Clitoral reconstruction after female genital mutilation/cutting (FGM/C): on the difficulties of generating evidence and its normative implications for counseling practice

Background Female genital mutilation and circumcision (FGM/C) practices present physicians in Germany with numerous challenges. One possible intervention is elective clitoral reconstruction for esthetic and physiological recovery after FGM/C. Even if the study situation regarding the results achieved by clitoral reconstruction is controversial, the range of reconstruction options is increasing. Arguments The aim of this study is to critically examine the epistemic and ethical dimensions of the interdisciplinary debate on clitoral reconstruction that has arisen over the last 20 years. It is intended to provide orientation in the complex field in which cultural, gender-specific, sexual, and psychosocial factors interact with anatomical-physiological knowledge and the lack thereof. The analysis shows the ambivalent role of evidence claims and promises in relation to clitoral reconstruction. Conclusions Difficulties in testing and comparing existing surgical procedures and in the use of standardized questioning tools demonstrate how essential cultural competence and diversity awareness are in dealing with those affected. The prima facie correct argument of insufficient evidence on the efficacy, comparability, and long-term consequences of reconstruction procedures proves to be problematic for ethical and epistemic reasons. In order to generate valid and useful data on sexuality, body perception, pain, and pleasure before and after clitoral reconstruction, survey modalities that address the culturally heterogeneous target group of women with FGM/C are needed. Cultural competence and sensitivity in medicine are also urgently needed for target group-oriented education and counseling as a prerequisite for self-determined decisions for/against clitoral reconstruction.