Psychosexual health after female genital mutilation/cutting and clitoral reconstruction

Since clitoral reconstruction (CR) after female genital mutilation/cutting (FGM/C) was first reported in Egypt by Thabet and in France by Pierre Fold’s in the early 2000s, multiple scholarly publications on CR have been published by urologists, gynaecologists and plastic surgeons. Most of these publications address surgical techniques, the need for multidisciplinary care accompanying the surgery as well as issues of safety, body image, sexual and pain outcomes. CR seems to reduce/resolve clitoral pain and to improve sexual function and body image at different rates. The reduction of pain may be explained by the removal of post-traumatic painful clitoral neuromas from the FGM/C scar. The improvement of the sexual function may be due to a more accessible clitoris and/or a better body image and gender identity after surgery. However, there is still very little understanding and evidence regarding CR and less invasive treatments (e.g. psychosexual therapy). Because of this, the Guidelines on Management of FGM/C of the Royal College of Obstetricians and Gynaecologists and of the World Health Organization do not recommend CR as a standard procedure. This chapter provides an overview of what is known about sexual health and CR after FGM/C. It suggests that further collaborations and research are needed to obtain more conclusive evidence and better understanding of the medical, psychosocial and cultural dimensions of CR, and then inform and treat women and girls more effectively.