DOCSLIB.ORG

Sexual Anatomy and Function in Women with and Without Genital Mutilation: a Cross-Sectional Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Sexual Anatomy and Function in Women with and Without Genital Mutilation: a Cross-Sectional Study FEMALE SEXUAL FUNCTION Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study Jasmine Abdulcadir, MD,1,2 Diomidis Botsikas, MD,1,3 Mylène Bolmont, PhD Candidate,4 Aline Bilancioni, RN,1 Dahila Amal Djema, MD,3 Francesco Bianchi Demicheli, MD,1 Michal Yaron, MD,1 and Patrick Petignat, MD1 ABSTRACT Introduction: Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations. Aim: To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image. Methods: A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d’Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index). Main Outcome Measures: Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores. Results: Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d’Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores. Conclusion: Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated. J Sex Med 2016;13:226e237. Copyright Ó 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. Key Words: Female Genital Mutilation; Female Genital Cutting; Female Genital Mutilation/Cutting; Clitoris; Clitoral Reconstruction; Sexual Function/Dysfunction; Clitoral Size INTRODUCTION Received August 24, 2015. Accepted December 6, 2015. Female genital mutilation (FGM) involves the partial or total 1Department of Obstetrics and Gynecology, Geneva University Hospitals, removal of the external genitalia or other injury to female genital 1 Geneva, Switzerland; organs for non-medical reasons. The practice of FGM exists in 2Faculty of Medicine, University of Geneva, Geneva, Switzerland; Africa, Asia, the Middle East, South America, and Western 1 3Division of Radiology, Department of Imaging, Geneva University Hospitals, countries. FGM is classified into four types by the World Geneva, Switzerland; Health Organization (WHO) and can involve cutting of the 4Faculty of Psychology and Educational Science, University of Geneva, clitoris,1 the principal organ of female sexual pleasure.2 Geneva, Switzerland FGM can cause long-term health consequences.3,4 However, Copyright ª 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. the impact of FGM on sexuality remains unclear because only http://dx.doi.org/10.1016/j.jsxm.2015.12.023 few studies are available and these include methodologic 226 J Sex Med 2016;13:226e237 Female Sexual Anatomy and Function With and Without Genital Mutilation 227 limitations.5,6 Current evidence does not focus on the different cutting, then the woman would develop lethal or very severe consequences and types of FGM, on cutting of the clitoris,5 or complications. Other sexually responsive tissues of the vulva are on the fact that female sexual development and sexuality depend the vascular tissue immediately beneath the epithelium of the on complex interactions among anatomic, biochemical, neuro- labia minora (distinct from the bulbs) and the spongy tissue physiological, cognitive, cultural, and socio-contextual factors.7 around the urethral lumen, called the corpus spongiosum of the Women with FGM have specific anatomic and sociocultural urethra.14,15 FGM types II and III involve cutting of the labia issues. In addition, they are more likely to have had other minora and can damage its vascular tissue. FGM complications traumatic experiences that can affect their sexuality, such as include lesions of the urethral meatus but these do not require forced marriage or rape.8 the removal of vascular tissue around the urethra. Several beliefs linked to the presence of a clitoris to a woman’s Because most erectile structures are not excised, healthy sexuality exist in the West and in countries where FGM is women with FGM who are devoid of long-term complications traditionally practiced and are held by caregivers.9 Removal of can reach orgasm and experience satisfying sexual e the clitoris is believed to decrease or eliminate sexual pleasure, relationships.6,12 14,17 Furthermore, because most of the clitoris arousal, and orgasm, which is the leading reason for the practice remains, the clitoral stump beneath the scar tissue can be re- of FGM.1 Many caregivers believe that sexual dysfunction in exposed by a procedure known as clitoral reconstruction.16 women with FGM results from the absence of sexual organs, for Currently, the effectiveness and safety of a such technique is which no treatment is available.9,10 Even the WHO classification debated and conclusive evidence is lacking.18 The surgery is re- of FGM misleadingly reports that some forms of FGM involve ported to improve sexual function16 because it seems to decrease total removal of the clitoris.1 However, anatomically, it is the clitoral pain by removing peri-clitoral fibrosis, thus making