Sexual Function and Self-genital Image After Clitoral Restorative Surgery in Women Who Had Female Genital Mutilation in Kenya- a Cross-sectional Study

Abstract

Background: Clitoral restoration surgery also known as clitoroplasty, is a procedure aimed at re- exposing the clitoral remnant with or without defibulation to restore function for females who had undergone genital mutilation. While results have been promising, there is paucity of data from studies that have used a validated assessment tool to evaluate sexual function post reconstruction. There is increasing evidence that FGM/C damages sexual function and this would appear logical following damage of sexually sensitive organ such as the clitoris. Long- term sexual dysfunction due to FGM / C, including dyspareunia, decreased sexual desire and excitement, decreased lubrication, decreased orgasm and anorgasmia has been recorded. As a potential manner to enhance sexual function among female genital mutilation, clitoral restorative surgery was suggested. However, the procedure remains somewhat controversial because there have been no studies using validated outcome measures to document the efficacy and safety of the procedure. Objective: To assess sexual function and self-genital image after clitoral restorative surgery in women who had previously undergone female genital mutilation/cut. Methodology: A cross-sectional study of 96 women with FGM/C aged 18-45 years who underwent clitoral restoration surgery at Platinum surgery center, at least one year from the time of administering the questionnaire was carried out. Records were reviewed, phone contacts extracted, and patients invited for interviews. After provision of informed consent, data was collected using an interviewer administered questionnaire, the Female Sexual Function Index (FSFI) and female self-genital image (FGSIS) tool used to assess sexual function and genital image post-surgery. Data was extracted from tools, uploaded into a Statistical Package for Social Sciences version 21.0 spreadsheet, and the demographic factors including age, education level, and marital status summarized into frequencies and proportions. Sexual function and genital image were analyzed as proportions and their incidence by the demographic and medical characteristics of participants determined using the Chi-square test and Logistic regression. Odds ratios and the P value were interpreted as our measures of association at 95% confidence level. Results: The participants were age 20-55 years with mean age of 30.5 years. A majority had attained college education (68.0%), those married were 53.3%, and hailed from the Ameru ethnic group (22.9%). Christians and patients who had undergone stage II fgm/c were the majority at 81.3% and 55.8% respectively. Satisfaction with genital self-image was reported in 52.1% of.................................................................................