Reconstructive surgery after female genital mutilation: a prospective cohort study.

BACKGROUND: Women who have undergone female genital mutilation rarely have access to the reconstructive surgery that is now available. Our objective was to assess the immediate and long-term outcomes of this surgery. METHODS: Between 1998 and 2009, we included consecutive patients with female genital mutilation aged 18 years or older who had consulted a urologist at Poissy-St Germain Hospital, France. We used the WHO classification to prospectively include patients with type II or type III mutilation. The skin covering the stump was resected to reveal the clitoris. The suspensory ligament was then sectioned to mobilise the stump, the scar tissue was removed from the exposed portion and the glans was brought into a normal position. All patients answered a questionnaire at entry about their characteristics, expectations, and preoperative clitoris pleasure and pain, measured on a 5-point scale. Those patients who returned at 1 year for follow-up were questioned about clitoris pain and functionality. We compared data from the 1-year group with the total group of patients who had surgery. FINDINGS: We operated on 2938 women with a mean age of 29·2 (SD 7·77 years; age at excision 6·1, SD 3·5 years). Mali, Senegal, and Ivory Coast were the main countries of origin, but 564 patients had undergone female genital mutilation in France. The 1-year follow-up visit was attended by 866 patients (29%). Expectations before surgery were identity recovery for 2933 patients (99%), improved sex life for 2378 patients (81%), and pain reduction for 847 patients (29%). At 1-year follow-up, 363 women (42%) had a hoodless glans, 239 (28%) had a normal clitoris, 210 (24%) had a visible projection, 51 (6%) had a palpable projection, and three (0·4%) had no change. Most patients reported an improvement, or at least no worsening, in pain (821 of 840 patients) and clitoral pleasure (815 of 834 patients). At 1 year, 430 (51%) of 841 women experienced orgasms. Immediate complications after surgery (haematoma, suture failure, moderate fever) were noted in 155 (5%) of the 2938 patients, and 108 (4%) were briefly re-admitted to hospital. INTERPRETATION: Reconstructive surgery after female genital mutilation seems to be associated with reduced pain and restored pleasure. It needs to be made more readily available in developed countries by training surgeons. FUNDING: French Urological Association.

Coitus as revealed by ultrasound in one volunteer couple.

INTRODUCTION: The anatomy and function of the G-spot remain highly controversial. Ultrasound studies of the clitoral complex during intercourse have been conducted to gain insight into the role of the clitoris and its relation to vagina and urethra during arousal and penetration. AIM: Our task was to visualize the anterior vaginal wall and its relationship to the clitoris during intercourse. METHODS: The ultrasound was performed during coitus of a volunteer couple with the Voluson® General Electric® Sonography system (Zipf, Austria) and a 12-MHz flat probe. The woman was in a gynecologic position, and her companion penetrated her with his erected penis from a standing position. We performed a coronal section on the top of the vulva during the penetration. MAIN OUTCOME MEASURE: We focused on the size of the clitoral bodies before and after coitus. RESULTS: The coronal section demonstrated that the penis inflated the vagina and stretched the root of the clitoris that has consequently a very close relationship with the anterior vaginal wall. This could explain the pleasurable sensitivity of this anterior vaginal area called the G-spot. CONCLUSIONS: The clitoris and vagina must be seen as an anatomical and functional unit being activated by vaginal penetration during intercourse.

Who's afraid of the G-spot?

