Risk factors for not proceeding to reconstructive surgery after female genital mutilation: A cohort study of 220 women in a specialized referral center

OBJECTIVE: This study identifies factors associated with not proceeding to clitoral reconstructive surgery among women with female genital mutilation (FGM) enrolled in a specialized surgical pathway. METHODS: A retrospective cohort study was conducted at a multidisciplinary referral center in Montreuil, France, between January 2021 and December 2023. The study included 220 women who expressed a wish for reconstructive surgery during their initial assessment. Factors associated with non-progression to surgery were identified using univariable and multivariable logistic regression, supplemented by Bayesian analysis. RESULTS: Of the 220 women, 35% did not proceed to surgery. In the multivariable model, lack of support within the care pathway (odds ratio [OR] 3.28, 95% confidence interval [CI] 1.46-7.55; P = 0.004) and financial vulnerability, specifically reliance on state welfare (OR 3.43, 95% CI 1.28-9.80; P = 0.017) or financial support from relatives/community (OR 6.18, 95% CI 1.40-28.9; P = 0.017), were independently associated with non-progression. Model discrimination was good (area under the curve 0.75). Bayesian analysis confirmed these findings (P[direction] >99%) and suggested that memory of the FGM event also played a role (OR 1.87, 95% credible interval 0.88-4.09; P[direction] 94.9%). CONCLUSION: Access to clitoral reconstruction is primarily determined by socioeconomic stability and social support rather than clinical factors alone. These findings highlight the need for multidisciplinary pathways that integrate social and psychological accompaniment to ensure equitable access to care for vulnerable women.