Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, VR, Italy.
Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, VR, Italy.
Sex Reprod Healthc. 2021 Sep;29:100619. doi: 10.1016/j.srhc.2021.100619. Epub 2021 Apr 2.
To summarize available evidence on clitoral reconstruction after Female genital mutilations/cut (FGM/C).
Systematic review of the literature to identify studies on clitoral reconstruction after previous FGM/C with at least 6 months of follow-up. The literature search was performed in the following databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. The period considered was from the database inception to June 30th, 2020.
Post-operative vulvar pain or dyspareunia, changes in sexual activity or orgasm, and the impact on self-image.
We identified 8 studies; four used the same "Foldès technique", and four adopted similar techniques based on the downward mobilization of the clitoral stump, with different reconstructions of glans and prepuce. The postoperative complication rate was reported at 5.3%. Sexual function is the only outcome investigated by all studies, which consistently suggest that clitoral reconstruction appear effective to improve clitoral pleasure/orgasm. Almost all studies assessed self-image, which appears improved. Only 2 studies provided data about pain and/or dyspareunia, which were improved by clitoral reconstruction. However, the risk of bias is high. Most patients were lost at follow-up, and validated instruments to assess outcomes were used only in a minority of studies.
Although clitoral reconstructive surgery for FGM/C appears safe and effective, caution is required to interpret available evidence due to significant limitations. Further studies are required to compare the proposed techniques and to confirm the effectiveness in terms of vulvar pain and/or dyspareunia, sexual activity and/or orgasm, and self-image improvement.
总结女性生殖器切割（FGM/C）后行阴蒂重建术的现有证据。
系统性文献回顾，以确定至少随访 6 个月的既往 FGM/C 后行阴蒂重建术的研究。文献检索在以下数据库中进行：PubMed、EMBASE、Web of Science 和 Cochrane 图书馆。考虑的时间范围是从数据库建立到 2020 年 6 月 30 日。
术后外阴疼痛或性交困难、性活动或性高潮的变化，以及对自我形象的影响。
我们确定了 8 项研究；其中 4 项使用了相同的“Foldès 技术”，4 项采用了类似的技术，即向下移动阴蒂残端，并对龟头和包皮进行不同的重建。术后并发症发生率为 5.3%。所有研究均调查了性功能这一单一结局，结果一致表明，阴蒂重建术可有效改善阴蒂快感/性高潮。几乎所有研究都评估了自我形象，结果表明自我形象有所改善。只有 2 项研究提供了关于疼痛和/或性交困难的数据，这些问题通过阴蒂重建术得到了改善。但是，存在很高的偏倚风险。大多数患者在随访时失访，只有少数研究使用了评估结局的有效工具。
尽管 FGM/C 后的阴蒂重建术看起来是安全有效的，但由于存在显著的局限性，需要谨慎解释现有证据。需要进一步的研究来比较所提出的技术，并确认在改善外阴疼痛和/或性交困难、性活动和/或性高潮以及自我形象方面的有效性。
