1. Anatomical study of the clitoris and its implications on female genital mutilation and surgical repair
- Author
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Cécile Philandrianos, Valentin Massin, Baptiste Bertrand, Maxime Abellan-Lopez, Olivier Camuzard, Dominique Casanova, Anne-Sophie Perchenet, Arthur Klein, and Fanny Blayney
- Subjects
Clitoridectomy ,medicine.medical_specialty ,Clitoris ,030230 surgery ,Glans Clitoris ,Vulva ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,medicine ,Humans ,030219 obstetrics & reproductive medicine ,business.industry ,Suspensory ligament ,Plastic Surgery Procedures ,Neurovascular bundle ,Surgery ,Dissection ,medicine.anatomical_structure ,Dorsal artery of clitoris ,Circumcision, Female ,Female ,Dorsal nerve of clitoris ,business - Abstract
Summary Background Worldwide, 200 million girls and women have been subjected to female genital mutilation. To restore the clitoral function and vulvar anatomy, clitoral repair has been performed since the 2000s. Nevertheless, there is a lack of precise and comprehensive data on the clitoral anatomy during surgical repair. This study aimed to precisely describe the terminal anatomies of the dorsal nerve and artery of the clitoris, and the clitoral neurovascular flap advancement for reconstruction in patients with female genital mutilation. Methods This study was performed on seven fresh female cadavers. The site of origin, diameter, length, and trajectory of each nerve and artery were recorded. The clitoral neurovascular flap advancement was measured after a midline transection of the suspensory ligament was performed and after extensive liberation of the dorsal bundles at their emergence from the pubic rami. Results At the distal point of the clitoral body, the width of the dorsal nerve and artery was 1.9 ± 0.3 mm and 0.9 ± 0.2 mm, respectively. The total length of the dorsal bundles was 6.6 cm (± 0.4). The midpart of the suspensory ligament was sectioned, which allowed a mean anteroposterior mobility of 2.7 cm (± 0.2). Extensive dissection of the neurovascular bundles up to their point of emergence from the suspensory ligament allowed a mean mobility of 3.4 ± 0.2 cm. Conclusion We described the anatomical characteristics of the dorsal nerve and artery of the clitoris and the mobility of the clitoral neurovascular flap for reconstruction post clitoridectomy. This was done to restore the anatomic position of the glans clitoris while preserving and potentially restoring clitoral function in patients with female genital mutilation.
- Published
- 2021