Management of infibulation during a humanitarian surgical caravan for urogenital fistula in Bouake (Cote D’IVOIRE): Case report

Abstract

Humanitarian surgical caravans for urogenital fistula cures are a godsend for patients with limited financial resources. Some patients with urogenital conditions other than fistulas sometimes take advantage of this opportunity to have their condition optimally managed.

We report the case of a 21-year-old woman. She had a history of genital mutilation in childhood.

Since childhood she had had an involuntary flow of urine through the vulval orifice.

She became one of the patients selected for the caravan of humanitarian surgery. Clinical examination revealed infibulation of the external genital organs. A labioplasty was successfully performed.

1 Introduction

Urogenital fistulas in sub-Saharan Africa are a real social problem. They mainly affect economically deprived women.

Their treatment in Côte d’Ivoire is subsidised by government partners through multi-centre caravans for the cure of urogenital fistulas.

Some economically disadvantaged patients with other urogenital pathologies take advantage of this opportunity to obtain free treatment. These other pathologies include female genital mutilation.

Ivorian law has prohibited genital mutilation since 1998.

These laws have made it possible to drastically reduce the practice of genital mutilation. The case of infibulation we are reporting is an unusual one, accidently introduced during our urogenital fistula treatment caravans. we will describe the mechanism of urinary incontinence and the difficulty of infibulation treatment in a community surgery caravan.

2 Case report

The patient was 21 years old. She presented with involuntary flow of urine into the vulval orifice. Her history was marked by genital mutilation in early childhood. She had never had sexual activity.

This patient presents with an involuntary flow of urine into the vulva during urination. There were no other associated urogenital signs.

Clinical examination revealed sutured external labia ( Fig. 1 ). There was only a 0.5cm orifice for urine drainage ( Fig. 2 ). We concluded that it was grade III female genital mutilation according to WHO 1997.