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Excision of clitoris without consent leads to $2 million settlement


Mr Kaplan is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP, specializing in medical malpractice defense and healthcare litigation. He welcomes feedback on this column via email to aikaplan@arfdlaw.com.

 

FACTS

On December 17, 2001, a 52-year-old woman saw Dr. A for a gynecology/oncology consult at the direction of her gynecologist. The patient/plaintiff had been diagnosed with lichen sclerosus years earlier. She reported to Dr. A that her condition had been unresponsive to all previous medical treatment, including antifungal, estrogen, testosterone, corticosteroid, and antibacterial medications. Dr. A performed an exam of the external genitalia and observed whitish discoloration in the anterior vulva area consistent with lichen sclerosus. He also noted small fissures in the discolored area and around the perianal area.

He recommended a trial of clobetasol propionate for 4 weeks and then a re-evaluation.

At a January 3, 2002, follow-up appointment, the plaintiff’s condition had not responded to the clobetasol and she complained of worsening vulvar itching. Dr. A performed a physical exam and observed scratched fissures on the labia minora and majora, as well as white discoloration on the perianal area. On January 14 he performed a simple vulvectomy. Superficial layers of skin were removed from the labia minora, the anterior part of the labia majora, the clitoral hood, and the posterior areas between the introitus and the perianal area. The full thickness of the skin was not excised and Dr. A’s operative report stated that he did not excise the clitoral area.

After surgery, the plaintiff was ambulating and afebrile, and Dr. A noted no complaints from her. At discharge, Dr. A instructed the patient to take sitz baths 3 times a day and avoid exaggerated movements and sexual activity.

On February 28, 2002, the patient saw Dr. A for a follow- up appointment. The plaintiff reported no pain or discharge, nor did she have complaints about her gastrointestinal or genitourinary systems. She was healing well except for small superficial wound suppuration in the posterior fourchette. Because of the suppuration, Dr. A advised the plaintiff to rest her pelvis, and specifically to abstain from sexual activity and avoid touching the area or using tampons. He instructed her to return in 4 weeks but she did not and also missed a June 6, 2002, follow-up appointment.

In the meantime, the woman saw another gynecologist on June 8 and again on June 27. She was treated with metronidazole for “a vaginal problem.”

 

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