Socioclinical profiles of women affected by female genital mutilation and factors associated with reconstructive surgery

Female genital mutilation affects millions of women worldwide, and reconstructive surgery has emerged as a therapeutic option within multidisciplinary care, although access remains uneven. We aimed to identify distinct social and clinical profiles among women living with female genital mutilation and to examine the sociodemographic and psychosocial factors associated with reconstructive surgery. We conducted a retrospective comparative cohort study at a multidisciplinary hospital unit specialised in the management of female genital mutilation in France, including all adult women (18 years or older) entering the care pathway between January 2022 and December 2023. Sociodemographic, clinical, and psychosocial data were extracted from standardised electronic medical records. We compared women who did and did not undergo reconstructive surgery, applied Partitioning Around Medoids clustering to identify socioclinical profiles, and used bootstrap random forest analyses to rank the variables defining each profile. The main outcomes were uptake of clitoral reconstructive surgery and the factors distinguishing women’s profiles. Among 247 women included, 137 (55.5%) underwent reconstructive surgery. Operated women were more often educated, employed, and socially integrated, whereas non-operated women presented higher social vulnerability and trauma exposure. Three profiles emerged: first-generation Sub-Saharan African women with moderate vulnerability and an intermediate surgery rate (62.5%); highly vulnerable first-generation migrants, mainly from Guinea and Côte d’Ivoire, with the lowest surgery rate (35.3%); and second-generation women born in France, socially integrated and empowered, with the highest surgery rate (80.8%). Access to reconstructive surgery after female genital mutilation is shaped less by the anatomical type or severity of the practice than by migration history, social integration, and psychosocial resources. Recognising these social-vulnerability profiles can help clinicians anticipate barriers to care, tailor counselling, and design more equitable, multidisciplinary reconstructive pathways, particularly for the most vulnerable migrant women.