the visible part of the clitoris (the glans) that is cut. The crura and clitoris more accessible to stimulation. However, many women part of the body of the clitoris remain intact under the scar.11,12 request clitoral reconstruction to improve their female identity The clitoris is a multiplanar organ with a boomerang shape. It and genital image, despite having an already functional clitoral 16 is composed of the glans (the only external, clinically visible stump. In these cases, sexual function could be improved by fi portion of the clitoris, covered by the prepuce), the body (con- enhanced body image, female identity, and self-con dence, nected to the pubic symphysis by the suspensory ligament of the rather than by a more accessible clitoris. The effects of psycho- clitoris), and the crura (two deep stems attached to the ischio- sexual and multidisciplinary care (alone or in association with pubic rami; Figure 1). The bulbs are two other female erectile surgery) need to be studied because they are safer and sometimes 18,19 structures that become engorged during arousal (Figure 1) and could be more effective than clitoral surgery alone. are beneath the labia.2,13 FGM can involve cutting of the labia Further scientific investigations regarding sexual anatomy, minora or majora (type II or III)1 and could put these structures development, and function in women with FGM are required to at risk. However, the bulbs are covered by the superficial perineal eradicate existing myths and misconceptions and would allow fascia and the bulbocavernosus muscles.2 If reached by deep offering the best available medical, surgical, and psychosexual care for complications after FGM. In uncut women, the visible part of the female erectile organs is the glans of the clitoris. In women with FGM that involves cutting of the clitoris, the clitoral stump is buried under a scar and can be palpated. Because most female sexual organs cannot be directly observed, pelvic magnetic resonance imaging (MRI) has been used e to investigate the anatomy of the clitoris and bulbs20 22 and its e relation to sexual function in women without FGM.23 26 AIMS One aim was to study the impact of FGM on (i) the anatomy of the clitoris and bulbs using MRI and (ii) sexual function using Figure 1. Clitoral and bulbar anatomy in relation to the sur- psychometric instruments. Another aim was to investigate fi rounding super cial anatomic structures. The clitoris is composed whether differences in the anatomy of women after FGM of the glans (visible portion of the clitoris covered by the prepuce), the body (connected to the pubic symphysis by the suspensory correlate with differences in sexual function. ligament of the clitoris), and the crura (the two deep stems attached to the ischiopubic rami). The bulbs are the other two METHODS erectile structures that are beneath the labia. They are covered by the bulbocavernosus muscles. Reprinted with permission from This was a cross-sectional study of sexual anatomy and func- Pauls,13 copyright John Wiley and Sons. Figure 1 is available in color tion in women with and without FGM. All participants signed at www.jsm.jsexmed.org. an informed consent form to undergo pelvic
Load more

Recommended publications
  • Hysteroscopy with Dilation and Curretage (D & C)
    501 19th Street, Trustees Tower FORT SANDERS WOMEN’S SPECIALISTS 1924 Pinnacle Point Way Suite 401, Knoxville Tn 37916 P# 865-331-1122 F# 865-331-1976 Suite 200, Knoxville Tn 37922 Dr. Curtis Elam, M.D., FACOG, AIMIS, Dr. David Owen, M.D., FACOG, Dr. Brooke Foulk, M.D., FACOG Dr. Dean Turner M.D., FACOG, ASCCP, Dr. F. Robert McKeown III, M.D., FACOG, AIMIS, Dr. Steven Pierce M.D., Dr. G. Walton Smith, M.D., FACOG, Dr. Susan Robertson, M.D., FACOG HYSTEROSCOPY WITH DILATION AND CURRETAGE (D & C) Please read and sign the following consent form when you feel that you completely understand the surgical procedure that is to be performed and after you have asked all of your questions. If you have any further questions or concerns, please contact our office prior to your procedure so that we may clarify any pertinent issues. Definition: HysterosCopy is an outpatient procedure that allows your doctor direct visualization of the inside of the uterine cavity (womb) by inserting a thin lighted telescope (hysteroscope) through the vagina (birth canal) and cervix, without making an abdominal incision. This procedure enables your doctor to examine the lining of the uterus, look for polyps, fibroids, scar tissue, blockages of the fallopian tubes, and abnormal partitions. In addition, this procedure allows your doctor to remove or surgically treat many of the abnormalities seen. Dilation and Curettage (D&C) allows your doctor to take a sample of the tissue that lines your uterus (endometrium) and/or to remove polyps, fibroid tumors, or hyperplasia. Suction D&C is used in cases of miscarriage.