INTRODUCTION: No controversy can be more controversial than that regarding the existence of the G-spot, an anatomical and physiological entity for women and many scientists, yet a gynecological UFO for others. METHODS: The pros and cons data have been carefully reviewed by six scientists with different opinions on the G-spot. This controversy roughly follows the Journal of Sexual Medicine Debate held during the International Society for the Study of Women's Sexual Health Congress in Florence in the February of 2009. MAIN OUTCOME MEASURE: To give to The Journal of Sexual Medicine's reader enough data to form her/his own opinion on an important topic of female sexuality. RESULTS: Expert #1, who is JSM's Controversy section editor, reviewed histological data from the literature demonstrating the existence of discrete anatomical structures within the vaginal wall composing the G-spot. He also found that this region is not a constant, but can be highly variable from woman to woman. These data are supported by the findings discussed by Expert #2, dealing with the history of the G-spot and by the fascinating experimental evidences presented by Experts #4 and #5, showing the dynamic changes in the G-spot during digital and penile stimulation. Experts #3 and #6 argue critically against the G-spot discussing the contrasting findings so far produced on the topic. CONCLUSION: Although a huge amount of data (not always of good quality) have been accumulated in the last 60 years, we still need more research on one of the most challenging aspects of female sexuality.

The clitoral complex: a dynamic sonographic study.

INTRODUCTION: The existence of the G-spot remains controversial partly because no appropriate structure and innervation have been clearly demonstrated in this pleasurable vaginal area. Using sonography, we wanted to visualize the movements of the clitoris and its anatomical relationship with the anterior wall of the vagina during voluntary perineal contraction and vaginal penetration without sexual stimulation. AIM: The aim of this presentation is to provide a dynamic sonographic study of the clitoris and to describe the movements of the quiescent clitoral complex during a voluntary perineal contraction. We aim to visualize the mechanical consequences of the pressure of the anterior vaginal wall with women who claim to have a special sensitivity of the G-spot area and vaginal orgasm. Histology and immunohistochemistry of the G-spot and other female genital tissues are beyond the scope of this study and have not been discussed. METHOD: The ultrasounds were performed in five healthy volunteers with the Voluson General Electric Sonography system (GE Healthcare, Zipf, Austria), with a 12-MHz flat probe, and with a vaginal probe. We used functional sonography of the quiescent clitoris with voluntary perineal contractions and with finger penetration without sexual stimulation. MAIN OUTCOME MEASURES: We focused on the size of the clitoris (raphe, glans, and clitoral bodies) and of the length of the movements of the clitoris during voluntary perineal contractions. RESULTS: The coronal planes during perineal contraction and finger penetration demonstrated a close relationship between the root of the clitoris and the anterior vaginal wall. CONCLUSIONS: We suggest that the special sensitivity of the lower anterior vaginal wall could be explained by pressure and movement of clitoris' root during a vaginal penetration and subsequent perineal contraction. The G-spot could be explained by the richly innervated clitoris.

Sonography of the clitoris.

INTRODUCTION: The prevalence of invasive procedures in diagnosing female sexual dysfunctions and pathologies is high. There is a need for a less invasive evaluation tool and medical imaging of the clitoris may be a solution. The clitoris has already been studied with nuclear magnetic resonance but there are very few sonographic 2D and 3D studies despite the fact that it is a simple, noninvasive, and inexpensive method. AIM: This study aims at determining the feasibility of using ultrasound (US) techniques to image the clitoris in sufficient detail to permit evaluation of anatomy for possible use in study. METHODS: The ultrasounds were performed in five healthy volunteers with the Voluson GE Sonography system (GE Healthcare Ultrasound, Zipf, Austria), using one 12-MHz flat probe. MAIN OUTCOME MEASURES: The clitoral body's diameter, the length of the raphe. RESULTS: The three planes-the cross-section, sagittal section, and coronal section-were revealed making it possible to study the entire organ. CONCLUSION: The sonography is a simple, inexpensive, noninvasive mean which might help for the evaluation of this organ.

[Reconstructive plastic surgery of the clitoris after sexual mutilation]. / Chirurgie plastique reconstructrice du clitoris après mutilation sexuelle.

This article describes a clitoris reconstruction technique after ritual excision. After resection of the scar, the angle and the body of the clitoris are then released by preserving the innervation. A clitoral glans is reconstituted by wedge plasty, then reimplanted in an anatomical position. This technique is designed to restore normal anatomy and obtain a normally innervated and whenever possible functional organ.