Sexual Anatomy and Function in Women With and Without Genital Mutilation
INTRODUCTION:
Female
genital mutilation (FGM), the partial or total removal of the external
genitalia for non-medical reasons, can affect female sexuality. However, only
few studies are available, and these have significant methodologic limitations.
AIM:
To
understand the impact of FGM on the anatomy of the clitoris and bulbs using
magnetic resonance imaging and on sexuality using psychometric instruments and
to study whether differences in anatomy after FGM correlate with differences in
sexual function, desire, and body image.
METHODS:
A
cross-sectional study on sexual function and sexual anatomy was performed in
women with and without FGM. Fifteen women with FGM involving cutting of the
clitoris and 15 uncut women as a control group matched by age and parity were
prospectively recruited. Participants underwent pelvic magnetic resonance
imaging with vaginal opacification by ultrasound gel and completed validated
questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire
d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function
(Female Sexual Function Index).
MAIN OUTCOME MEASURES:
Primary
outcomes were clitoral and bulbar measurements on magnetic resonance images.
Secondary outcomes were sexual function, desire, and body image scores.
RESULTS:
Women
with FGM did not have significantly decreased clitoral glans width and body
length but did have significantly smaller volume of the clitoris plus bulbs.
They scored significantly lower on sexual function and desire than women without
FGM. They did not score lower on Female Sexual Function Index sub-scores for
orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle
but did report significantly more dyspareunia. A larger total volume of
clitoris and bulbs did not correlate with higher Female Sexual Function Index
and Sexual Desire Inventory scores in women with FGM compared with uncut women
who had larger total volume that correlated with higher scores.
CONCLUSION:
Women
with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure.
Women with sexual dysfunction should be appropriately counseled and treated.
Below: Vulvar appearance of (A) a
woman without female genital mutilation (arrow = glans of clitoris) and
(B) a woman with female genital mutilation type IIb (arrow = palpable
clitoral stump hidden under the scar). Panel C shows a corresponding sagittal
proton density-weighted fat-saturated magnetic resonance image of the woman
without female genital mutilation. Depicted are the clitoral crus (white
arrowhead), bulb (black arrowhead), intact clitoral glans (short black arrow),
ultrasound gel in the distal vagina (black spherical mark), and symphysis pubis
(long black arrow). Panel D shows a T2-weighted magnetic resonance image of the
woman with female genital mutilation. The distal part of the clitoral body
(white arrows) is covered by the scar. The clitoris is not in direct contact
with the ultrasound gel in the distal vagina (black spherical mark). Also
depicted is the symphysis pubis (white arrowheads)
- 1Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: jasmine.abdulcadir@hcuge.ch.
- 2Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland; Division of Radiology, Department of Imaging, Geneva University Hospitals, Geneva, Switzerland.
- 3Faculty of Psychology and Educational Science, University of Geneva, Geneva, Switzerland.
- 4Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland.
- 5Division of Radiology, Department of Imaging, Geneva University Hospitals, Geneva, Switzerland.
- J Sex Med. 2016 Jan 27. pii: S1743-6095(15)00058-2. doi: 10.1016/j.jsxm.2015.12.023.
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