    [Show full text]
  • A Discursive Approach to Female Circumcision: Why the United Nations Should Drop the One-Sided Conversation in Favor of the Vagina Dialogues
    NORTH CAROLINA JOURNAL OF INTERNATIONAL LAW Volume 38 Number 2 Article 6 Winter 2013 A Discursive Approach to Female Circumcision: Why the United Nations Should Drop the One-Sided Conversation in Favor of the Vagina Dialogues Kathleen Bradshaw Follow this and additional works at: https://scholarship.law.unc.edu/ncilj Recommended Citation Kathleen Bradshaw, A Discursive Approach to Female Circumcision: Why the United Nations Should Drop the One-Sided Conversation in Favor of the Vagina Dialogues, 38 N.C. J. INT'L L. 601 (2012). Available at: https://scholarship.law.unc.edu/ncilj/vol38/iss2/6 This Note is brought to you for free and open access by Carolina Law Scholarship Repository. It has been accepted for inclusion in North Carolina Journal of International Law by an authorized editor of Carolina Law Scholarship Repository. For more information, please contact [email protected]. A Discursive Approach to Female Circumcision: Why the United Nations Should Drop the One-Sided Conversation in Favor of the Vagina Dialogues Cover Page Footnote International Law; Commercial Law; Law This note is available in North Carolina Journal of International Law: https://scholarship.law.unc.edu/ncilj/vol38/iss2/ 6 A Discursive Approach to Female Circumcision: Why the United Nations Should Drop the One-Sided Conversation in Favor of the Vagina Dialogues KATHLEEN BRADSHAWt I. Introduction ........................................602 II. Background................................ 608 A. Female Circumcision ...................... 608 B. International Legal Response....................610 III. Discussion......................... ........ 613 A. Foreign Domestic Legislation............. ... .......... 616 B. Enforcement.. ...................... ...... 617 C. Cultural Insensitivity: Bad for Development..............620 1. Human Rights, Culture, and Development: The United Nations ................... ............... 621 2.
    [Show full text]
  • Physiology of Female Sexual Function and Dysfunction
    International Journal of Impotence Research (2005) 17, S44–S51 & 2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00 www.nature.com/ijir Physiology of female sexual function and dysfunction JR Berman1* 1Director Female Urology and Female Sexual Medicine, Rodeo Drive Women’s Health Center, Beverly Hills, California, USA Female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30–50% of American women. While there are emotional and relational elements to female sexual function and response, female sexual dysfunction can occur secondary to medical problems and have an organic basis. This paper addresses anatomy and physiology of normal female sexual function as well as the pathophysiology of female sexual dysfunction. Although the female sexual response is inherently difficult to evaluate in the clinical setting, a variety of instruments have been developed for assessing subjective measures of sexual arousal and function. Objective measurements used in conjunction with the subjective assessment help diagnose potential physiologic/organic abnormal- ities. Therapeutic options for the treatment of female sexual dysfunction, including hormonal, and pharmacological, are also addressed. International Journal of Impotence Research (2005) 17, S44–S51. doi:10.1038/sj.ijir.3901428 Keywords: female sexual dysfunction; anatomy; physiology; pathophysiology; evaluation; treatment Incidence of female sexual dysfunction updated the definitions and classifications based upon current research and clinical practice.
