Division of Plastic Surgery, Department of Surgery, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, South Tower, 14th Floor, Philadelphia, PA, 19104, USA.
Drexel University College of Medicine, Philadelphia, PA, USA.
Aesthetic Plast Surg. 2022 Feb;46(1):468-477. doi: 10.1007/s00266-021-02648-y. Epub 2021 Nov 2.
Female genital mutilation/cutting (FGM/C) is the intentional alteration, removal, or injury of female genitalia for non-medical reasons. Approximately 200 million females have been victims of FGM/C, and genital reconstructive procedures are increasing in demand.
The objectives of this study were to assess clinical and patient-reported outcomes after FGM/C reconstruction to help guide treatment practices.
Adult patients undergoing anatomic reconstruction after FGM/C were retrospectively identified. Outcomes included clitoral, labial, and donor site surgical site occurrences (SSO) and the need for revision operations. Patient-reported outcomes were assessed using an adapted version of the Female Sexual Function Index (FSFI), a validated outcomes instrument that assesses sexual function through 6 domains, with each domain having a maximum score of 6.
Nineteen patients were identified in our review. Patients presented for reconstruction due to dyspareunia, inability to orgasm, chronic infections, to normalize appearance, and/or to "feel normal." There were no SSOs and two revision operations for adhesions. 74% of patients completed the FSFI postoperatively. Despite most patients seeking repair for inability to orgasm and/or dyspareunia, the median scores for these domains were 4.6 and 5.2. Patients' desire to engage in sexual activity scored lowest (3.9), and patients reported concerns over the appearance of their genitalia (50%) that affected self-confidence (85.7%).
FGM/C reconstruction is safe and contributes to improvements in physical sexual health. Psychological trauma may contribute to lessened sexual desire and self-confidence even after reconstruction. Multidisciplinary treatment is important to address the long-term psychological effects of this practice.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
女性生殖器切割是指出于非医疗原因而对女性生殖器进行故意的改变、切除或伤害。大约有 2 亿女性遭受过女性生殖器切割，而且生殖器重建手术的需求正在增加。
本研究的目的是评估女性生殖器切割重建后的临床和患者报告结果，以帮助指导治疗实践。
回顾性地确定了接受女性生殖器切割后解剖重建的成年患者。结果包括阴蒂、阴唇和供体部位的手术部位发生（SSO）和需要进行修正手术。使用经过改编的女性性功能指数（FSFI）评估患者报告的结果，这是一种经过验证的评估性功能的工具，通过 6 个领域进行评估，每个领域的最高得分为 6 分。
在我们的综述中确定了 19 名患者。患者因性交疼痛、无法达到性高潮、慢性感染、使外观正常化和/或“感觉正常”而接受重建。没有 SSO 发生，有 2 例因粘连而进行了修正手术。74%的患者在手术后完成了 FSFI。尽管大多数患者因无法达到性高潮和/或性交疼痛而寻求修复，但这些领域的中位数评分为 4.6 和 5.2。患者对参与性活动的愿望得分最低（3.9），患者报告对生殖器外观的担忧（50%）影响了自信（85.7%）。
女性生殖器切割重建是安全的，并有助于改善身体的性健康。即使在重建后，心理创伤也可能导致性欲和自信降低。多学科治疗对于解决这种做法的长期心理影响很重要。
证据水平 IV：本杂志要求作者为每篇文章分配一个证据水平。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266。
