Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Walterhöferstr. 11, 14165 Berlin, Germany.
Desert Flower Center, Center of Colorectal and Pelvic Floor Surgery, Hospital Waldfriede, Argentinische Allee 40, 14163 Berlin, Germany.
Int J Environ Res Public Health. 2023 Mar 2;20(5):4439. doi: 10.3390/ijerph20054439.
Reconstruction after female genital mutilation (FGM) has developed from being merely a therapy for complications to addressing body perception and sexuality. However, evidence regarding a direct correlation between FGM and sexual dysfunction is scarce. The present WHO classification provides an imprecise grading system, which makes it difficult to compare present studies with treatment outcomes. The aim of this study was to develop a new grading system based on a retrospective study of Type III FGM, evaluating operative time and postoperative results.
The extent of clitoral involvement, operative time of prepuce reconstruction and lack of prepuce reconstruction, and postoperative complications of 85 patients with FGM-Type III were retrospectively analyzed at the Desert Flower Center (Waldfriede Hospital, Berlin).
Even though universally graded by the WHO, large differences in the degree of damage were found after deinfibulation. In only 42% of patients, a partly resected clitoral glans was found after deinfibulation. There was no significant difference in operative time when comparing patients who required prepuce reconstruction and patients who did not ( = 0.1693). However, we found significantly longer operative time in patients who presented with a completely or partly resected clitoral glans when compared to patients with an intact clitoral glans underneath the infibulating scar ( < 0.0001). Two of the 34 patients (5.9%) who had a partly resected clitoris required revision surgery, while none of the patients in whom an intact clitoris was discovered under the infibulation required revision. However, these differences in the complication rates between patients with and without a partly resected clitoris were not statistically significant ( = 0.1571).
A significantly longer operative time was found in patients who presented with a completely or partly resected clitoral glans when compared with patients with an intact clitoral glans underneath the infibulating scar. Furthermore, we found a higher, though not significantly significant, complication rate in patients with a mutilated clitoral glans. In contrast to Type I and II mutilations, the presence of an intact or mutilated clitoral glans underneath the infibulation scar is not addressed in the present WHO classification. We have developed a more precise classification, which may serve as a useful tool when conducting and comparing research studies.
女性生殖器残割（FGM）的重建已经从单纯的并发症治疗发展到了关注身体感知和性问题。然而，FGM 与性功能障碍之间直接关联的证据却很少。目前的世界卫生组织（WHO）分类提供了一种不精确的分级系统，这使得很难将目前的研究与治疗结果进行比较。本研究旨在开发一种新的分级系统，该系统基于对 III 型 FGM 的回顾性研究，评估手术时间和术后结果。
在沙漠之花中心（柏林 Waldfriede 医院），对 85 例 III 型 FGM 患者的阴蒂受累程度、包皮重建手术时间、包皮未重建、以及术后并发症进行回顾性分析。
尽管普遍按照 WHO 分级，但在切开缝合术后，发现损伤程度存在很大差异。只有 42%的患者在切开缝合术后发现部分切除的阴蒂龟头。需要包皮重建的患者与不需要包皮重建的患者之间，手术时间没有显著差异（=0.1693）。然而，我们发现，与阴蒂龟头完整的患者相比，完全或部分切除阴蒂龟头的患者手术时间明显更长（<0.0001）。在 34 例部分切除阴蒂的患者中，有 2 例（5.9%）需要再次手术，而在切开缝合瘢痕下发现阴蒂龟头完整的患者中，无一例需要再次手术。然而，在部分切除阴蒂和完整阴蒂龟头的患者之间，并发症发生率的差异无统计学意义（=0.1571）。
与阴蒂龟头完整的患者相比，完全或部分切除阴蒂龟头的患者手术时间明显更长。此外，我们发现，阴蒂龟头残缺的患者并发症发生率更高，但无统计学意义。与 I 型和 II 型残割不同，目前的 WHO 分类并未涉及切开缝合瘢痕下阴蒂龟头完整或残缺的情况。我们已经开发了一种更精确的分类方法，可作为开展和比较研究的有用工具。
