The Woman in the Surgeons Body

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Coronary artery bypass , most commonly referred to as simply "bypass surgery," is often performed in people who have angina chest pain and coronary artery disease where plaque has built up in the arteries. During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest may also be used to create a bypass graft.

Total or simple mastectomy , in which the surgeon removes the entire breast, including the nipple, the areola the colored, circular area around the nipple , and most of the overlying skin, and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands.

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Modified radical mastectomy surgery involves removing the entire breast including the nipple, the areola, and the overlying skin , some of the lymph nodes under the arm, and the lining over the chest muscles. In some cases, part of the chest wall muscle is also removed. Additional information. Surgery preparation Tests performed before surgery Recovering After surgery discomforts.

Pain management Discharge planning. Previous Section Next Section. Clinical Trials. MyHealth Login. Financial Assistance. Medical Records. Contact Us. Get a Second Opinion. Healthcare Professionals. Referring Physicians. Allied Healthcare. Yet despite the extraordinary need for appropriate medical care, there has been little rigorous research on how surgeons can relieve enduring physical harm or improve sexual sensation.

The procedure, often called clitoral reconstruction or restoration, is viewed with caution and scepticism by some medical experts. The World Health Organisation says that while there are some promising reports that the operation may relieve pain, there is not yet enough evidence of safety and effectiveness.

The organisation advises against raising unrealistic expectations, especially for women seeking sexual improvement. Still, demand for such operations is growing in the United States and other western nations as more women who have been genitally cut move to countries where medical techniques are advanced, insurance often covers surgery, and women can make decisions about their bodies.

Over the past two years, four women — a health professional, a hairstylist, a bus driver and Sillah, the hospital pharmacist — shared intimate details of their experiences, and one allowed me to be in the operating room during her surgery. All were patients of Percec pronounced per-check. She regularly performs plastic surgery for medical or cosmetic reasons, including labiaplasty to reshape the inner labia, but until Sillah contacted her, she had never tried clitoral reconstruction on women who were cut. Like many Sudanese women, this patient underwent the most extreme form, called infibulation : clitoris, labia majora and minora are severed, labia are repositioned and the vagina is sewn mostly closed, requiring surgical opening for childbirth.

Infibulation makes urination, menstruation and sex arduous, and increases risks of pregnancy complications. In her twenties, she married a Sudanese-American man she met via Facebook. Still, she says, for a while, sex hurt.

What are the surgical specialties?

She never had an orgasm. After she joined him in Pennsylvania, he encouraged her search for clitoral reconstruction.

After weeks of recovery she felt more sensation, and intercourse became more comfortable. After joining her mother in New Jersey at 16, she held off on dating, fearing men would be appalled.

Fibroids Surgery: Myomectomy, Hysterectomy Open Surgery

Although he was also from Sierra Leone, he was raised to oppose cutting. She had worried he would think less of her. Genital cutting, also called female genital mutilation FGM , is a centuries-old practice that varies by culture. International efforts to end cutting have been somewhat successful, but it persists in many countries. He realised that the uncut clitoris was sealed underneath scar tissue, often pushed back and up, adhering to the pubic bone. He devised a technique to unearth the clitoral remnant and shift it into position by detaching connective tissue called a suspensory ligament.

He says he has operated on about 6, women, mostly in France, and trained about surgeons, primarily in Africa. He led the largest, most comprehensive study of clitoral reconstruction, involving 2, women from to , although the study had limitations, including that he assessed his own work. Post-surgical complications, like blood clots and fever, were experienced by women, of whom required brief re-hospitalisation.

Longer-range results were assessed in a one-year check-up, which less than a third of the patients attended. Sexual satisfaction varied. About a third of women who had never had orgasms reported experiencing them to some degree. But a few who already had regular orgasms reported less sexual satisfaction. Now, she says, complications are rare, besides a few infections. Some experts are much more cautious about recommending or performing clitoral reconstruction. She is a co-author of a review of clitoral reconstruction studies that concluded more evidence of safety and efficacy was needed.

After that, she said, less than a fifth choose surgery. She has referred a few patients to Foldes, but worries about nerve damage from surgery and discomfort from a resurfaced clitoris. But at 20, soon after joining her mother and sisters in Columbus, Ohio, she began seeing things differently. At a Job Corps programme, she heard young women discussing sex, mentioning the clitoris. Her solution was to avoid sex. But while studying cosmetology and training in weight lifting, she increasingly felt her body was not whole.

I just want to look normal. The sulcus, between the clitoris and labia majora, was gone, Percec says.

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Percec, director of basic science research in plastic surgery at Penn Medicine, has developed her own surgical approach, reusing scar tissue whenever possible, she says. Unlike Foldes, she does not cut the suspensory ligament, believing that her method better protects nerves and blood vessels. Yet she is also learning on the job. When her first patient, Sillah, remained in pain two weeks post-surgery, Percec began prescribing women an ointment with lidocaine. When another patient struggled with a dressing, Percec began sewing on gauze with dissolving stitches.

Two patients needed additional surgery, one because her clitoris partially readhered, possibly because her work uniform included tight trousers, Percec says. Later, Percec began grafting fat into the labia, theorising it would aid healing and add fullness to depleted tissue. Initially, Gbaya was enthusiastic about the results. But eventually, she says, scar tissue formed back over the clitoris.

Before her surgery last year, Aminata Welcome, 33, who immigrated from Niger, talked with her pre-teen daughter, showing her drawings from a website. The morning of her operation, dressed in a black-and-gold abaya, she swept the air with orange-polished fingernails as she described how American men she dated after her divorce dumped her when they learned she had been cut.

One boyfriend asked if she was transgender. She sliced carefully. An hour later, Percec unearthed about 3cm of the clitoris. No labia minora remained. The doctors placed the cheek-cell skin graft over the surgical opening and injected fat around it. After two hours in recovery, Welcome was discharged. Exhausted, she rested on a green velour sofa at home. You can find our Community Guidelines in full here. Want to discuss real-world problems, be involved in the most engaging discussions and hear from the journalists? Start your Independent Premium subscription today.

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