    [Show full text]
  • Sexual Reproduction & the Reproductive System Visual
    Biology 202: Sexual Reproduction & the Reproductive System 1) Label the diagram below. Some terms may be used more than once. Spermatozoa (N) Mitosis Spermatogonium (2N) Spermatids (N) Primary Oocyte (2N) Polar bodies (N) Ootid (N) Second polar body (N) Meiosis I Primary spermatocyte (2N) Oogonium (2N) Secondary oocyte (2N) Ovum (N) Secondary spermatocytes (2N) First polar body Meiosis II Source Lesson: Gametogenesis & Meiosis: Process & Differences 2) Label the diagram of the male reproductive system below. Seminal vesicle Testis Scrotum Pubic bone Penis Prostate gland Urethra Epididymis Vas deferens Bladder Source Lesson: Male Reproductive System: Structures, Functions & Regulation 3) Label the image below. Rectum Testis Ureter Bulbourethral gland Urethra Urinary bladder Pubic bone Penis Seminal vesicle Ductus deferens Epididymis Prostate gland Anus Source Lesson: Semen: Composition & Production 4) Label the structures below. Inner and outer lips of the vagina Mons pubis Vaginal opening Clitoris Anus Urethral opening Perineum Vulva Source Lesson: Female Reproductive System: Structures & Functions 5) Label the diagram below. Some terms may be used more than once. Clitoris Vulva Labia majora Labia minora Perineum Clitoral hood Vaginal opening Source Lesson: Female Reproductive System: Structures & Functions 6) Label the internal organs that make up the female reproductive system. Uterus Fallopian tubes Ovaries Cervix Vagina Endometrium Source Lesson: Female Reproductive System: Structures & Functions 7) Label the diagram below. LH Follicular
    [Show full text]
  • Chapter 28 *Lecture Powepoint
    Chapter 28 *Lecture PowePoint The Female Reproductive System *See separate FlexArt PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Introduction • The female reproductive system is more complex than the male system because it serves more purposes – Produces and delivers gametes – Provides nutrition and safe harbor for fetal development – Gives birth – Nourishes infant • Female system is more cyclic, and the hormones are secreted in a more complex sequence than the relatively steady secretion in the male 28-2 Sexual Differentiation • The two sexes indistinguishable for first 8 to 10 weeks of development • Female reproductive tract develops from the paramesonephric ducts – Not because of the positive action of any hormone – Because of the absence of testosterone and müllerian-inhibiting factor (MIF) 28-3 Reproductive Anatomy • Expected Learning Outcomes – Describe the structure of the ovary – Trace the female reproductive tract and describe the gross anatomy and histology of each organ – Identify the ligaments that support the female reproductive organs – Describe the blood supply to the female reproductive tract – Identify the external genitalia of the female – Describe the structure of the nonlactating breast 28-4 Sexual Differentiation • Without testosterone: – Causes mesonephric ducts to degenerate – Genital tubercle becomes the glans clitoris – Urogenital folds become the labia minora – Labioscrotal folds
    [Show full text]
  • The Cyclist's Vulva
    The Cyclist’s Vulva Dr. Chimsom T. Oleka, MD FACOG Board Certified OBGYN Fellowship Trained Pediatric and Adolescent Gynecologist National Medical Network –USOPC Houston, TX DEPARTMENT NAME DISCLOSURES None [email protected] DEPARTMENT NAME PRONOUNS The use of “female” and “woman” in this talk, as well as in the highlighted studies refer to cis gender females with vulvas DEPARTMENT NAME GOALS To highlight an issue To discuss why this issue matters To inspire future research and exploration To normalize the conversation DEPARTMENT NAME The consensus is that when you first start cycling on your good‐as‐new, unbruised foof, it is going to hurt. After a “breaking‐in” period, the pain‐to‐numbness ratio becomes favourable. As long as you protect against infection, wear padded shorts with a generous layer of chamois cream, no underwear and make regular offerings to the ingrown hair goddess, things are manageable. This is wrong. Hannah Dines British T2 trike rider who competed at the 2016 Summer Paralympics DEPARTMENT NAME MY INTRODUCTION TO CYCLING Childhood Adolescence Adult Life DEPARTMENT NAME THE CYCLIST’S VULVA The Issue Vulva Anatomy Vulva Trauma Prevention DEPARTMENT NAME CYCLING HAS POSITIVE BENEFITS Popular Means of Exercise Has gained popularity among Ideal nonimpact women in the past aerobic exercise decade Increases Lowers all cause cardiorespiratory mortality risks fitness DEPARTMENT NAME Hermans TJN, Wijn RPWF, Winkens B, et al. Urogenital and Sexual complaints in female club cyclists‐a cross‐sectional study. J Sex Med 2016 CYCLING ALSO PREDISPOSES TO VULVAR TRAUMA • Significant decreases in pudendal nerve sensory function in women cyclists • Similar to men, women cyclists suffer from compression injuries that compromise normal function of the main neurovascular bundle of the vulva • Buller et al.
