Outcomes of clitoral reconstruction in women that experienced genital mutilation and/or genital cutting: 10 years of experience in the Netherlands

Background: The empowerment of women that migrated from Africa and the Middle East to the Netherlands increased the awareness and demand for clitoral reconstruction in women that experienced genital mutilation and/or genital cutting (FGM/C). Our aim was to investigate the outcomes of FGM/C-corrective surgeries conducted over a 10-year period. Methods: We recruited 72 patients with FGM/C from January 2010 to January 2021. All patients received counseling and underwent strict selection for surgery. Clitoroplasty was performed according to the Foldès technique. Patients were followed for a mean of 13 months. Surgery outcomes were evaluated with a questionnaire. Results: Of 72 women recruited, 19 (26%) were unsuitable for clitoral reconstructive surgery, due to comorbidities that required prior treatment (n = 5), unrealistic expectations about the surgery outcome (n = 12), a desire for information only about the procedure (n = 2), a choice to treat only a Bartholin cyst (n = 1), or previous surgery for FGM/C (n = 1). As of January 2021, 45 patients had undergone surgery and were included in the present study. After surgery, we performed primary clitoroplasty. Postoperatively, we observed four minor complications. Among all 45 patients, 35 (76%) reported satisfaction with the treatment and improvements in self-respect. Four woman reported disappointment in the aesthetic results, but they were satisfied with the surgery. Six women were lost to follow-up. Conclusions: After well-specified preoperative patient selection, clitoral reconstructive surgery led to a high patient satisfaction rate with minor surgical complications. Among patients that desire reconstruction, this surgery can be performed after careful counseling. Level of evidence: Level IV, Risk/Prognostic study.