Obstetric Perineal Morbidity After Clitoral Re-exposure (CR) in Patients Who Have Undergone Genital Mutilation: A Retrospective Study

---

Résumé

<i>Background:</i> Female genital mutilation is a real public health problem in developing countries. the consequences of this practice are sometimes obstetric and are responsible for high maternal and perinatal mortality. <i>Objective:</i> To analyse the effect of clitoral re-exposure surgery in patients who have undergone female genital mutilation on obstetric perineal complications. <i>Material and methods:</i> This is a retrospective cohort study, exposed - unexposed, multi-centric, carried out in two university hospitals in Ouagadougou, Burkina Faso: Yalgado-Ouédraogo and Bogodogo. We studied the first delivery of patients operated on for CR (exposed) between March 2006 and March 2019 (over 13 years), compared with a group of unexposed women (victims of unreconstructed FGM). A ratio of two unexposed women to one exposed woman was used. The two groups were comparable according to the matching criteria. <i>Results:</i> We included 44 patients who had given birth after CR and 88 non-operated (unexposed) patients. Patients who had undergone FGM had more perineal lesions during childbirth than patients who had undergone CR. In fact, women not operated on for CR were 2 times more likely to suffer a perineal tear than women operated on for CR (RR = 1.93; 95% CI (1.22-3.07); p = 0.005). The same applies to episiotomy, for which women not operated on for CR were 2.62 times more likely to undergo than women operated on for CR (RR=2.62; 95% CI (1.60-4.28), p=0.000). <i>Conclusion:</i> Clitoral re-exposure is associated with better obstetric perineal adaptation.

Mots-clés

Medicine, Sex organ, Retrospective cohort study, Obstetrics, Clitoris, Gynecology, Surgery