Conceptualizing Sexual Pain in Women with Female Genital Mutilation/Cutting

Archives of Sexual Behavior -     

Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature

The purpose of this study was to evaluate the reliability of image-guided 14-gauge needle core biopsy in the diagnosis of radial scar without associated atypical epithelial proliferation, by comparison with definitive histological diagnosis on surgical excision. The records of 8792 consecutive image-guided 14-gauge needle core biopsy of the breast performed from January 1996 to December 2009 were reviewed. Forty-nine cases of radial scar without associated atypical epithelial proliferation were identified and compared with definitive histological diagnosis on surgical excision. The definitive histological diagnosis on surgical excision confirmed the results of image-guided 14-gauge needle core biopsy in 36 of 49 cases (73.5%), in 9 cases (18.3%) radial scar was associated with atypical epithelial proliferation, while 4 cases out of 49 cases were upgraded to carcinoma (3 cases of ductal carcinoma in situ and one case of invasive lobular carcinoma), with an underestimation rate of 8.2%. A diagnosis of radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy does not exclude a malignancy on surgical excision; consequently during the multidisciplinary discussion further assessment by surgical excision or vacuum-assisted excision, as recently reported, needs to be considered to obtain a definitive histological diagnosis.     

Missed opportunities for diagnosis of female genital mutilation

Objective

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

Methods

In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification.

Results

In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis.

Conclusion

Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.     

Autologous Platelet-Rich Plasma for Clitoral Reconstruction: A Case Study

Clitoral reconstruction after female genital mutilation/cutting (FGM/C) is associated with significant post-operative pain and months-long recovery. Autologous platelet-rich plasma (A-PRP) reduces the time of healing and pain in orthopedic and burn patients and could also do so in clitoral reconstruction. In the present case, a 35-year-old Guinean woman who had undergone FGM/C Type IIb presented to our clinic for clitoral reconstruction. Her request was motivated by low sexual satisfaction and body image. We surgically reconstructed the clitoris using the Foldès method and applied plasma and glue of A-PRP. The patient was highly satisfied with the procedure. Two months post-operatively, her pain had ceased entirely and re-epithelialization was complete. We conclude that A-PRP may improve pain and healing after clitoral reconstruction. Extensive studies investigating long-term outcomes are needed.

     

Defibulation: A Visual Reference and Learning Tool

Female genital mutilation type III (infibulation) is achieved by narrowing the vaginal orifice by creating a covering seal, accomplished by cutting and appositioning the labia minora and/or labia majora, with or without clitoral excision. Infibulation is responsible for significant urogynecological, obstetrical, and psychosexual consequences that can be treated with defibulation (or de-infibulation), an operation that opens the infibulation scar, exposing the vulvar vestibule, vaginal orifice, external urethral meatus, and eventually the clitoris. This article provides a practical comprehensive, up-to-date visual learning tool on defibulation, with information on pre-operative, post-operative, and follow-up information.Abdulcadir J, Marras S, Catania L, et al. Defibulation: a visual reference and learning tool. J Sex Med 2018;15:601–611.     

Role of Preoperative Breast MRI in Ductal Carcinoma In Situ for Prediction of the Presence and Assessment of the Extent of Occult Invasive Component

Ductal carcinoma in situ (DCIS) is a common neoplasm that may be associated with focal invasive breast cancer lesions. The aim of our study was to evaluate the role of preoperative magnetic resonance imaging (MRI) in determining occult invasive presence and disease extent in patients with preoperative diagnosis of pure DCIS. We analyzed 125 patients with postoperative pure DCIS (n = 91) and DCIS plus invasive component (n = 34). Diagnostic mammography (MRX) showed a size underestimation rate of 30.4% while MRI showed an overestimation rate of 28.6%. Comparing the mean absolute error between preoperative MRI and MRX evaluations and final disease extent, MRI showed an improved accuracy of 51.2%. In our analysis preoperative breast MRI showed a better accuracy in predicting postoperative pathologic extent of disease, adding strength to the growing evidences that preoperative MRI can lead to a more appropriate management of DCIS patients.     

The impact of method of biopsy on the incidence of breast cancer sentinel lymph node metastases

Background

The dislocation of the malignant cells along the needle tract during breast cancer (BC) diagnosis has been demonstrated by several studies. However, the published experiences that relate the diagnostic technique with sentinel node (SN) involvement are few and controversial. The aim of our analysis was to evaluate the impact of different techniques for preoperative BC biopsy among prognostic factors of metastases occurrence in SN.

Materials and methods

We reviewed the institutional clinical database of our Center. A total of 674 patients were diagnosed between February 1999 and December 2006 with invasive BC. SN metastases classification followed the 2002 American Joint Committee on Cancer (AJCC) TNM pathological staging: macrometastases, micrometastases, isolated tumor cells or negative. Only macrometastases and micrometastases were considered positive. Concerning fine-needle aspiration cytology, we used disposable needles of the size of 21–27 G. For percutaneous biopsy we used cutting needle type “tru-cut”; the Gauge needle ranged between 14 and 20.

Results

At univariate analysis of specific parameters using positive SN as outcome, percutaneous diagnostic technique did not affect significantly the SN positivity (p = 0.60). At multivariate models only central quadrant lesion (p = 0.005) and lymph vascular invasion (LVI) presence (p < 0.0001) maintained the statistical significance as risk factor for positive SN status. Polytomic logistics models showed that only LVI maintained the statistical significance both for prediction of micrometastases and macrometastases.

Conclusions

Our analysis showed that different techniques used for BC diagnosis did not influence SN status.     

Clitoral neuroma after female genital mutilation/cutting: a rare but possible event

IntroductionFemale genital mutilation/cutting (FGM/C), in particular, type III, also called infibulation, can cause various long‐term complications. However, posttraumatic neuroma of the clitoris is extremely rare; only one case was previously reported in the literature.AimThe aim of this study was to describe the case of a patient presenting a clitoral neuroma post‐FGM/C in detail and her successful multidisciplinary treatment.MethodsWe report the case of a 24‐year‐old woman originating from Somalia presenting a type III a–b FGM/C who attended our outpatient clinic at the Geneva University Hospitals complaining of primary dysmenorrhea and a post‐mutilation painful clitoral mass. The mass was clinically diagnosed as a cyst and surgically removed. Histopathological analysis revealed that it was a posttraumatic neuroma and a foreign body granuloma around the ancient surgical thread. Our patient was also offered a multidisciplinary counseling by a specialized gynecologist on FGM/C, a sexologist, and a reproductive and sexual health counselor.ResultsOne month after surgical treatment, the vulvar pain was over.ConclusionsThis is the second case of clitoral neuroma after FGM/C reported and the first with complete clinical, as well as histopathological documentation and multidisciplinary care. Considering the high frequency of clitoral cysts in case of infibulation, clitoral neuroma should be considered in the differential diagnosis. In this case, if symptomatic, the treatment should be surgery, clinical follow‐up, and counseling. If necessary, appropriate sexual therapy should be offered too. Abdulcadir J, Pusztaszeri M, Vilarino R, Dubuisson JB, and Vlastos A‐T. Clitoral neuroma after female genital mutilation/cutting: A rare but possible event. J Sex Med 12;9:1220–1225.