reconstructive surgery for fgm victims: a critical initiative against

Reconstructive Surgery for FGM Victims: A Critical Initiative against FGM in Sudan :

Reconstructive Surgery for FGM Victims: A Critical Initiative against FGM in Sudan Dr. Atif B. FAZARI, MBBS .MD.FOG. MPH.MTH * Dr. Khalifa ELMUSHARAF ,MBBS .PG Dip .PhD researcher. Prof. Abdelsalam GERAIC ,MBBS. MD. FRCOG Dr. Vanja BERGGREN , PHD 4/23/2011 1 atiffazari@hotmail.co.uk UMST- Sudan

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INTRODUCTION:

INTRODUCTION Female genital mutilation (FGM) constitutes all procedures that might involve partial or complete removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or any other non-therapeutic reasons 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 3

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Sudan is one of the countries where FGM is highly prevalent; also in its most sever forms. Finding from the 2006 Sudan Household Survey (SHHS) indicate the average FGM prevalence rate in Sudan was 69.4 per cent, 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 4

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Few data are available with which to assess the operation of reconstructive surgery of mutilated external genital organs, a procedure that aim to restore some of the mutilated genital anatomy 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 5

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While it is recommended to do defibulation for the women with type III female genital mutilation during childbirth , in some cultures, where FGM is the accepted norm, a woman is reinfibulated (re-stitched) following childbirth as a matter of routine. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 6

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What shall we do? 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 14

OBJECTIVES: :

OBJECTIVES: The purpose of this study was to examine surgical outcomes, the clients’ acceptability and satisfaction for reconstructive surgery for the female genital mutilation victims. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 15

STUDY DESIGN: :

STUDY DESIGN: It was a prospective study, which was conducted at the Academy Teaching Hospital, Khartoum- Sudan from January 2005 to June 2010. 660 cases were underwent the surgery and completed the study restricted to a special designed protocol. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 16

METHODS& MATERIALS:

METHODS& MATERIALS Selection of the patients Counseling Pre-surgery preparation Technical procedure Post operative follow up. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 17

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4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 18 Satisfaction with Very satisfied satisfied dissatisfied Very dissatisfied No. % No. % No. % No. % Healing and healing duration 546 82.73 101 15.30 8 1.21 5 0.76 Shape of the vulva 528 80.00 119 18.03 6 0.91 7 1.06 Disappearance of vaginal discharge 531 80.45 112 16.97 11 1.67 6 0.91 Regaining or starting of the sexual activity and the interest. 652 98.79 6 0.91 2 0.30 0 0.00 Average 564.25 85.49 84.50 12.80 6.75 1.02 4.50 0.68 Table (1): Reconstructive Surgery satisfaction outcome

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4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 19 HEALING& ITS DURATION

SHAPE OF THE VULVA :

SHAPE OF THE VULVA 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 20

DISAPPEARANCE OF VAGINAL DISCHARGE :

DISAPPEARANCE OF VAGINAL DISCHARGE 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 21

REGAINING OR STARTING OF THE SEXUAL ACTIVITY AND THE INTEREST. :

REGAINING OR STARTING OF THE SEXUAL ACTIVITY AND THE INTEREST. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 22

AVERAGE :

AVERAGE 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 23

Results: :

Results: The clients reported that they were accepted the issue of the reconstructive surgery. The majority were very satisfied (86%), the rest ( 13%) of the group were satisfied with the results of the surgery regards the healing& its duration, shape of the vulva, disappearance of vaginal discharge and the regaining or starting of the sexual activity and the interest . (1% ) of the group is unsatisfied. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 24

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COMMENT:

COMMENT We found three key published studies on reconstructive surgery / defibulation, none of them conducted in neither Africa nor Middle East. In the latest study the authors identified 40 women as having undergone defibulation, and reported minimal complication rates, and high satisfaction rates among patients and their husbands Authors in another study performed defibulation in five women and suggested that defibulation procedure to be performed before pregnancy 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 26

Conclusion: :

Conclusion: 1. This study confirmed that the reconstructive surgery for the female genital mutilation victims ( RCSFGM ) can be performed to restore some of the genital anatomy with high degree of clients’ acceptance and satisfaction. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 27

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2. Lucky enough the study proves the clients’ refusal to perform FGM for their girls in the future, which gives an excellent chance for the health promotion and education initiative to stand against FGM. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 28

RECOMMENDATIONS:

RECOMMENDATIONS Activation of the laws against FGM in a very strict way . Break down of the SILENCE WALL among the FGM/C victims to increase the awareness and health education about the running FGM/C complications. Reconstructive surgery for the female genital mutilation victims (RCSFGM) should be performed to restore some of the genital anatomy . 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 29

ACKNOWLEDGMENT:

ACKNOWLEDGMENT Special thanks to Alhikma Pharmaceutical Company Team- Sudan for their great support. Our deep grateful thanks for the University of Medical Sciences& Technology , for the unlimited support. My thanks also to the ACTH’s staff for their kind cooperation. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 30

REFERENCES: :

REFERENCES: WHO, Female Genital Mutilation: Report of a WHO Technical Working Group. Geneva, 17–19 July 1995. Geneva, World Health Organization, 1996. WHO, World Health Organization. Female genital mutilation: an overview. Geneva: World Health Organization, 1998 Rushwan H, Slot C, El Dareer A, Bushra N. Female Circumcision in the Sudan. Prevalence, Complication, attitudes and changes. Khartoum: Faculty of Medicine, University of Khartoum, 1983 Elmusharaf K, Shakour S, Fazari A. Attitude of circumcised Sudanese women towards mutilating their daughters. Contraception. 2009;80(2):225. SHHS, Sudan Household Health Survey 2006: Federal Ministry of Health, the Central Bureau of Statistics, South Sudan Ministry of Health, and Southern Sudan Commission for Census, Statistics and Evaluation. December 2007 American College of Obstetricians and Gynecologists . Female Circumcision/Female Genital Mutilation: Clinical Management of Circumcised Women. ACOG Slide-lecture kit. Washington, DC: ACOG; 1999. Nawal M. Nour , Karin B. Michels , and Ann E. Bryant. Defibulation to Treat Female Genital Cutting: Effect on Symptoms and Sexual Function. Obstet Gynecol 2006;108:55–60 McCaffrey M, Jankowska A, Gordon H. Management of female genital mutilation: the Northwick Park Hospital experience. Br J Obstet Gynaecol 1995; 102:787–90. Penna C, Fallani MG, Marchionni M. Type III female genita mutilation: Clinical implications and treatment by carbon dioxide laser surgery. Am J Obstet Gynecol 2002;187:1550–4. 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 31

Participants’ word:- :

Participants’ word:- “ No, no more, we aren’t going to do this anymore” 4/23/2011 atiffazari@hotmail.co.uk UMST- Sudan 32