Novel Clitoral Reconstruction and Coverage With Sensate Labial Flaps: Potential Remedy for Female Genital Mutilation

Background Clitoral reconstruction after female genital mutilation (FGM) could help alleviate complications caused by FGM, such as clitoral pain, reduced sensation, diminished sexual function, as well as improving aesthetics of the genitalia and restoring anatomy. Objectives Create sensate labial flaps to cover the neo-clitoris and assess its outcome. Methods Between December 2018 and July 2020, forty patients with FGM underwent clitoral reconstruction and coverage with sensate labial flaps donated by the remnant of the labia minora and were followed prospectively. Flaps were mapped on the less mutilated labia minora, based on recent description of arterial anatomy and innervation. Before the surgery, the patients’ clitoral sensation was assessed on a 6 point scale and they were also given the Female Sexual Functional Index (FSFI) to complete. Eight and twenty four weeks postoperatively, the same assessment was repeated and the data compared. Results The mean preoperative FSFI was 11.64 (range 2.8-25.6) and post-operatively was 29.14 (range 12.8-35.4), demonstrating a significant increase. Similarly, the Clitoral sensation increased from 2.35 (range 1-4) before the surgery to 4.9 (range 2-6) after the surgery, demonstrating a significant increase. In total, 95% of patients benefited from the surgery. Conclusions Clitoral reconstruction after FGM using sensate labial flaps resulted in significant improvement of sexual function, clitoral sensation, genital aesthetics and self-esteem.