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Current Sexual Health Reports

, Volume 10, Issue 2, pp 44–49 | Cite as

Addressing FGM with Multidisciplinary Care. The Experience of the Belgian Reference Center CeMAViE

  • Martin Caillet
  • Sarah O’Neill
  • Anne-Frédérique Minsart
  • Fabienne Richard
Sociocultural Issues and Epidemiology (J Abdulcadir and C Johnson-Agbakwu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Sociocultural Issues and Epidemiology

Abstract

Purpose of Review

To describe the multidisciplinary approach of the Brussels-based referral center, one of the two centers for women living with female genital mutilation (FGM) in Belgium. This approach is contextualized and compared to the latest literature on the subject.

Recent Findings

According to the World Health Organization, women who have undergone FGM should be able to benefit from multidisciplinary care. Clitoral reconstructive surgery appears to be a crucial but controversial element of this holistic treatment; its long-term benefits and role in sexual satisfaction are still the focus of many questions.

Summary

Clitoral reconstructive surgery has been reimbursed by Belgian social security since 2014 only in conjunction with multidisciplinary care. In our referral center, the care is provided by a gynecologist, a midwife, a psychotherapist, and a sexologist. Five preoperative consultations are mandatory to obtain the refund. CeMaVie’s first line of treatments is non-surgical therapies.

Keywords

Female genital mutilation Gender-based violence Multidisciplinary care Clitoris reconstructive surgery Sexology Psychotherapy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as:• Of importance •• Of major importance