    [Show full text]
  • Vaginal Screening After Hysterectomy in Australia
    CATEGORY: BEST PRACTICE Vaginal screening after hysterectomy in Australia Objectives: To provide advice on vaginal This statement has been developed and screening after hysterectomy. reviewed by the Women’s Health Committee and approved by the RANZCOG Target audience: Health professionals Board and Council. providing gynaecological care. A list of Women’s Health Committee Values: The evidence was reviewed by the Members can be found in Appendix A. Women’s Health Committee (RANZCOG), and applied to local factors relating to Disclosure statements have been received Australia. from all members of this committee. Background: This statement was first developed by Women’s Health Disclaimer This information is intended to Committee in November 2010 and provide general advice to practitioners. This reviewed in March 2020. information should not be relied on as a substitute for proper assessment with respect Funding: This statement was developed by to the particular circumstances of each RANZCOG and there are no relevant case and the needs of any patient. This financial disclosures. document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The document has been prepared having regard to general circumstances. First endorsed by RANZCOG: November 2010 Current: March 2020 Review due: March 2023 1 1. Introduction In December 2017, the National Cervical Screening Program in Australia changed from 2 yearly cervical cytology testing to 5 yearly primary HPV screening with reflex liquid-based cytology for those women in whom oncogenic HPV is detected in women aged 25–74 years. New Zealand has not yet transitioned to primary HPV screening.
    [Show full text]
  • Masturbation Among Women: Associated Factors and Sexual Response in a Portuguese Community Sample
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Repositório do ISPA Journal of Sex & Marital Therapy Masturbation Among Women: Associated Factors and Sexual Response in a Portuguese Community Sample DOI:10.1080/0092623X.2011.628440 Ana Carvalheira PhDa & Isabel Leal PhDa Accepted author version posted online: 14 Feb 2012 http://www.tandfonline.com/doi/full/10.1080/0092623X.2011.628440 Abstract Masturbation is a common sexual practice with significant variations in reported incidence between men and women. The goal of this study was to explore the (1) age at initiation and frequency of masturbation, (2) associations of masturbation with diverse variables, (3) reported reasons for masturbating and associated emotions, and (4) the relationship between frequency of masturbation and different sexual behavioral factors. A total of 3,687 women completed a web-based survey of previously pilot-tested items. The results reveal a high reported incidence of masturbation practices amongst this convenience sample of women. Ninety one percent of women, in this sample, indicated that they had masturbated at some point in their lives with 29.3% reporting having masturbated within the previous month. Masturbation behavior appears to be related to a greater sexual repertoire, more sexual fantasies, and greater reported ease in reaching sexual arousal and orgasm. Women reported a diversity of reasons for masturbation, as well as a variety of direct and indirect techniques. A minority of women reported feeling shame and guilt associated with masturbation. Early masturbation experience might be beneficial to sexual arousal and orgasm in adulthood. Further, this study demonstrates that masturbation is a positive component in the structuring of female sexuality.
    [Show full text]
  • National Health Statistics Reports, Number 104, June 22, 2017
    National Health Statistics Reports Number 104 June 22, 2017 Sexual Activity and Contraceptive Use Among Teenagers in the United States, 2011–2015 by Joyce C. Abma, Ph.D., and Gladys M. Martinez, Ph.D., Division of Vital Statistics Abstract Introduction Objective—This report presents national estimates of sexual activity and Monitoring sexual activity and contraceptive use among males and females aged 15–19 in the United States in contraceptive use among teenagers 2011–2015, based on data from the National Survey of Family Growth (NSFG). For is important because of the health, selected indicators, data are also presented from the 1988, 1995, 2002, and 2006–2010 economic, and social costs of pregnancy NSFGs, and from the 1988 and 1995 National Survey of Adolescent Males, which was and childbearing among the teen conducted by the Urban Institute. population (1,2). Although teen Methods—NSFG data were collected through in-person interviews with nationally pregnancy and birth rates have been representative samples of men and women aged 15–44 in the household population of declining since the early 1990s and the United States. NSFG 2011–2015 interviews were conducted between September reached historic lows at 22.3 per 1,000 2011 and September 2015 with 20,621 men and women, including 4,134 teenagers females aged 15–19 in 2015 (3), U.S. (2,047 females and 2,087 males). The response rate was 72.5% for male teenagers and rates are still higher than those in other 73.0% for female teenagers. developed countries. For example, Results—In 2011–2015, 42.4% of never-married female teenagers (4.0 million) in 2011, the teen birth rate in Canada and 44.2% of never-married male teenagers (4.4 million) had had sexual intercourse was 13 per 1,000 females aged 15–19, at least once by the time of the interview (were sexually experienced).
