(024) Sexual Function and Stimulation Beyond the Clitoris in Women with FGM/C: A Systematic Review of Alternative Pathways and Urogenital Anatomy

Introduction Female genital mutilation/cutting (FGM/C) damages or removes the clitoris, the primary organ for female orgasm, leading to profound sexual dysfunction. There is an urgent clinical need to validate non-clitoral pathways to sexual pleasure and orgasm for affected women. Objective To systematically review the efficacy of alternative sexual stimulation techniques and to synthesize the anatomical and physiological basis for non-clitoral pathways to orgasm. Methods A systematic review was conducted according to PRISMA guidelines. We included studies which reported non-clitoral stimulation techniques (breast, vaginal, perineal), anatomical basis of the G-spot, use of vibratory devices and sexual response in populations with compromised clitoral anatomy. Extracted data included imaging findings (MRI, ultrasound), histological measurements of glandular structures, quantitative assessments of orgasm frequency and intensity, hemodynamic changes during stimulation, and qualitative subjective reports. Results A total of seven studies were included in this systematic review. In two studies, direct breast/nipple stimulation elicited orgasm in 48%–62% of participants, with mean intensity scores increasing by 35% (p<0.01). Qualitative reports described distinct pleasure pathways independent of genital stimulation. Subjective data from three studies identified a “urethro-vaginal complex” or neural plexus cluster as a focal area of sensitivity. Imaging and histological analyses delineated Skene’s glands at the anterior vaginal wall, with mean glandular volume of 2.8 cm3 (SD 0.7) and ductal diameter 1.4 mm (range 1.1–1.7 mm). Two studies employing Doppler ultrasound documented significant increases in blood flow (mean peak flow velocity rise of 52%, p<0.005) and tissue engorgement of the anterior vaginal wall during targeted stimulation. Experimental electrovaginal mapping using surface electrodes confirmed heightened neuroelectric responses in this region, with mean evoked potential amplitude 1.8 μV higher than adjacent vaginal sites (p<0.01). Three studies evaluated perineal massage and external vibratory devices applied to the perineal body. Targeted perineal massage increased orgasm frequency from a median of 0 to 1 per session (p=0.03) and raised intensity ratings by 30% (p<0.02). Vibratory stimulation achieved orgasm in 57% of sessions, with mean intensity scores of 7.5/10 (SD 1.2). One study assessed combined breast, G-spot compression, and perineal vibration, reporting orgasm in 78% of sessions and a 65% increase in intensity scores versus single modalities. A dose-response relationship was observed: sessions exceeding 6 minutes of cumulative stimulation yielded a 20% higher orgasm rate (p=0.04). Conclusions Our study confirms that women with FGM/C can achieve orgasm via multiple non-clitoral pathways. Breast and nipple stimulation, engagement of the urethro-vaginal complex supported by Skene’s gland anatomy and hemodynamic changes, perineal massage, and vibratory assistance each elicit orgasmic responses. Integrative multimodal approaches demonstrate synergistic benefits. These evidence-based strategies are essential for sexual rehabilitation and counseling of women with compromised clitoral anatomy. Disclosure No