Surgery is recommended for women with Type III FGC complications such as dysmenorrhea, a desired vaginal birth that would not be possible without surgery, apareunia, dyspareunia, or difficulty voiding. The defibulation should be preformed after counseling regarding risks and benefits, the former including bleeding infections, preterm labor if the woman is already pregnant, and scar formation. The benefits include lower risk of chronic urinary and vaginal infections, voiding difficulties, dysmenorrhea, dyspareunia, and intrapartum complications. Regional or general anesthesia is required, as local anesthesia may allow the sensation of touch to trigger ﬂashbacks to the original traumatic procedure. The surgical technique of defibulation was detailed and summarized (111).
It is apparent to people helping women who underwent FGC that culture plays a very important role in their sexual health. It is imperative that the specific needs of the individual woman with FGC are understood in order to help her. Care should be given in a nonjudgmental manner that encourages trust and open discussion. Her own cultural significance of the FGC should be explored and often an interpreter is necessary to really understand her situation.
Sexual assault of children and adult women has reached epidemic proportions in the United States and is the fastest growing, most frequently committed, and most underreported crime (112–114). Sexual assault is a crime of violence, conquest, control, and aggression, not passion, and encompasses a continuum of sexual activity that ranges from sexual coercion to contact abuse (unwanted kissing, touching, or fondling) to forcible rape. The terms sexual abuse survivor and assault survivor are preferable to victim.
In a survey of female family practice patients, 47% reported some type of contact sexual victimization during their lifetime; 25% reported attempted rape, and 13% had been forcibly raped, many as children (115). Among battered women, approximately 68% experience marital rape as an element of their repetitive abuse (116). Uninvited sexual attention in the workplace is reported by 50% of women in the United States (117). Spousal rape is reported infrequently because of fear of retribution and economic dependency (118). Obstetrician–gynecologists should routinely inquire about a history of childhood sexual abuse or adult sexual assault. These experiences are common and often have a lasting and profound effect on a woman’s mental and sexual function as well as her general health and well-being.