    [Show full text]
  • FGM in Canada
    Compiled by Patricia Huston MD, MPH Scientific Communications International, Inc for the Federal Interdepartmental Working Group on FGM. Copies of this report are available from: Women's Health Bureau Health Canada [email protected] The Canadian Women's Health Network 203-419 Graham Avenue Winnipeg, Manitoba R3C 0M3 fax: (204)989-2355 The opinions expressed in this report are not necessarily those of the Government of Canada or any of the other organizations represented. Dedication This report is dedicated to all the women in the world who have undergone FGM and to all the people who are helping them live with and reverse this procedure. This report is part of the ongoing commitment of Canadians and the Government of Canada to stop this practice in Canada and to improve the health and well-being of affected women and their communities. Executive Summary Female genital mutilation (FGM), or the ritual excision of part or all of the external female genitalia, is an ancient cultural practice that occurs around the world today, especially in Africa. With recent immigration to Canada of peoples from Somalia, Ethiopia and Eritrea, Sudan and Nigeria, women who have undergone this practice are now increasingly living in Canada. It is firmly believed by the people who practise it, that FGM improves feminine hygiene, that it will help eliminate disease and it is thought to be the only way to preserve family honour, a girl's virginity and her marriageability. FGM has a number of important adverse health effects including risks of infection and excessive bleeding (often performed when a girl is pre-pubertal).
    [Show full text]
  • MR Imaging of Vaginal Morphology, Paravaginal Attachments and Ligaments
    MR imaging of vaginal morph:ingynious 05/06/15 10:09 Pagina 53 Original article MR imaging of vaginal morphology, paravaginal attachments and ligaments. Normal features VITTORIO PILONI Iniziativa Medica, Diagnostic Imaging Centre, Monselice (Padova), Italy Abstract: Aim: To define the MR appearance of the intact vaginal and paravaginal anatomy. Method: the pelvic MR examinations achieved with external coil of 25 nulliparous women (group A), mean age 31.3 range 28-35 years without pelvic floor dysfunctions, were compared with those of 8 women who had cesarean delivery (group B), mean age 34.1 range 31-40 years, for evidence of (a) vaginal morphology, length and axis inclination; (b) perineal body’s position with respect to the hymen plane; and (c) visibility of paravaginal attachments and lig- aments. Results: in both groups, axial MR images showed that the upper vagina had an horizontal, linear shape in over 91%; the middle vagi- na an H-shape or W-shape in 74% and 26%, respectively; and the lower vagina a U-shape in 82% of cases. Vaginal length, axis inclination and distance of perineal body to the hymen were not significantly different between the two groups (mean ± SD 77.3 ± 3.2 mm vs 74.3 ± 5.2 mm; 70.1 ± 4.8 degrees vs 74.04 ± 1.6 degrees; and +3.2 ± 2.4 mm vs + 2.4 ± 1.8 mm, in group A and B, respectively, P > 0.05). Overall, the lower third vaginal morphology was the less easily identifiable structure (visibility score, 2); the uterosacral ligaments and the parau- rethral ligaments were the most frequently depicted attachments (visibility score, 3 and 4, respectively); the distance of the perineal body to the hymen was the most consistent reference landmark (mean +3 mm, range -2 to + 5 mm, visibility score 4).
    [Show full text]
  • Gender Reassignment Surgery Policy Number: PG0311 ADVANTAGE | ELITE | HMO Last Review: 07/01/2021
    Gender Reassignment Surgery Policy Number: PG0311 ADVANTAGE | ELITE | HMO Last Review: 07/01/2021 INDIVIDUAL MARKETPLACE | PROMEDICA MEDICARE PLAN | PPO GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder terms, conditions, exclusions and limitations contract. It does not constitute a contract or guarantee regarding coverage or reimbursement/payment. Self-Insured group specific policy will supersede this general policy when group supplementary plan document or individual plan decision directs otherwise. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to assist in making coverage decisions and administering benefits. SCOPE X Professional X Facility DESCRIPTION Transgender is a broad term that can be used to describe people whose gender identity is different from the gender they were thought to be when they were born. Gender dysphoria (GD) or gender identity disorder is defined as evidence of a strong and persistent cross-gender identification, which is the desire to be, or the insistence that one is of the other gender. Persons with this disorder experience a sense of discomfort and inappropriateness regarding their anatomic or genetic sexual characteristics. Individuals with GD have persistent feelings of gender discomfort and inappropriateness of their anatomical sex, strong and ongoing cross-gender identification, and a desire to live and be accepted as a member of the opposite sex. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined at birth.
    [Show full text]