Defective sexuality and female circumcision: the cause and the possible management.

AIM: To verify the effect of circumcision on female sexuality and to define the need for clitorolabioplasty in these cases. METHODS: Thirty uncircumcised controls, 30 minorly circumcised, 30 minorly circumcised mutilated, and 57 circumcised cases having clitoral cysts were selected on random bases at Kasr El Aini School of Medicine. Sexuality was assessed by a special questionnaire sheet prepared by the authors to fit the circumcised cases. Clitorolabioplasty and clitoral cyst excision were also done in cases of sexual defects. RESULTS: Sexuality was not affected in minorly circumcised cases. However, sexuality was markedly affected in the mutilated cases. The scores for sex desire and arousal and for orgasm were especially affected in such cases. These defects were not detected in cases having clitoral cysts until late, when cysts enlarged. The role of clitorolabioplasty in restoration of sexuality was confirmed. The loss of certain clitoral and labial bulk, necessary for orienting the woman towards her genitalia and initiating her interest in their function, was responsible for the occurrence of such defects; this was able to be restored by surgery. CONCLUSION: Counseling parents about these sexual defects and asserting the need for correcting the mutilation, which resulted from these circumcisions, are effective steps in banning such procedures.

Role of new sono-imaging technique 'sonocolpography' in the diagnosis and treatment of the complete transverse vaginal septum and other allied conditions.

OBJECTIVE: To evaluate the value of a newly suggested ultrasonographic technique 'Sonocolpography' in diagnosing the complete transverse vaginal septum and other allied conditions and planning their treatment. SUBJECTS AND METHODS: Ten cases of complete vaginal septum, eight cases of atresia and four cases of vaginal aplasia seen at Kasr El Aini School of Medicine, Cairo University were selected for this study. Sonocolpography is done using a vaginal balloon and transabdominal ultrasonography. The efficacy of the latter is assessed in comparison to the conventional transabdominal technique. The different sonographic criteria in the conventional technique and in sonocolpography were determined for the studied cases. A cross-over test was also suggested for anticipating the needed surgery. This is done by pushing the balloon maximally inward and determining the ability of the echoes of the vaginal pouch to accommodate the balloon to stretch and to cross over the defect, in turn determining the needed surgery. RESULTS: Improved ultrasonographic images were successfully obtained for all cases studied. The diagnostic accuracy for these cases was 95.5% for septa, 86.4% for atresia and 90.9% for aplasia. The corresponding figures for the conventional techniques were 54.5, 68.2 and 77.2%, respectively. Sonocolpography was more sensitive and more specific for all cases studied compared to the conventional technique. Planning of the necessary surgery was successfully determined in 16 cases having positive cross-over tests, where excision and direct anastomosis were performed. Surgery planning was also successful in two cases having negative tests and four cases of invalid tests, where more extensive surgery was needed. CONCLUSION: Sonocolpography is a new achievement that is essential for imaging cases of the complete vaginal septum and other allied conditions, and also in planning the associated treatment.