Modern Surgical Procedures are a Milestone in the Therapy of Circumcised Girls and Women

When girls and women are circumcised, which violates human rights, the external female sex organs, i. e. the tip of the clitoris, the clitoral hood, and the inner and outer labia, are partially or completely removed. In addition, the vaginal entrance is incompletely closed. “From a medical perspective, we therefore speak of an amputation, which is usually carried out in childhood and adolescence without anesthesia and with non-sterile, non-medical cutting objects such as razor blades, broken glass or sharp-edged stones”, explains Dr. Dan mon O'Dey, a specialist in plastic, reconstructive and aesthetic surgery. He has specialized in the anatomical reconstruction of the external female genitalia. He contributed his expertise to the creation of the new unit “Circumcision forms and vulva reconstruction” for the THIEME Atlas of Anatomy. This content will be published soon on MedOne, the multimedia platform for e-learning and clinical medicine by Thieme.

The extremely painful procedure of circumcision is practiced for cultural reasons in many African countries in particular, but also in some Arab, Asian and South American countries. It immediately and subsequently causes numerous health impairments from which those affected suffer physically and emotionally for the rest of their lives. The removal of the tip of the clitoris severely impairs sexual sensation. During hormonal changes, such as menstruation, painful compressive stress occurs on the clitoral stump as well as in the area of the scar tissue caused by the amputation. There may also be pain during sexual intercourse or problems with urination. If the circumcision has significantly narrowed the vaginal opening, this also has negative effects on the birth process. In addition, there is psychological stress triggered by the traumatic experience of circumcision.

Modern surgical procedures enable the anatomical reconstruction of the genitals

Today, the affected women’s physical symptoms can be successfully alleviated by suitable surgical procedures. The therapies range from a reopening of the vaginal entrance, or defibulation, to complex plastic-reconstructive operations with which the anatomy of the external female genitalia can be restored. “In addition to defibulation, the comparatively simple salvage of the clitoral stump can also help to alleviate discomfort, but these procedures do not bring about an anatomical reconstruction with normalization of the genital form and function,” explains O'Dey, chief physician at the Luisenhospital in Aachen, Germany. The situation is different with reconstruction using the body's own tissue and neurotisation, in which the nerve endings of the clitoral organ are reintegrated into a newly formed clitoral tip via a microsurgical procedure. Women can thus regain their clitoral sensitivity as well as their corresponding sexual pleasure, even including the ability to orgasm.

Raising awareness is the key 

However, cultural and family constraints often make it difficult for the affected women to access medical help. Many also lack knowledge and information about their own symptoms. That is why educational work is so important – ideally in a variety of languages, so that women from all affected cultural groups can be reached. “But we also have to start with the education of young doctors,” explains O'Dey. “Medical students need to be made aware of the anatomy of the female genitalia and the issue of female circumcision, learn which anatomical structures are damaged in the process and know how those affected can be helped surgically.”

This is where the new content on the medical e-learning platform MedOne, based on the Thieme Atlas of Anatomy, comes in. Here the clitoris and its surrounding structures are presented with all the details necessary from a functional-anatomical point of view. Also included are vivid illustrations and background information on the different types of genital circumcision and their surgical treatment methods.

“In the interest of education, but also of overall societal awareness, it is indispensable that we have included the external female genital organs and this important topic with all its facets in the THIEME Atlas of Anatomy", explains Professor Dr. Dr. Michael Schünke, one of the editors of the Atlas. Learn more about why the representation of female genitalia has been neglected in the professional literature in the past: How PROMETHEUS arrived at the clitoris (thieme.de)

The new content will be available in the electronic version of the English-language edition soon.

Source:
Schünke M, Schulte E, Schumacher U,
THIEME Atlas of Anatomy
Illustrations by Voll M und Wesker K.
3rd Edition. Stuttgart: Thieme; 2021.
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