Access to and Training in Reconstruction for Female Genital Mutilation/Cutting in the United States and Western Europe
Ankoor Talwar 1Abhishek Desai 1Phoebe McAuliffe 1Robyn Broach 1Ivona Percec 1
University of Pennsylvania, Philadelphia, PA
Background: Female genital mutilation/cutting (FGM/C) is the intentional alteration, removal, or injury of female genitalia for non-medical reasons. FGM/C affects nearly 200 million women worldwide, many of whom live in developed countries. Genital reconstructive procedures have promising functional and patient-reported outcomes, but it is unclear how many victims have access to surgical and associated psychosocial care. The purpose of this study was to determine how many victims of FGM/C have access to comprehensive care, including reconstructive surgery, in the United States (U.S.) and Western Europe. Additionally, we characterized current plastic surgery resident training and interest in FGM/C reconstruction for the future.
Methods: FGM/C care centers were identified using End FGM European Network. Access to comprehensive care (surgical, psychological, sexological, and gynecologic) and to publicly insured FGM/C care within the region (U.S.) or country (Western Europe) was documented. Population data were extracted from the U.S. Centers for Disease Control and Prevention, U.S. Census Bureau, End FGM European Network, and World Bank. A 10-item survey capturing interest in and exposure to FGM/C reconstruction was administered to residents at our institution.
Results: Approximately 1.3 million women in Western Europe and the U.S. are affected by FGM/C. Reconstructive surgery in these areas is offered by plastic surgeons (36.8%), gynecologists (57.9%), and urologists (5.3%). Overall, 32% (n=411,624) of women do not have access to reconstructive surgical care (U.S.: 33.8%, Western Europe: 30.8%). 57.7% (n=742,784) of affected women do not have access to comprehensive care (U.S.: 80.3%, Western Europe: 42.8%). 69.4% (n=892,621) do not have access to publicly insured care (U.S.: 100%, Western Europe: 49.1%). 21 residents at our institution completed the survey. 67% of residents had some clinical or operative exposure to FGM reconstruction patients. Further, 71% cited a desire for increased exposure in residency. The most preferred method of exposure was greater operative experience. Residents of minority background are more interested in incorporating FGM reconstruction into future practice.
Conclusions: Female genital mutilation/cutting affects millions of females in the developed world. One-in-three of these women do not have access to reconstructive surgical options. Most affected women cannot obtain publicly insured comprehensive care. Plastic surgeons should consider incorporating reconstructive surgery into their armamentarium. Residents, especially those of minority descent, are interested in incorporating FGM/C reconstruction into their training. There must be a greater effort from plastic surgeons to care for this vulnerable population.
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