告疼痛（840 名患者中的 821 名）和阴蒂快感（834 名患者中的 815 名）得到改善，或至少没有恶化。在 1 年时，841 名女性中有 430 名（51%）经历了性高潮。2938 名患者中有 155 名（5%）发生了术后即刻并发症（血肿、缝线失败、中度发热），108 名（4%）患者短暂住院。
女性生殖器切割后的重建手术似乎与疼痛减轻和快感恢复有关。通过培训外科医生，这种手术需要在发达国家更广泛地提供。
法国泌尿科医师协会。
