Pelvi-périnéologie

, Volume 3, Issue 2, pp 146–151

Chirurgie plastique reconstructrice pour excision rituelle et mutilations sexuelles

Dossier Thématique / Thematic File
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Résumé

Les mutilations sexuelles rituelles, dont le traitement chirurgical a été bien étudié, sont source de complications urologiques, gynécologiques et obstétricales. Moins d’attention a été portée jusqu’à maintenant aux séquelles sexuelles. La technique de désinfibulation est rappelée. Nous proposons et analysons les résultats d’une technique de réparation chirurgicale du clitoris. La douleur préopératoire et le retentissement sexuel de la mutilation ont été évalués en cinq catégories. L’intervention consiste, après résection de la peau cicatricielle, à identifier le moignon clitoridien, puis à sectionner le ligament suspenseur de manière à mobiliser le moignon. Les tissues scléreux de l’extrémité du moignon sont ensuite réséqués et le néogland fixé en position physiologique. L’aspect esthétique et la fonction clitoridienne au sixième mois postopératoire sont évalués en cinq catégories. Quatre cent cinquante-trois patientes ont été complètement évaluées avec un recul d’au moins six mois. L’hospitalisation a duré 24 heures et l’intervention moins de 30 minutes. Il y a eu 58 complications mineures (désunions, hématomes, douleur). Quatre patientes ont signalé des douleurs persistantes à quatre mois. Un massif clitoridien nettement visible a pu être restauré dans 87 % des cas et une amélioration significative de la fonction sexuelle clitoridienne a été obtenue dans 75 % des cas. Discussion et conclusion: la technique décrite est facile et fiable. Au prix de complications minimes, elle donne d’excellents résultats anatomiques et fonctionnels.

Mots clés

Excision Mutilation sexuelle Clitoris Réparation 

Reconstructive plastic surgery for ritual excision and sexual mutilation

Abstract

Ritual excision is responsible for urological, gynaecological and obstetric complications, whose surgical treatment has been fully described. Sexual sequels deserve the same attention. A procedure to reverse infibulation is described. We describe and analyze the results of a surgical procedure for clitoral rehabilitation. The skin covering the stump is resected and the clitoris identified. The suspensor ligament is sectioned in order to mobilize the stump, the sclerous tissues are removed from the extremity and the neoglans brought to a normal position. Preoperative pain and clitoral impairment are assessed within five categories. The same was done with anatomical and functional postoperative results at six months. Four hundred and fifty-three patients have been completely evaluated. Length of hospitalisation was 24 hours and the procedure took under 30 minutes. Minor early complications were recorded in 58 patients (haematoma, disrupture of the suture, pain). Four patients reported persistent pain at four months. A visible clitoral mass could be restored in 87% of the cases and a real improvement in clitoral function was obtained in 75% of the patients. Conclusion: This surgical procedure is easy and reliable. It provides promising cosmetic and functional results with minor complications.

Keywords

Excision Sexual mutilation Clitoris Repair 

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Copyright information

© Springer Paris 2008

Authors and Affiliations

  1. 1.CHI de Saint-Germain-en-LayeSaint-Germain-en-LayeFrance

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