A Novel Approach to Female Genital Mutilation Reconstruction with Fat Grafting and Adipose Stem Cell Therapies: A Minimally Invasive Solution with a Potential Impact on Millions of Women Worldwide.

BACKGROUND

FGM is an issue of increasing concern also in countries where it is not traditionally practiced. Vulvar scarring is the most common long-term effect associated with FGM, representing one of the main unmet issues in FGM women's health. Regenerative therapies based on the use of adipose-derived stem cells are considered the standard of care for ameliorating scarring and fibrosis. This study aimed to explore the potential of fat grafting in the treatment of post-FGM vulvar scars.

METHODS

Thirteen FGM survivors with vulvar scars underwent autologous fat grafting and were assessed using the Vulvar architecture severity scale (VASS), Female genital self-image scale (FGSIS), Female sexual function index (FSFI), and Hospital anxiety and depression scale (HADS).

RESULTS

At an average follow-up of 12.23 months (± 3.03), clinical results (VASS) showed a significant improvement in all vulvar aesthetic units treated with FG (p < 0.001). Patients reported improvements in genital-related self-image (FGSIS) (p = 0.001), sexual function (FSFI) (p = 0.019), and psychological well-being (HADS) (p = 0.002).

CONCLUSIONS

Fat grafting ameliorates FGM-related vulvar scars and improves volumetric contouring of vulvar aesthetic units, with a positive effect on women's quality of life. This minimally invasive intervention has far-reaching implications, providing a cost-effective solution accessible even in low-resource settings to potentially improve the overall well-being of millions of women living worldwide with a form of FGM. The results of this study warrant further testing in future clinical trials.

LEVEL OF EVIDENCE IV

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