A flap is described for recreation of the labia majora. The flap was designed for a young woman who developed vulvar squamous cell carcinoma in-situ after immunosuppression for treatment of juvenile rheumatoid arthritis. The patient underwent removal of the labia majora, and was reconstructed with a bi-lobed abdominal flap tunneled through the mons pubis. The flap produced a normal genital contour and has functioned well to seven years follow-up.

M.A. / Many women who live with body disfigurement as a consequence of illness, continue to suffer from body perceptual disturbances many years following their recovery. Problematic however, is the tendency of disease-specific studies investigating body perceptual disturbances to focus on illness associated body changes. Consequently, this silences the experiences of many women who live with body disfigurement in the absence of illness and more specifically, in instances where body disfigurement is the result of having suffered a common ailment (Francis, 2002; Newell, 2000). Impeding the concerns raised are inferences of earlier studies such as that by Patterson and Craig (1963) who reason that, by virtue of the body's integrity being dependent upon external appearances, hysterectomy, as something internal to the body, fails to feature as a psychological difficulty experienced in women who have this. Recent studies by Newell (2000) and Francis (2002) identify a need for research on body disfigurement following a common ailment and in the absence of illness. In an attempt to address some of the concerns raised, and in keeping with body disfigurement resulting from a common ailment (e.g. cancer, dysmenorrhoea and uterine fibroids, etc), this study compares levels of depression and self-concept in women who have undergone either mastectomy, hysterectomy or vulvectomy. Additionally, this study challenged the inferences by Patterson and Craig (1963) in that the onset of psychopathology in these women is here thought to develop irrespective of the levels of disfigurement visibility (whether disfigurement is internal to the body as in hysterectomy or external to the body as in mastectomy and vulvectomy). In terms of the three areas of participation, of the hysterectomy group (n = 16), of the mastectomy group (n = 8), and of the vulvectomy group (n = 4). Additionally, only participants who had not undergone reconstructive surgery were selected. To investigate for self-concept and body perceptual disturbances, data was collected using the Beck Depression Inventory II, the Self-Description Questionnaire III, the Six Factor Self-Concept Scale and also from open-ended questions posited in a Biographical Questionnaire. The Mann-Whitney, Kruskal-Wallis and Wilcoxon Signed Ranks tests were utilised as nonparametric statistics of choice in the data analyses. The results showed seven areas of significant group differences as this pertains to: levels of depression, physical appearance, spiritual/religious values, general esteem, opposite sex peer relations, parent relations and power. Most striking was the participant responses made in respect to the Importance versus Accuracy subsection of the SDQ-III. Of the 12 statements contained under this section, all were considered to be more important to the participants than the statement was thought accurate of them. Significant differences on this subsection were observed in terms of: parent relations, spiritual/religious values, emotional stability and physical appearance. Although investigating depression and self-concept in women with body disfigurement in South Africa proved to be a complex and difficult research undertaking, the results of this study clearly strengthen its implementation value and demonstrate the need for future research in this area. This pilot study enabled for invaluable insight to be gleaned in terms of the thoughts, feelings and struggles of these women. Similarly the study provided for a method of pre-testing and fine-tuning prior to Phase Two. Additionally, the results of this study contribute to the sparse volume of literature on body disfigurement in the absence of illness. This complex, yet emotionally charged and dynamic terrain is fraught with a magnitude of possibilities for future research and of which can take an infinite number of directions. Altered body appearance and function can invariably result in highly complex psychological and psychosocial disturbances. Francis (2002) echoes what this study commits to when she says: "… when the process of knowing is fractured in a sudden catastrophe, when knowing of the external surfaces of the familiar body is interrupted, the sense of being at home in ones body becomes problematic" (p. 108). As such, this study embraces the possibility that many women in South Africa, who live with body disfigurement in the absence of illness, continue to suffer disturbances in body perception years later and that this is so despite being illness free and irrespective of visibility levels. The study's demonstration of this in real-life intervention serves to highlight this. Similarly, in that 92.3% of participants felt the need to join group therapy or formulate support groups for disfigured individuals as a means by which to voice and better come to terms with past and current traumatic experiences encountered as a result of living with altered body appearance and function, the need for future research in body disfigurement in the absence of illness, is strengthened. It is hoped that, albeit in some small way, this study adds volume to the silenced experience of these women. Similarly, this study hopes to provide a foundation from which many silenced experiences can be voiced.