gineco
ro
Badreldeen Ahmed, Mandy Abushama, Zahra Ghaffari
Figure 1
Sexual difficulty including pain and
Figure 2: Inclusion cyst which can reach a large size causing pain,
failure to consummate marriage. This is
difficulty in walking and dyspareunia
a common reason to seek medical advice
and it may be the first time she presents
to the care of the obstetrician.
Retention cyst occurs with all types
of FGM and may reach a quite big size
or become infected or may become in-
fected necessitating immediate inter-
vention, (Figure 2).
Variable degree of urinary obstructi-
on, painful flow and recurrent urinary
tract infection.
Keloid scar formation, this could be
quite big and may cause embarrass-
ment to the women and marital pro-
blems
Chronic pelvic infection is common
and may lead to tubal blockage and
primary infertility.
Fistula is extremely rare compli- Figure 3: Surgical removal of inclusion cyst involve a longitudinal incision
cation of FGM, and can be the result
The cyst should then be evacuated and the dead space closed with either
of injury at the initial procedure or
Continuous or interrupted stitches
following laceration in labour (Shan- infected and become very painful (Fi- underlying tissues using a finger, (Fi-
dall). gure 2). The cyst can easily be removed gure 4).
Menstrual disturbance, dysmenor- under general anaesthesia or occasio- 4. Incise in the mid-line to expose
rhoea is a common problem. nally under local anaesthesia (Figure the urethral opening. Do not incise be-
Psychosexual problems and fla- 3). The time of removal of this cyst is yond the urethra. Extending the inci-
shbacks (psychological reliving the ex- ideal time for defibulation after coun- sion forward may cause haemorrhage
perience many years later) selling the women and her husband in which is difficult to control.
great details. 5. Suture the raw edges to secure
Presentation and management haemostasis and prevent adhesion
of FMG outside pregnancy
Elective Defibulation formation. Healing should take place
The operation to open up type III within one week (Gordon H., 1998).
The commonest presentation before FGM consists of the following steps: The impact of FGM on the mana-
pregnancy and in the adulthood are fa- 1. Observe an aseptic technique (wa- gement of pregnancy, childbirth and
ilure to consummate marriage, recur- shing hands thoroughly, wearing glo- postpartum period.
rent vaginal and urinary tract infecti- ves etc.)
on and inclusion cyst which can vary 2. Locate the remaining opening and Antenatal assessment
in size. Inclusion cysts may be so big clean the surrounding area. In areas where type III FGM does not
that it interferes with walking and get 3. Rise up the scar tissue from the involve the majority of the population,
Vol. 4, Nr. 3/septembrie 2008
pag. 167
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