Journal of Gynecology and Obstetrics

Submit a Manuscript

Publishing with us to make your research visible to the widest possible audience.

Propose a Special Issue

Building a community of authors and readers to discuss the latest research and develop new ideas.

Research Article |

Obstetric Perineal Morbidity After Clitoral Re-exposure (CR) in Patients Who Have Undergone Genital Mutilation: A Retrospective Study

Background: Female genital mutilation is a real public health problem in developing countries. the consequences of this practice are sometimes obstetric and are responsible for high maternal and perinatal mortality. Objective: To analyse the effect of clitoral re-exposure surgery in patients who have undergone female genital mutilation on obstetric perineal complications. Material and methods: This is a retrospective cohort study, exposed - unexposed, multi-centric, carried out in two university hospitals in Ouagadougou, Burkina Faso: Yalgado-Ouédraogo and Bogodogo. We studied the first delivery of patients operated on for CR (exposed) between March 2006 and March 2019 (over 13 years), compared with a group of unexposed women (victims of unreconstructed FGM). A ratio of two unexposed women to one exposed woman was used. The two groups were comparable according to the matching criteria. Results: We included 44 patients who had given birth after CR and 88 non-operated (unexposed) patients. Patients who had undergone FGM had more perineal lesions during childbirth than patients who had undergone CR. In fact, women not operated on for CR were 2 times more likely to suffer a perineal tear than women operated on for CR (RR = 1.93; 95% CI (1.22-3.07); p = 0.005). The same applies to episiotomy, for which women not operated on for CR were 2.62 times more likely to undergo than women operated on for CR (RR=2.62; 95% CI (1.60-4.28), p=0.000). Conclusion: Clitoral re-exposure is associated with better obstetric perineal adaptation.

Clitoral Re-exposure, Perineal Morbidity, CHU-YO, CHU-B, Burkina Faso

APA Style

Adama, O., Laetitia, B., Yobi Alexi, S., Sibraogo, K., Issa, O., et al. (2023). Obstetric Perineal Morbidity After Clitoral Re-exposure (CR) in Patients Who Have Undergone Genital Mutilation: A Retrospective Study. Journal of Gynecology and Obstetrics, 11(6), 168-173. https://doi.org/10.11648/j.jgo.20231106.18

ACS Style

Adama, O.; Laetitia, B.; Yobi Alexi, S.; Sibraogo, K.; Issa, O., et al. Obstetric Perineal Morbidity After Clitoral Re-exposure (CR) in Patients Who Have Undergone Genital Mutilation: A Retrospective Study. J. Gynecol. Obstet. 2023, 11(6), 168-173. doi: 10.11648/j.jgo.20231106.18

AMA Style

Adama O, Laetitia B, Yobi Alexi S, Sibraogo K, Issa O, et al. Obstetric Perineal Morbidity After Clitoral Re-exposure (CR) in Patients Who Have Undergone Genital Mutilation: A Retrospective Study. J Gynecol Obstet. 2023;11(6):168-173. doi: 10.11648/j.jgo.20231106.18

