Access to Reconstructive Surgery After Female Genital Mutilation/Cutting in the United States: A Patient-Reported Outcomes Study.

Abstract

Female genital mutilation/cutting (FGM/C) remains prevalent worldwide and has lasting physical and psychological consequences. In the United States, an estimated 513,000 women and girls have undergone or are at risk of FGM/C, yet clitorolabial reconstruction is rarely offered and performed by few specialists. This study aimed to identify barriers to accessing reconstructive surgery. Patients who underwent FGM/C reconstruction by a single plastic surgeon at a quaternary academic center between 2017 and 2024 were surveyed. The survey assessed access to care, perceived barriers, social support, and satisfaction with surgical outcomes. Of 38 eligible patients, 21 completed the survey (55.3% response rate). Median age was 37 years (IQR: 32.1-46.5). The majority identified as Black/African American (81.0%) or Middle Eastern/North African (14.3%) and as cisgender female (85.7%). Type 2 FGM/C was most common (85.7%). Over half (57.1%) had considered reconstruction for more than 3 years before pursuing care. Most (81.0%) independently located their surgeon online, and 85.7% had never consulted another provider regarding FGM/C. Patients in this cohort frequently considered reconstruction for several years before accessing surgical care. Although 92.5% had insurance, 57.1% reported financial hardship. Additional barriers included travel burden and limited emotional support. Despite these challenges, most respondents reported satisfaction with their surgical outcomes. Persistent financial, geographic, and social barriers highlight the need for increased provider awareness, improved referral pathways, and expanded reconstructive services to ensure timely and comprehensive care for individuals affected by FGM/C.