Abstract
BACKGROUND: FGM is an issue of increasing concern also in countries where it is not traditionally practiced. Vulvar scarring is the most common long-term effect associated with FGM, representing one of the main unmet issues in FGM women's health. Regenerative therapies based on the use of adipose-derived stem cells are considered the standard of care for ameliorating scarring and fibrosis. This study aimed to explore the potential of fat grafting in the treatment of post-FGM vulvar scars. METHODS: Thirteen FGM survivors with vulvar scars underwent autologous fat grafting and were assessed using the Vulvar architecture severity scale (VASS), Female genital self-image scale (FGSIS), Female sexual function index (FSFI), and Hospital anxiety and depression scale (HADS). RESULTS: At an average follow-up of 12.23 months (± 3.03), clinical results (VASS) showed a significant improvement in all vulvar aesthetic units treated with FG (p < 0.001). Patients reported improvements in genital-related self-image (FGSIS) (p = 0.001), sexual function (FSFI) (p = 0.019), and psychological well-being (HADS) (p = 0.002). CONCLUSIONS: Fat grafting ameliorates FGM-related vulvar scars and improves volumetric contouring of vulvar aesthetic units, with a positive effect on women's quality of life. This minimally invasive intervention has far-reaching implications, providing a cost-effective solution accessible even in low-resource settings to potentially improve the overall well-being of millions of women living worldwide with a form of FGM. The results of this study warrant further testing in future clinical trials. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .