A multidisciplinary approach to clitoral reconstruction after female genital mutilation: the crucial role of counselling

Abstract

Objectives: Female genital mutilation (FGM) is becoming more widely seen in the West, due to immigration and population movement. Health services are being confronted with the need to provide care for women with FGM. One of the more recent trends is the provision of clitoral reconstruction. It remains unclear, however, what constitutes good practice with regard to this type of surgery. Methods: Based on a keynote presentation about reconstructive clitoral surgery, we briefly discuss the possible consequences of FGM and the findings from recent publications on clitoral reconstruction. Recognising individual differences in women, we suggest a multidisciplinary counselling model to provide appropriate care for women requesting clitoral reconstruction. Results: The literature shows that FGM influences physical, mental and sexual health. Clitoral reconstructive surgery can lead to an increase in sexual satisfaction and orgasm in some, but not all, women. A multidisciplinary approach would enable a more satisfactory and individually tailored approach to care. The multidisciplinary team should consist of a midwife, a gynaecological surgeon, a psychologist-psychotherapist, a sexologist and a social worker. Comprehensive health counselling should be the common thread in this model of care. Our proposed care pathway starts with taking a thorough history, followed by medical, psychological and sexological consultations. Conclusions: Women with FGM requesting clitoral reconstruction might primarily be looking to improve their sexual life, to recover their identity and to reduce pain. Surgery may not always be the right answer. Thorough counselling that includes medical, psychological and sexual advice is therefore necessary as part of a multidisciplinary approach.

Chinese abstract

目的：随着移民与人口流动, 女性割礼（FGM）在西方国家越来越多见。被实行FGM的女性需要卫生系统为其提供帮助, 其中最新趋势之一是为这些女性进行阴蒂重建。方法：基于阴蒂重建手术的主题发言, 我们简明地讨论了FGM可能带来的影响及近期阴蒂重建的相关论著。鉴于女性的个体差异, 我们建议采用多学科的咨询模式, 为咨询阴蒂重建术的女性提供恰当的帮助。结果：文献表明, FGM可影响女性的身体、心理及性健康。阴蒂重建术可以改善部分女性的性满意与性高潮情况, 而非全部女性。多学科联合的方法可提供更加满意且个体适用的帮助。多学科团队应该包括一名陪护、妇科医生、心理医生、性医学家以及社会工作者。综合的健康咨询应该是这个帮助模式的共同点。我们提出的帮助方法首先是采集完整病史, 接下来进行医学、心理学和性科学的会诊。结论：请求阴蒂重建的FGM女性可能会首先希望改善她们的性生活, 以恢复自己的特征并减少疼痛。手术不一定总是最佳选择。深入的咨询应该包括医学、心理和性方面的建议, 是多学科方法必要的一部分。

Keywords:

• Clitoral reconstruction
• counselling
• female circumcision
• female genital cutting
• female genital mutilation
• migrant health
• multidisciplinary approach
• reconstructive surgery

Acknowledgements

This paper is based on the keynote lecture ‘Do all gynaecologists support the option of clitoral repair surgery after female genital mutilation? The viewpoint of a clinician’ by Mireille Merckx, presented at the 2014 conference of the International Centre for Reproductive Health, symposium ‘Optimizing care for women requesting clitoral repair surgery after female genital mutilation’ on 4 December 2014.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.