Female genital mutilation/cutting and orgasm before and after surgical repair

Introduction. - Female genital mutilation/cutting (FGM/C) is often performed to decrease women's sexual pleasure. Removal of the external clitoris may particularly impair pleasure and orgasmic functioning. Aims and methods. - This review evaluates the literature on: the orgasmic functioning of women with FGM/C whose clitorises have and have not been excised and; the effect of surgical repair on orgasm. A PubMed search was performed to identify all published studies of FGM/C that included an assessment of orgasm. Results. - White three of the seven FGM/C studies that included a control group found decreased orgasmic functioning in affected women, no study fully controlled for demographic differences between groups or separated the FGM/C group by clitoral integrity. The impact of FGM/C on orgasm therefore remains unknown; however, indirect evidence suggests that orgasm rates would be reduced in women who cannot engage in direct stimulation of the external clitoris. Surgical defibutation releases the infibulation scar and appears to improve global sexual functioning but not orgasm. Clitoral reconstructive surgery, which creates a new external clitoris, restores a more normal genital appearance, resolves pain at the excision site, and increases clitoral pleasure. One large study found that it enabled clitoral orgasm in approximately 40% of patients. Since rates of orgasm from all forms of stimulation (e.g., vaginal) were not assessed, it is unclear for how many women an external clitoris is necessary for orgasm. Conclusions. - Future studies on FGM/C and orgasm should address the methodological limitations of previous research. Although clitoral reconstruction allows many women with FGM/C to become clitorally orgasmic, it does not guarantee orgasm. Women should be offered psychotherapy to improve their sexual or orgasmic functioning regardless of their genital integrity. (C) 2011 Elsevier Masson SAS. All rights reserved.