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)

Full article at:   http://goo.gl/f4D99t

By:  Abdulcadir J1, Botsikas D2, Bolmont M3, Bilancioni A4, Djema DA5, Bianchi Demicheli F4, Yaron M4, Petignat P4.

• 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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A Prospective Evaluation of Female External Genitalia Sensitivity to Pressure following Labia Minora Reduction and Clitoral Hood Reduction

Little research has been conducted into the effects of labiaplasty on sensitivity of external genitalia. This study aimed to determine the effect of labia minora and clitoral hood reduction using the edge resection technique on external genitalia sensitivity.

Female subjects electing to undergo labia minora and clitoral hood reduction were enrolled. Subjects underwent sensitivity testing using monofilaments at five locations (one at the clitoral hood and four labial with each labium measured 0.5 cm from the leading edge and 1.5 cm distal to the hymen) at baseline; 2 weeks; and 3, 6, and 12 months postoperatively. Self-evaluations using the Sexual Function Questionnaire were performed at baseline and 3, 6, and 12 months postoperatively.

Thirty-seven subjects undergoing labia minora and clitoral hood reduction were enrolled. Subjects experienced a median increase in sensitivity at month 6 of 0.118 mN at the 0.5-cm right labial location (p = 0.027) and 0.059 mN at the 0.5-cm left labial location (p = 0.046) compared with baseline. No change in sensitivity was demonstrated at the clitoral hood or either of the 1.5-cm labial locations. At 6 months, an increase in the number of sexual relations was observed in 44.1 percent of subjects (p = 0.011), an improvement in orgasm frequency was exhibited by 35.3 percent of subjects (p = 0.013), and an increase in orgasm strength was observed in 35.3 percent of subjects (p = 0.006).

Labia minora and clitoral hood reduction as performed by the trim/edge resection method does not result in diminished sensitivity.

Via:  http://ht.ly/SHZyv Purchase full article at: http://goo.gl/FLiUhm

By: Placik OJ1, Arkins JP.

• 1Chicago and Arlington Heights, Ill. From Northwestern University Feinberg School of Medicine; and Associated Plastic Surgeons, S.C.

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