  1. 1.
    WHO. Eliminating female genital mutilation [Internet]. WHO. [cited 2017 Dec 1]. Available from: http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/
  2. 2.
    Unicef. UNICEF’S DATA WORK ON FGM/C [Internet]. Unicef; 2016 [cited 2018 Jan 14]. Available from: https://data.unicef.org/wp-content/uploads/2016/04/FGMC-2016-brochure_250.pdf
  3. 3.
    Russia orders inquiry into claims of FGM in Dagestan | Society | The Guardian [Internet]. [cited 2018 Jan 14]. Available from: https://www.theguardian.com/society/2016/nov/05/russia-orders-inquiry-into-claims-of-fgm-in-dagestan
  4. 4.
    Shell-Duncan B, Hernlund I. Female “circumcision” in Africa dimensions of the practice and debates. Vol. In Female ‘circumcision’ in Africa: culture, controversy, and change. London: Lynne Rienner Publishers; 2000.Google Scholar
  5. 5.
    Shell-Duncan B, Hernlund I. Transcultural Bodies: female genital cutting in global context. New Brunswick: Rutgers University Press; 2007.Google Scholar
  6. 6.
    Hosken F. Genital mutilation of women in Africa. Munger Afr Libr Notes. 1976;36:3–21.Google Scholar
  7. 7.
    O’Neill S. Defying the Law Negotiation Change: the Futanke’s opposition to the national ban on FGM in Senegal. Vol. Unpublished PhD Thesis. London: Goldsmiths, University of London; 2013.Google Scholar
  8. 8.
    Boddy J. Wombs and alien spirits: women, men, and the Zar cult in Northern Sudan [Internet]. University of Wisconsin Press; 1989 [cited 2018 Jan 12]. Available from: https://muse.jhu.edu/book/8761
  9. 9.
    Ahmadu F. Rites and wrongs: an insider/outsider reflects on power and excision. Vol. Female ‘circumcision’ in Africa: culture, controversy, and change. London: Lynne Rienner Publishers; 2000.Google Scholar
  10. 10.
    Ahmadu F, Ain’t I. A woman too? Challenging myths of sexual dysfunction in circumcised women. Vol. Transcultural bodies: female genital cutting in global context. New Brunswick: Rutgers University Press; 2007.Google Scholar
  11. 11.
    Kahn S. “You see, one day they cut”: the evolution, expression, and consequences of resistance for women who oppose female genital cutting. J Hum Behav Soc Environ. 2016 Nov 16;26(7–8):622–35.CrossRefGoogle Scholar
  12. 12.
    Koukoui S, Hassan G, Guzder J. The mothering experience of women with FGM/C raising ‘uncut’ daughters, in Ivory Coast and in Canada. Reprod Health. 2017 Apr 5;14:51.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    •• Berg RC, Underland V, Odgaard-Jensen J, Fretheim A, Vist GE. Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open. 2014;4(11):e006316. The meta-analysis we expected on the consequences of FGM. A work that confirms or invalidates some widely held beliefs, to be considered according to the limited data available. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    •• Abdulcadir J, Rodriguez MI, Say L. Research gaps in the care of women with female genital mutilation: an analysis. BJOG Int J Obstet Gynaecol. 2015;122(3):294–303. An in-depth summary of the issues that practitioners and researchers need to consider for the present and the future. CrossRefGoogle Scholar
  15. 15.
    Legros C. Pierre Foldes et Frédérique Martz, après des mutilations sexuelles réparer les corps et les âmes. Le Monde.fr [Internet]. 2017 Jul 8 [cited 2018 Jan 12]; Available from: http://www.lemonde.fr/festival/visuel/2017/07/08/apres-des-mutilations-sexuelles-reparer-les-corps-et-les-ames_5157723_4415198.html
  16. 16.
    WHO. Health complications of female genital mutilation including sequelae in childbirth [Internet]. WHO. [cited 2017 Dec 1]. Available from: http://www.who.int/reproductivehealth/publications/fgm/who_fch_wmh_00.2/en/
  17. 17.
    Dubourg D, Richard F. Etude de prévalence des femmes excisées et des filles à risque d’excision en Belgique. Brussels: SPF Santé Publique, Sécurité de la Chaîne alimentaire et Environnement; 2014.Google Scholar
  18. 18.
    Foldes P, Louis-Sylvestre C. Results of surgical clitoral repair after ritual excision: 453 cases. Gynecol Obstet Fertil. 2006;34(12):1137–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Foldès P, Cuzin B, Andro A. Reconstructive surgery after female genital mutilation: a prospective cohort study. Lancet Lond Engl. 2012;380(9837):134–41.CrossRefGoogle Scholar
  20. 20.
    • CMR O, Madzou S, Simporé A, Combaud V, Ouattara A, Millogo F, et al. Clitoral reconstruction after female genital mutilation at CHU Yalgado of Ouagadougou, Burkina Faso. About 68 patients operated. J Gynecol Obstet Biol Reprod (Paris). 2016;45(9):1099–106. The author proposes a new interesting technique CrossRefGoogle Scholar
  21. 21.
    Abdulcadir J, Bianchi Demicheli F, Willame A, Recordon N, Petignat P. Posttraumatic stress disorder relapse and clitoral reconstruction after female genital mutilation. Obstet Gynecol. 2017;129(2):371–6.CrossRefPubMedGoogle Scholar
  22. 22.
    •• Berg RC, Taraldsen S, Said MA, Sørbye IK, Vangen S. The effectiveness of surgical interventions for women with FGM/C: a systematic review. BJOG Int J Obstet Gynaecol. 2017; The most recent and comprehensive meta-analysis of FGM surgery.Google Scholar
  23. 23.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun 1;67(6):361–70.CrossRefPubMedGoogle Scholar
  24. 24.
    Mazer NA, Leiblum SR, Rosen RC. The brief index of sexual functioning for women (BISF-W): a new scoring algorithm and comparison of normative and surgically menopausal populations. Menopause N Y N. 2000;7(5):350–63.CrossRefGoogle Scholar
  25. 25.
    DeMaria AL, Hollub AV, Herbenick D. The Female Genital Self-Image Scale (FGSIS): validation among a sample of female college students. J Sex Med. 2012;9(3):708–18.CrossRefPubMedGoogle Scholar
  26. 26.
    Ouédraogo CMR, Madzou S, Touré B, Ouédraogo A, Ouédraogo S, Lankoandé J. Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases. Ann Chir Plast Esthet. 2013;58(3):208–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Abdulcadir J, Boulvain M, Petignat P. Reconstructive surgery for female genital mutilation. Lancet Lond Engl. 2012;380(9837):90–2.CrossRefGoogle Scholar
  28. 28.
    Puppo V. Embryology and anatomy of the vulva: the female orgasm and women’s sexual health. Eur J Obstet Gynecol Reprod Biol. 2011 Jan;154(1):3–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Abramowicz S, Oden S, Dietrich G, Marpeau L, Resch B. Anatomic, functional and identity results after clitoris transposition. J Gynecol Obstet Biol Reprod (Paris). 2016;45(8):963–71.CrossRefGoogle Scholar
  30. 30.
    Merckelbagh H-M, Nicolas M-N, Piketty M-P, J-L-B B. Assessment of a multidisciplinary care for 169 excised women with an initial reconstructive surgery project. Gynecol Obstet Fertil. 2015;43(10):633–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Martin Caillet
    • 1
  • Sarah O’Neill
    • 1
    • 2
  • Anne-Frédérique Minsart
    • 3
  • Fabienne Richard
    • 1
  1. 1.CeMAViE, Department of Obstetrics and GynecologySaint-Pierre University HospitalBrusselsBelgium
  2. 2.LAMC, Department of SociologyFree University of BrusselsBrusselsBelgium
  3. 3.Laboratory of Human Reproduction, Department of Obstetrics and GynecologyErasme HospitalBrusselsBelgium

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