Infibulation

Deinfibulation

Indication

Infibulation

Technique

Enhancement of clitoral remnants +/- vulvar reconstruction and small labia reconstruction + vulvar femifill

Procedure

90/180 minutes, spinal anesthesia, hospitalization

Postoperative Pain

Moderate if common painkillers are used.

Complications

Rare (infections, hematomas)

Recovery

 60/120 days

Asportazione di recidiva di ghiandola del Bartolini

Tecnica

asportazione e ricostruzione per piani

Procedura

40/90 minuti, anestesia locale + sedazione, day hospital

dolore

scarso se si utilizzano comuni antidolorifici

complicanze

rare (infezioni, ematomi)

recupero

 2/4 settimane

Femifill® vulvare di esito doloroso di asportazione di ghiandola del Bartolini

Tecnica chirurgica

prelievo di tessuto adiposo, trattamento opportuno del medesimo, impianto multistrato di preparati adiposi diversi + laser co2 vulvare

Procedura

60 /90 min, , anestesia locale + sedazione, day hospital

Complicanze

rare (infezioni, ematomi)

Dolore post operatorio

scarso se si utilizzano farmaci antidolorifici comuni

Recupero

2/4 settimane

Sollevamento del pube

Indicazione

pube molle

Tecnica chirurgica

puboplastica +/- addominoplastica Laser assistita

Procedura

60/180 min , sedazione o anestesia generale, day hospital o ricovero

Complicanze

rare (infezioni, ritardi di guarigione)

Dolore post operatorio

scarso se si utilizzano farmaci antidolorifici comuni

Recupero

4 settimane

The term “infibulation” has its etymological root in “fibula,” which means pin or clasp in Latin. It is a form of female genital mutilation that involves the excision of parts of the vulva. Three types of infibulation are classified based on the extent of organ demolition. In the first type, only the clitoris is excised; in the second type, the clitoris and small labia; and in the third type, the clitoris, small labia, and large labia. Following the demolition and mutilation, the vulva is stitched, leaving only a small opening for the passage of urine and menstrual blood. If the large labia are also removed, they are cauterized with a hot iron. The procedure is usually performed by an elder, imam, or local notable. This practice is still prevalent in certain regions of Africa, the Arabian Peninsula, and some parts of Asia. Its origin is believed to be rooted in ancient Egypt, hence the name “pharaonic infibulation” given to type 3 infibulation. WHO data indicates that in Egypt, even today, more than 80% of women have undergone some form of infibulation, and even more in Somalia. It is crucial to emphasize that this is a cultural tradition and not a religious one because infibulation is not mentioned in the Quran. Nevertheless, it is evident that this practice is found in predominantly Islamized countries. Infibulation is rarely practiced by Christians, with the exception of some Coptic groups in the Horn of Africa, Eritrea, and Ethiopia.

Why it is practiced

The purpose of infibulation is to maintain the impossibility of sexual intercourse until marriage and to not experience the pleasure derived from clitoral stimulation leading to orgasm. It is a tradition for both the groom and the wedding night to deinfibulate the vulva with a blade. Subsequent sexual relations often become painful and challenging. During childbirth, women are frequently subjected to re-stitching. Reinfibulation is a common practice in Lower Egypt, Sudan, and Somalia, even for widows and divorced women.

The problems

The relationships are consistently painful and challenging, with slowly healing scarred tissues that are often inelastic and sometimes ulcerated. Cystitis, vaginal infections, and urinary retentions are frequent. Complications significantly increase during childbirth because the inelastic vulvar tissue makes the descent of the baby difficult, and prolonged labor leads to hypoxia, a reduction in cerebral oxygenation. The mortality rate during childbirth is markedly higher in countries where this procedure is practiced.

The treatment

The treatment of infibulated patients aims to restore function and aesthetics. Functional restoration takes precedence, with the goal of making penetration no longer painful and satisfying, enabling natural childbirth, and at least partially recovering clitoral sensitivity. The most commonly adopted procedures involve the use of flaps, grafts, and adipose tissue implants (lipofilling) to provide new and healthy tissue. The implantation of cells derived from adipose tissue helps soften the hard and inelastic vulvar walls. Techniques have been developed for the recovery of the clitoral stump, involving the identification and careful dissection of portions of the unexcised clitoris that can be brought closer to the surface. The superficialization of the remaining clitoris often allows for the regaining of some denied sensitivity. Aesthetic aspects of the vulva are also important. The reconstruction of the clitoris, small labia using extraordinarily innovative techniques allows infibulated women to regain a nearly normal aesthetic.

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