Penn surgeon develops reconstructive surgery for victims of female genital mutilation

A new reconstructive surgical procedure developed by a surgeon at Penn Medicine’s Center for Human Appearance can increase the sexual function of patients who have undergone female genital mutilation.

Female genital mutilation is defined by the World Health Organization as “any procedure that intentionally alters or causes injury to female genital organs for non-medical reasons and with no health benefits,” and is conducted as a cultural ritual in parts of Africa, the Middle East and Asia. WHO estimates that over 200 million women have undergone FGM by the time they are adolescents, while the Population Reference Bureau calculated that 506,795 women in the United States were at risk for FGM, with 16,417 in the Philadelphia metropolitan area.

Ivona Percec, assistant professor in the Division of Plastic Surgery and associate director of cosmetic surgery at the Perelman School of Medicine, developed the procedure after being introduced to the issue of FGM by accident.

Percec’s first patient who underwent the procedure was referred to her by the patient’s gynecologist, whom she had gone to see because of the pain and embarrassment of undergoing FGM earlier in life. The patient was so ashamed of her body that “she would not let her husband see her, even though they had two children together,” Percec said.

Percec said she looked through the national and international medical research on FGM and found nothing about procedures to help ease the pain and medical problems that can result from FGM. Percec then used her “toolbox as a plastic surgeon” to design the new procedure with her patient.

Since the initial success, Percec has performed the technique on two additional patients — referred to her by the first patient — who also underwent FGM. She says that the patients have referred the procedure to other women in their social communities due to the success and emotional benefits they received as a result.

The three patients, who were all recent immigrants from Sierra Leone between the ages of 30 and 33 according to the Penn Medicine News press release, suffered from what is known as Type II mutilation also known as excision. Excision is defined by WHO as “the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva).”

Joseph Serletti, chief of the Division of Plastic Surgery at Penn, says that medical practitioners across other disciplines often use plastic surgeons as a resource for patients with problems related to reconstruction, like the scarring and tissue damage that can occur as a result of FGM.

“It’s not something from a reconstructive standpoint that we may typically do, and so [doctors] look to plastic surgery to provide some of the unique solutions to that problem,” Serletti said about “primarily scarring around the vagina.”

Percec is currently working with one of her former patients to speak at the patient’s women’s group, which includes other women who have undergone FGM. Percec said her patients informed members of their community and received a mixed response, as some women felt that the procedure would distance the patients from their home culture because of the social significance of the procedure.

Percec hopes to bring greater awareness to what she sees as a human rights issue for women all over the world. She published a paper on the procedure in the Aesthetic Surgery Journal after only performing the procedure three times because “it was more important to publish ... based on my limited experience just to get the word out there” to other surgeons, Percec said. “There is something we can do about this.”