Clinical, Sexual and Psychopathological Changes after Clitoral Reconstruction in a Type II Female Genital Mutilation/Cutting: A Case Report

Gemma Mestre-Bach, Iris Tolosa-Sola, Pere Barri-Soldevila, María Jiménez-Bonora, Gracia Lasheras, Josep M. Farré


Female genital mutilation/cutting (FGM/C) is a health issue associated with serious negative psychological and health consequences. However, there is little literature on the impact of FGM/C on female sexuality, mental health and genital self-image after clitoral reconstructive surgery. Our aim was to assess sexual function, psychopathology and genital self-image in a type II FGM/C patient. The patient was assessed prior to FGM/C reconstructive surgery and at a 6-month follow-up. At follow-up, she reported an improvement in sexual function and a clear improvement of the psychopathological state. However, a worsening in genital self-image was also endorsed after the surgery. Our findings uphold that FGM/C reconstructive surgery can lessen psychopathological and sexual distress, although more research is needed in order to increase awareness of the potential benefits of genital reconstruction and to perfect the surgery procedures. These results have repercussions for health practitioners and psychologists alike in terms of developing prevention strategies and treatment protocols for FGM/C women. (Afr J Reprod Health 2019; 23[1]: 154-162).

Full Text:



World Health Organization. . WHO guidelines on the management of health complications from female genital mutilation (No. 9789241549646). World Health Organization. 2016

World Health Organization (WHO). Eliminating female genital mutilation: an interagency statement. (World Health Organization, 2008). 9/?sequence=3

Calder B L, Brown Y M and Rae D I. Female circumcision/genital mutilation: culturally sensitive care. Health Care Women Int. 1993; 14: 227–238.

Kaplan-Marcusán A, Moreno-Navaro J and Pérez-Jarauta M J. Mutilación Genital Femenina (MGF). Manual para profesionales .- Fuentes Documentales .-Bienestar y protección Infantil. (Universidad Autónoma de Barcelona, 2010).

Jiménez-Ruiz I, Almansa-Martínez P and Alcón-Belchí C. Dismantling the man-made myths upholding female genital mutilation. Health Care Women Int. 2017; 38: 478–491.

Berg R C, Underland V, Odgaard-Jensen J, Fretheim A and Vist G E. Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open 2014; 4: e006316.

Biglu M H, Farnam A, Abotalebi P, Biglu S and Ghavami M. Effect of female genital mutilation/cutting on sexual functions. Sex. Reprod. Healthc. 2016; 10: 3–8.

Vital M, de Visme S, Hanf M, Philippe H J, Winer N and Wylomanski S. Using the Female Sexual Function Index (FSFI) to evaluate sexual function in women with genital mutilation undergoing surgical reconstruction: a pilot prospective study. Eur. J. Clitorial reconstruction in FGM/C Obstet. Gynecol. Reprod. Biol. 2016; 202: 71–4.

Baron E M and Denmark F L. An exploration of female genital mutilation. in Annals of the New York Academy of Sciences 2006; 1087: 339–355.

Mazloomdoost D and Pauls R N. A Comprehensive Review of the Clitoris and Its Role in Female Sexual Function. Sex. Med. Rev. 2015; 3: 245–263.

Knipscheer J, Vloeberghs E, van der Kwaak A and van den Muijsenbergh M. Mental health problems associated with female genital mutilation. BJPsych Bull. 2015; 39: 273–7.

Vloeberghs E, van der Kwaak A, Knipscheer J and van den Muijsenbergh M. Coping and chronic psychosocial consequences of female genital mutilation in the Netherlands. Ethn. Health 2012; 17: 677–695.

Vissandjée B, Kantiébo M, Levine A and N‘Dejuru R

The cultural context of gender, identity: Female genital, excision and infibulation. Health Care Women Int. 2003; 24: 115–124.

Ogunsiji O. Female Genital Mutilation (FGM): Australian Midwives‘ Knowledge and Attitudes. Health Care Women Int. 2015; 36: 1179–1193.

Ortiz E T Female genital mutilation and public health: Lessons from British experience. Health Care for Women International 1998; 19: 119–129.

