Table 3.

Clitoral reconstruction outcomes.

Author,year	Study design and population	Intervention and follow-up	Results	Strengths	Weaknesses	Quality
Thabet and Thabet, 2003 [1]	Case–control study at one center in Egypt (n = 147) Group 1: controls (n = 30) Group 2: FGM/C type I (n = 30) Group 3: FGM/C type II/III (n = 30) Group 4: FGM/C of any type with associated clitoral cysts (n = 57)	Groups 1 and 2: no intervention Group 3: clitoral reconstruction Group 4: clitoral reconstruction and excision of a clitoral cyst (30/57)a Follow-up at 6 months	Safety: not reported Postoperative clitoral appearance: not reported Chronic pain/dyspareunia: not reported Clitoral function: baseline/preoperative mean questionnaire score for sexual function/orgasm 82.2 ± 1.5 in group 1, 78.9 ± 1.7 in group 2, 65.6 ± 1.7 in group 3, 76.8 ± 2.0 in group 4; postoperative mean score 80.5 ± 1.7 in group 3 (P < 0.001), 63.0x ± 1.1 in group 4 with cyst excision alone (P < 0.001), 79.0 ± 1.1 in group 4 with cyst excision and clitoral reconstruction (P > 0.05)	Inclusion of a control group	No sample size calculation No data on the different types of FGM/C Vulvar pain not explored Non-validated questionnaire Unknown loss to follow up Unclear comparisons between groups	II-2 Poor
Foldès et al., 2006 [4]	Prospective cohort at one center in France (n = 453) FGM/C type II or III (frequency of each type not reported)	Clitoral reconstruction Follow-up at 6 months	Safety: 23.6% (n = 107) had complications; 3.7% (n = 17) required reoperation; 5.3% (n = 24) required readmission Postoperative clitoral appearance: 37% (n = 168) had hoodless glans; 21% (n = 97) had “almost normal clitoris” Chronic pain/dyspareunia: 4% (n = 17) pain without sexual intercourse and 25% (n = 116) moderate-to-severe dyspareunia preoperatively; not reported postoperatively Clitoral function: 19% (n = 84) slightly improved; 32% (n = 146) significantly improved without orgasms and 29% (n = 130) significantly improved with occasional orgasms; 14% (n = 65) normal clitoral function	–	Non-validated scales with no clear definition of categories Results reported by surgeon Surgical outcome evaluated as “clitoral function” instead of pain, pleasure, orgasm, etc. No data for the outcome of symptoms such as dyspareunia or chronic vulvar pain Unknown loss to follow up No statistical comparisons	II-3 Poor
Foldès et al. 2012 [2]	Prospective cohort at one center in France (n = 2938) FGM/C type III (n = 146) FGM/C type II (n = 2792) Clitoral pain and functionality evaluated at 1 year for 840 and 834 women, respectively	Clitoral reconstruction Follow-up at 1 year	Safety: 5.3% (n = 155) had complications; reoperation rate not reported; 3.7% (n = 108) required readmission Postoperative clitoral appearance: 42% (363/866) had hoodless glans; 28% (239/866) had normal clitoral appearance Chronic pain/dyspareunia: 3% (28/840) had pain without intercourse and 24% (202/840) had moderate-to-severe pain with sexual intercourse preoperatively; 50% (14/28) reported a slight or real improvement in pain without intercourse and 49% (99/202) reported a slight or real improvement in moderate-to-severe dyspareunia postoperatively Clitoral function: 430 women reported “restricted or regular” orgasm postoperatively; 129 of 368 who had never experienced orgasm reported “restricted” or “regular” orgasms after surgery; 51 of 97 who had had “restricted orgasms” preoperatively reported an improvement after surgery; 12 of 53 women who had experienced regular orgasm reported an orgasm of reduced intensity after surgery	–	Non-validated scales with no clear definition of categories Results reported by surgeon 71% loss to follow-up at 1 year Outcomes reported inconsistently among population	II-3 Poor
Ouédraogo et al. 2013 [3]	Prospective cohort at one center in Burkina Faso (n = 94) FGM/C type II (n = 89) FGM/C type III (n = 5)	Clitoral reconstruction Follow-up at 6 months	Safety: 23.4% (n = 22) reported immediate complications; 4.2% (n = 4) required reoperation; readmission rate not reported; 2.1% (n = 2) had long-term complications Postoperative clitoral appearance: 3.2% (n = 3) had normal clitoral appearance; 71.3% (n = 67) satisfied with appearance of the neoglans Chronic pain/dyspareunia: 39.4% (n = 37) had dyspareunia and 5.4% (n = 5) had superficial dyspareunia preoperatively; not reported postoperatively Clitoral function: 5.3% (n = 5) reported slight improvement; significant improvement without orgasms reported by 14.8% (n = 14) and with occasional orgasms by 36.2% (n = 34); 38.3% (n = 36) reported normal clitoral function; no significant difference in orgasm before and after clitoral reconstruction (P = 0.446)	–	Non-validated scales with no clear definition of each category Results reported by surgeon Patient satisfaction reported without explaining how satisfaction was evaluated Surgical outcome evaluated as “clitoral function” instead of pain, pleasure, orgasm, etc. No data concerning the outcome of single symptoms Unknown loss to follow-up	II-3 Poor

^aNot specified why only 30 of the 57 women received the intervention.