5.10 Deinfibulation


Infibulation or Type III mutilation refers to clitoral circumcision with partial or complete removal of the clitoris, often combined with removal of the labia minora, in addition to vulvar occlusion with partial or complete removal of the labia majora, the edges of which are sealed together. All that is left is a residual opening at the base of the vulva for the passage of urine and menstrual blood.

Infibulation may interfere with the ability to monitor cervical dilation and with the normal childbirth process.
It can cause prolonged retention of the foetus against the perineum, increasing the risk of severe maternal tissue damage (tears and fistula) and the risk of foetal distress and death.

Deinfibulation, performed during pregnancy or labour, may be necessary for the birth of the child. Double episiotomy is not an acceptable substitute for deinfibulation.

5.10.1 Equipment

– Suture set containing: sterile scissors, dissecting forceps and needle holder
– Antiseptic (10% polyvidone iodine)
– Local anaesthesia (1% lidocaine)
– One or two Dec3 (2/0) absorbable sutures
– Sterile drape and gloves

5.10.2 Technique

– Ask the patient to urinate.
– Administer local anaesthesia.
– Swab the perineum and vagina with 10% polyvidone iodine.
– Insert one finger of one hand in the opening in the vulva to protect the urethra.
– With the other hand, use scissors to cut the midline anterior strip of scar tissue; this allows access to the vagina and urethra.
– Ensure haemostasis with a continuous suture along each edge.

After delivery, the opening of the vulva allows free passage of urines and lochias. Women should never be re-infibulated.

Postoperative care is identical to that for a perineal tear or episiotomy.