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. WHO. World Health Organization. [Internet]. 2018 [cité 11 juill 2019]. Available on: Https://www.who.int/fr/news-room/fact-sheets/detail/female-genital-mutilation.
2. Boulou PN. The fight against female circumcision in Burkina Faso: the experience of Radio Vénégré's integrated communication plan. Master's degree in information and communication sciences. Option: Communication for development. Université de Ouagadougou 1 Professeur Joseph Ki-Zerbo. 2007; 94p.
3. Ouedraogo CMR, Madzou S, Touré B, Ouédraogo A, Ouédraogo S, Lankoandé J. Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases. Ann Chir Plast Esthet. Juin 2013; 58(3): 208-15.
4. Ndiaye P, Diongue M, Faye A, Ouédraogo A, et al. Female genital mutilation and complication in childbirth in the province of Gourma (Burkina Faso). Santé publique. Sept-Oct 2010; 22(5): 563-70.
5. WHO. Female genital mutilation. Fact sheet. [Internet]. 2017 [cited june 2019]. Disponiblesur: https://www.who.int/mediacentre/factsheets/fs241/en/.
6. Thubert T, Cardaillac C, Fritel X, Winer N, Dochez V. Definitions, epidemiology and risk factors for 3rd and 4th degree perineal lesions. CPR Perineal prevention and protection in obstetrics CNGOF. Gynécol Obstét Fertil Sénol. dec 2018; 46(12): 913-21..
7. Siddig I. Female genital mutilation: what do we know so far? Br J Nurs. 2016; 25(16). 912-916.
8. Millogo-Traore F, Kaba STA, Thieba B, Akotionga M, Lankoande J. Maternal and fetal prognosis during childbirth in circumcised women. J Gynecol Obstet Biol Reprod. Juin 2007; 36(4): 393-8.
9. Thera T, Kouma A, Toure M, Coulibaly A, Sima M, Ongoiba I, et coll. Obstetric complications of genital mutilation in rural Mali. J Gynecol Obstet Biol Reprod. March 22, 2015; 44(3): 276-9.
10. Meirik EO, Farley T, Akande O, Bathija H, et al. WHO study group on female genital mutilation and obstetric outcome, Banks. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet (London, England). 2006; 367(9525): 1835-41.
11. Jerlström A, Johansson M. Kenyan midwives experiences of female genital mutilation and of caring for genitally mutilated women in connection with childbirth [Internet]. [Sweden (Suède)]: Örebro universitet, Institutionen för hälsovetenskap och medicin Omvårdnad; 2015 [cité 20 juill 2020]. Disponible sur: diva-portal.org.
12. Hamid A, Grace KT, Warren N. A Meta-Synthesis of the Birth Experiences of African Immigrant Women Affected by Female Genital Cutting. J Midwifery Womens Health. 2018; 63(2): 185–95.
13. Rodriguez MI, Say L, Abdulcadir J, Hindin MJ. Clinical indications for cesarean delivery among women living with female genital mutilation. Int J Gynaecol Obstet. 1 oct 2017; 139(1): 21-7.
14. Rodriguez MI, Seuc A, Say L, Hindin MJ. Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis. Reprod Health. Déc 2016; 13(1): 131-38.
15. Teufel K, Dörfler DM. Female genital circumcision/mutilation: implications for female urogynaecological health. Int Urogynecology J. 2013; 24(12): 2021–27.
16. Eloranta V, Friedmann C, Parvi E. Immigrant Women’s Experience of Childbirth and Implications for Midwifery Practice: A Literature Review. [Finlande]: Helsinki Metropolia University of Applied Science. 2016; 46p.
17. Abdulcadir J, Dugerdil A, Yaron M, Irion O. Obstetric care of women with female genital mutilation attending a specialized clinic in a tertiary center. Int J Gynecol Obstet. 2015; 132(2): 174-8.
18. Khaled MA. Effects of female genital mutilation on childbirth [Internet]. [Arabie Saoudite-Egypte-Soudan]: University of South Wales (United Kingdom); 2017 [cité 20 juill 2020]. Disponible sur: search.proquest.com.
19. Nyarango M. Fluid identities: contextualising genital reconstructive surgery after female circumcision in Burkina Faso: a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Anthropology at Massey University, Auckland, New Zealand. [PhD Thesis]. Massey University. 2016; 354p.
20. Yount KM, Carrera JS. Female genital cutting and reproductive experience in Minya, Egypt. Med Anthropol Q. 2006; 20(2): 182–211.
21. Edeh AJ, Anekpo CC, Olu EA. Female Circumcision Complicated by Vulva Adhesion and Emergency Cesarean Delivery: A Case Report. Clin Case Rep Open Access. 2019; 2(3): 132-38.
22. Buggio L, Facchin F, Chiappa L, Barbara G, Brambilla M, Vercellini P. Psychosexual Consequences of Female Genital Mutilation and the Impact of Reconstructive Surgery: A Narrative Review. Health Equity. 1 févr 2019; 3(1): 36-46.
