Marly BAH

Service de Gynécologie-Obstétrique, Hôpital Lariboisière, France

Title: Postoperative Pain after Clitoral Reconstruction in Women with Female Genital Mutilation an evaluation of practices

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Biography

Marly BAH is a Gynecologist obstetrician specialized in benign surgery and care of FGM survivors. Practicing reconstructive surgery. She is also a member of ONG equipop and trainer of specialist on the FGM topic. She is also benign surgery and fertility care and surgery.

Abstract

More than 200 million women and girls have undergone genital mutilation. Clitoral reconstruction (CR) can improve the quality of life of some of them, but is accompanied by significant postoperative pain.

Objective: Assess and describe the management of postoperative pain after CR, and the practices among specialists in different countries. 

Methods: Between March and June 2020, 32 surgeons in 14 countries (Germany, Austria, Belgium, Burkina Faso, Canada, Ivory Coast, Egypt, Spain, United States of America, France, the Netherlands, Senegal, Switzerland, Sweden) responded to an online questionnaire on care and analgesic protocols for CR surgery. 

Results: At day 7 post CR, 97% of the surgeons observed pain among their patients, which persisted up to 1 month for half of them. 22% of the participants reported feeling powerless in the management of such pain. The analgesic treatments offered are mainly step II and anti-inflammatory drugs (61%). Screening for neuropathic pain is rare (3%), as is the use of pudendal nerve block, used by 8% of the care providers and only for a small percentage of women.

Conclusion: Pain after CR is frequent, long-lasting, and potentially an obstacle for the women who are willing to undergo clitoral surgery and also their surgeons. Most surgeons from different countries follow analgesic protocols that do not use the full available therapeutic possibilities. Early treatment of neuropathic pain, optimization of dosing of standard analgesics, addition of opioids, use of acupuncture, and routine intraoperative use of pudendal nerve block might improve the management of pain after CR.