Recurrent vulvar abscess following Type III FGM: management with vulvar reconstruction

Abstract

Introduction Female genital mutilation (FGM) is a deeply rooted cultural practice affecting over 200 million women globally. It is associated with significant long-term gynecological, sexual, and psychological consequences. Despite growing awareness, women with a history of FGM continue to face barriers to care, particularly when presenting with recurrent infections and sexual dysfunction. Understanding these cases through a biopsychosocial framework allows for individualized and trauma-informed management. Objective The objective of this case was to eliminate recurrent vulvar abscess formation and associated dyspareunia through surgical reconstruction of FGM-related scar tissue. The goal was to restore normal vulvar anatomy and drainage while relieving mechanical tension. Although psychological and psychosexual support were offered, the patient chose surgery as the sole intervention. The case demonstrates that even when treatment is limited to the biological domain, biopsychosocial awareness-through informed consent, cultural sensitivity, and respect for patient choice-remains essential. Methods A 30-year-old married woman, gravida 2 para 2, presented with recurrent vulvar abscesses and pain during intercourse. She had undergone Type III female genital mutilation at age 7 in Central Africa. Examination revealed fibrotic scarring and partial labial fusion leading to obstruction of glandular drainage and recurrent abscess formation. As the pathology was purely anatomical and infectious, surgical reconstruction was planned as the definitive treatment. Under general anesthesia, defibulation and excision of scar tissue were performed with careful labial reconstruction to restore drainage and relieve tension. Standard perioperative antibiotic prophylaxis and postoperative wound care were provided. Follow-up visits at one week, one month, and three months evaluated healing, recurrence, and sexual comfort. Results Postoperative healing was uncomplicated. The patient experienced complete resolution of pain and no recurrence of abscesses. Examination confirmed a widened introitus, healthy mucosal healing, and restored tissue flexibility. At the three-month visit she reported the ability to resume sexual activity without discomfort and expressed satisfaction with the physical and emotional outcome. Although she declined further psychosexual counseling, the shared decision-making process itself fostered trust and empowerment, reflecting the psychosocial value of autonomy. Conclusions This case underscores the need for a holistic, patient-centered approach in women with FGM-related complications. Integrating medical, psychological, and sociocultural perspectives facilitates individualized care and supports sexual health and well-being. Awareness and sensitivity among healthcare professionals are crucial to providing effective and respectful management for this population. Disclosure No