23. Johnson-Agbakwu CE, Helm T, Killawi A, Padela AI. Perceptions of obstetrical interventions and female genital cutting: insights of men in a Somali refugee community. Ethn Health. 2014; 19(4): 440–57.
24. Gebremicheal K, Alemseged F, Ewunetu H, Tolossa D, Ma’alin A, Yewondwessen M, et al. Sequela of female genital mutilation on birth outcomes in Jijiga town, Ethiopian Somali region: a prospective cohort study. BMC Pregnancy Childbirth. 2018; 18(1): 305-15.
25. Abdulcadir J, Rodriguez M, Say L. Research gaps in the care of women with female genital mutilation: an analysis. BJOG Int J Obstet Gynaecol. 1 févr 2015; 122(3): 294-303.
26. Abramowicz S, Oden S, Dietrich G, Marpeau L, Resch B. Evaluation of anatomical, functional and identity-related results after clitoral transposition in 30 patients. J Gynécol Obstet Biol Reprod. 18 oct 2016; 45(8): 963-71.
27. Millogo-Traoré F, Akotionga M, Lankoande J. Complications of infibulation: about three vaginal plasties in Kossodo (Burkina Faso). Bull Society Pathol Exot. Nov 2002; 95(4): 250-2.
28. Ouedraogo CMR, Madzou S, et coll. Clitoral reconstruction after female genital mutilation at the Yalgado University Hospital in Ouagadougou, Burkina Faso. About 68 patients operateds. J Gynecol Obstet Biol Reprod. 2016; 45(9): 1099-1106.
29. Foldes P, Morel C. Reconstructive surgery for female genital mutilation. EMC - Tech Chir - Gynecology. Oct 2015; 10(1): 1-8.
30. Foldes P, Cuzin B, Andro A. Reconstructive surgery after female genital mutilation: a prospective cohort study. Lancet Lond Engl. 14 juill 2012; 380(9837): 134-41.
31. Abdulcadir J, Bianchi Demicheli F, Willame A, Recordon N, Petignat P. Posttraumatic Stress Disorder Relapse and Clitoral Reconstruction After Female Genital Mutilation. Obstet Gynecol. 2017; 129(2): 371-6.
32. Iweulmor J, Scholar M, Veney C. Preserving a Woman’s Genitalia: An Analysis of Female Circumcision/Female Genital Mutilation in Africa. Penn State McNair J. 2006; 27(12): 27–52.
33. Diouf AA, Diallo M, et al. Surgical Treatment of Complication of Female Genital Mutilation in Pikine Hospital, Senegal. African journal of reproductive health. Mars 2017; 21(1): 122-25.
34. Chang CS, Low DW, Percec I. Female Genital Mutilation Reconstruction: A Preliminary Report. Aesthet Surg J. 1 sept 2017; 37(8): 942-6.
35. Coulibaly M. Clitoral reconstruction after female genital mutilation about 77 cases, at the Yalgado Ouedraogo University Hospital Center from March 06 to September 15, 2017. [Thesis in gynecology diploma]. Ouagadougou: University of Ouagadougou 1 Professor Joseph Ki-Zerbo. 2017; 81p.
36. Chevrot A, Lousquy R, Arfi A, Haddad B, Paniel BJ, Touboul C. [Operative technique: The clitoral transposition]. J Gynécol Obstét Biol Reprod. Oct 2015; 44(8): 787-91.
37. Bakyono A. Re-exposure of the clitoris after female genital mutilation: anatomical findings and assessment of sexual satisfaction in recipients.. [Thesis in gynecology diploma.]. [Ouagadougou (Burkina Faso)]: University Joseph Ki Zerbo of Ouagadougou. 2019; 99p.
38. Madzou S, Reau-giusti C, Soazig H, H Zhu K, Ouedraogo CMR. Effects of clitoral reconstruction for female genital mutilation on perinatal outcomes: a retrospective case-control study. Elsevier Masson SAS. 17 oct 2020; 2020 Oct 17; 101954. doi: 10.1016/j.jogoh.2020.101954. Online ahead of print. (PMID: 33080401).
39. Foldes P, Louis-Sylvestre C. Results of surgical repair of the clitoris after genital mutilation: 453 cases. Gynécol Obstet Fertil Sénol. 2006; 34(12): 1137-41.
40. Merckelbagh HM, Nicolas MN, Piketty MP, Benifla JL. Assessment of a multidisciplinary care for 169 excised women with an initial reconstructive surgery project. Gynecol Obstet Fertil Senol. oct 2015; 43 (10): 633-9.
41. Abdulcadir J, et al. Clitoral reconstruction after female genital mutilation/cutting: case studies. J Sex Med. 2015; 12(1): 274-81.
42. Catania L. Female genital mutilation: current situation and obstetrical outcomes in maternity units in the Rouen region. [Thesis in medecine]. Nantes Institutes of surgery in gynecology, 2016; 147136385: 32p.
43. Jacquetin B, Dreyfus M, Gaffinet F, Teurnier F and al. Recommendations for clinical practice: episiotomy. CNGOF. 2005; 18p.
44. Essen B, Bodker B, Sjoberg N-O, Gudmundsson S, et al. Is there an association between female circumcision and perinatal death? Bull World Health Organ. 2002; 80(8): 629-32.
45. Madzou S. econstructive plastic surgery of the clitoris after FGM Annals Of Plastic And Aesthetic Surgery.. 2011; 56 (01): 59-64.