Tamaddon L, Johnsdotter S, Liljestrand J and Essén B.

Swedish health care providers‘ experience and knowledge of female genital cutting. Health Care Women Int. 2006; 27: 709–722.

Khadija K, Lay K and Boys S. Female circumcision: Toward an inclusive practice of care. Health Care Women Int. 2010; 31: 686–699.

Leye E, Powell R A, Nienhuis G, Claeys P and Temmerman M. Health care in Europe for women with genital mutilation. Health Care Women Int. 2006; 27: 362–378.

Berg R C, Taraldsen S, Said M A, Sørbye I K and Vangen S. Reasons for and Experiences With Surgical Interventions for Female Genital Mutilation/Cutting (FGM/C): A Systematic Review. J. Sex. Med. 2017; 14: 977–990.

De Schrijver L, Leye E and Merckx M. A multidisciplinary approach to clitoral reconstruction after female genital mutilation: the crucial role of counselling. Eur. J. Contracept. Reprod. Health Care 2016; 21: 269–75.

Abdulcadir J, Rodriguez M I and Say L. A systematic review of the evidence on clitoral reconstruction after female genital mutilation/cutting. Int. J. Gynecol. Obstet. 2015; 129: 93–97.

Shabila N P, Ahmed H M and Safar K. Knowledge, Attitude, and Experience of Health Professionals of

Female Genital Mutilation (FGM): A Qualitative Study in Iraqi Kurdistan Region. Heal. Care Women Int 2017; 38(11): 1202-18.. doi:10.1080/07399332.2017.1365867

Comunidad de Madrid. Guía de actuaciones sanitarias frente a la Mutilación Genital Femenina en la Comunidad de Madrid. Red de Prevención de la Mutilación Genital Femenina en la Comunidad de Madrid (2017).

Missailidis K and Gebre-Medhin M. Female genital mutilation in eastern Ethiopia. Lancet 2000; 356: 137–8.

Derogatis, L R. SCL-90-R. Cuestionario de 90 síntomas.

[SCL-90-R.90-Symptoms Questionnaire]. Baltimore, MD: Clinical P: 1994.

Derogatis, L SCL-90-R: cuestionario de 90 síntomas: manual. Madrid: TEA Editorial: 2002.

Rosen C, Brown J, Heiman S, Leiblum C, Meston R, Shabsigh D, Ferguson R, and D'Agostino R. The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function. J. Sex Marital Ther. 2000; 26: 191–208.

Blumel J E, Binfa L, Cataldo P, Carrasco A, Izaguirre H, and Sarrá S. Female sexual function index: a test to evaluate sexuality in women. Rev. Chil. Obstet. Ginecol. 2004; 69: 118–125.

DeRogatis L, Clayton A, Lewis-D‘Agostino D, Wunderlich G and Fu Y. Validation of the Female Sexual Distress Scale-Revised for Assessing Distress in Women with Hypoactive Sexual Desire Disorder. J. Sex. Med. 2008; 5: 357–64.

Herbenick D and Reece M. Outcomes assessment: Development and Validation of the Female Genital Self-Image Scale. J. Sex. Med. 2010; 7: 1822–30.

American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders 5 edition (DSM-5) 5. Washington, DC: American Psychiatric Association, 2013.

Behrendt A and Moritz S. Posttraumatic stress disorder and memory problems after female genital mutilation. Am. J. Psychiatry 2005; 162: 1000–2.

Abdulcadir J, Bianchi Demicheli F, Willame A, Recordon N and Petignat P. Posttraumatic Stress Disorder Relapse and Clitoral Reconstruction After Female Genital Mutilation. Obstet. Gynecol. 2017;


Goodman M P, Placik O J, Matlock D L, Simopoulos A F, Dalton T A, Veale D., and Hardwick-Smith S. Evaluation of Body Image and Sexual Satisfaction

in Women Undergoing Female Genital Plastic/Cosmetic Surgery. Aesthetic Surg. J. 2016;36:1048–57.


  • There are currently no refbacks.