50: Pelvic organ prolapse surgery in the setting of female genital mutilation

Abstract

To provide an overview of female genital mutilation (FGM). To demonstrate the approach to prolapse repair in a patient with a history of female genital mutilation. A 72-year-old East Indian female with a history of type III FGM presented with stage III pelvic organ prolapse. The patient had previously been managed with a pessary, but then began to have obstructive voiding symptoms secondary to scarring from FGM and worsening of her pelvic organ prolapse. The decision was then made to proceed with surgical management with colpocleisis. On examination, the labia were noted to be completely fused down to the posterior vagina with the prolapse protruding through a small opening near the posterior fourchette. A unique surgical approach was taken, first performing a labial defibulation with partial vulvectomy. This released the prolapse from within the scarred vagina, which then demonstrated complete procidentia. The colpocleisis, posterior repair, perineorraphy were then completed. Her postoperative course was uncomplicated and the patient no longer has symptoms of prolapse or obstructive voiding. Our case demonstrates a unique patient in which pelvic organ prolapse occurred in the setting of FGM and no such case is currently documented in the literature. In evaluating patients with FGM, gynecologists must consider the long-term consequences of FGM and identify when it is appropriate to proceed with surgical management. Given the distortion in anatomy, referral to a specialist such as a Female Pelvic Medicine and Reconstructive Surgeon may be necessary.