Clitoral reconstruction: challenges and new directions

Abstract

Clitoral reconstruction (CR) has been the subject of several studies in recent years, mainly in the medical field. Women with female genital mutilation or cutting (FGM/C) seek clitoral reconstructive surgery to improve their sexual well-being, but also because they are affected by poor self- and body image. CR is supposed to help women with FGM/C reconstruct their sense of self, but the benefits and risks of this surgery have not been sufficiently explored. There are currently no recommendations supporting CR from mainstream medical bodies, and there have been very few ethical studies of the procedure. This article critically discusses the principal studies produced in the medical field and available reflections produced in the social sciences. Through the theoretical frameworks of postcolonial and feminist studies, the article discusses sexuality and pleasure, gender and identity, and race and positionality, with the aim of promoting collaborative work on CR between researchers and social and health professionals.

“Damaged genitals”—Cut women's perceptions of the effect of female genital cutting on sexual function. A qualitative study from Sweden

“…Thus, new sexual scripts highlighting women's sexual pleasure may not be liberating for cut women, but may instead cause them to remain in the penetrative sexual script, as their FGC is less pronounced or noticed in such practices. Thus, we agree with Villani (2022) that future studies on FGC and sexual function need to include a broader spectrum of sexual practices than the heterosexual vaginal intercourse and the significance attributed to these practices.…”

“…Yet, an inability to enjoy sex was perceived to limit their partner's pleasure, which created shame and guilt. As the coital imperative is dominant within the heterosexual sexual script, with its implicit focus on child production (Levin, 2020;Mahar et al, 2020), penetrative sex is also often the focus in studies on the effects of FGC on sexual function (Obermeyer, 2005;Nour, 2006;Catania et al, 2007;Krause et al, 2011;Rouzi et al, 2017;Villani, 2022). However, due to criticism of the coital imperative, which has been shown to create an orgasm gap in heterosexual couples (Mahar et al, 2020;Andrejek et al, 2022), a new sexual script with increased focus on pleasure for both parties is likely to be on the rise.…”

“…In the present study, institutional recognition could be translated into the offering of clitoral reconstruction. Clitoral reconstruction, while growing in popularity, is still not available in most countries Villani, 2022). While there are currently no recommendations supporting clitoral reconstructive surgery from mainstream medical bodies such as the WHO and the RCOG in the UK (Royal College of Obstetricians and Gynaecologists, 2015;WHO, 2016;Villani, 2022), which could be related to a fear of exposing cut women to unnecessary surgical risks and pain (Bah et al, 2021), many women who have undergone clitoral reconstruction claim it has helped them gain a newfound ability to enjoy sex (including oral sex) or to now no longer feel "cut" and thus less ashamed and distressed in intimate relationships (author).…”

“…This rationale has raised concern regarding the potential negative effects of FGC, particularly clitorectomy, on female sexuality. While negative health consequences after FGC-including obstetric, psychological and sexual problems-are widely reported (Berg et al, 2010(Berg et al, , 2014Berg and Denison, 2012;Villani, 2022), studies investigating the effects of FGC on sexual function have inconsistent or contradictory findings. This is largely due to difficulties involved in measuring sexuality in finding an appropriate comparison group as well as the complex interplay between physical, psychological and sociocultural aspects of sexuality (Esho, 2012;Johnson-Agbakwu and Warren, 2017).…”

“…Thus, the FSFI is likely to be insufficient in investigating women's subjective perceptions and experiences of a potential connection between FGC and sexual function. Villani (2022) notes that questions of pleasure and desire are largely embedded in social expectations and norms, which should be considered when studying the sexual consequences of FGC. It has been argued that cut women's encounter with Western values-which tend to assign higher significance to women's sexual rights to desire and pleasure, and to the importance of the clitoris in securing these things -affects their perceptions of their own sexuality and its relation to FGC (Johnsdotter, 2013;Ziyada et al, 2020;O'Neill et al, 2021).…”