Reconstructive surgery brings hope to survivors of genital cutting

New advances can give women more normal lives
From Africa Renewal: 
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A patient in Sierra Leone awaiting surgery to correct fistula, a condition often  caused by FGMA patient in Sierra Leone awaiting surgery to correct fistula, a condition often caused by FGM.
Photo: Alamy/Celia Mannings

Tonte Ikoluba was 13 years old when her grandmother came to her family home to circumcise her. She remembers it as if it were yesterday. Her grandmother coaxed her and told her not to worry. It was important she go through the rite, she was told, in order to become a respectable woman and increase her chances of getting married some day.

“I closed my eyes tight and tried to gather my courage,” she said. She wanted to wait a little bit, but her grandmother and another woman held her down.

Tonte does not like talking about that day. The memory is too painful. She was scared. Her sister had the procedure done before her, and she bled so much that she had to have a blood transfusion in the Malian hospital. 

Female circumcision — otherwise known as female genital mutilation or cutting (FGM/C) — is defined by the World Health Organization as “all procedures that involve partial or total removal of the external female genitalia. It also involves any other injury to the female genital organs for non-medical reasons.”

FGM/C is a millennia-long custom that practicing communities believe is an essential part of raising a girl properly. About 140 million girls and women worldwide are currently living with the consequences of FGM/C, according to the World Health Organization. Some 92 million girls 10 years old and above who have undergone the practice are in Africa, the agency adds. 

Health consequences

The practice has several immediate and long-term health consequences, says Marci Bowers, a gynaecologist in San Mateo, California. Many women like Tonte suffer for years after being circumcised because of scarring and frequent infections. The pain is constant, says Tonte. She is 35 years old and is still single, she says, because she cannot bear to have anyone touch her “down there.” Not even a doctor.

Dr. Bowers told Africa Renewal that pain is a major problem for her patients. The majority have undergone the most severe kind of cutting, called infibulation, in which the clitoris is removed and the labia are stitched together to form a cover over the vagina. Only a small hole is left for urine, menstrual blood, childbirth and intercourse. 

Dr. Bowers is a surgeon who performs “reversal surgery” on her patients to repair the vagina and clitoris so that these women can have more normal lives. “The scar tissue that forms around the clitoris and encases it is uncomfortable. But in the cases where women have been infibulated, by dividing that infibulation, for the first time since the incision they are able to pass urine normally, they are able to pass menses normally. And they are able to have sex or childbirth without a constricting band that prevents those things.”

She says the surgery is 100 per cent effective in alleviating pain for patients. “The relief that overwhelms these women has been one of the reasons women are glad they went through this surgery.”

Advances in surgery

Reconstructive surgery for patients who have gone through FGM/C has been around for a long time. But the technique of clitoral repair surgery was only developed in 2004 by a French urologist, Dr. Pierre Foldès. It entails opening the scar tissue, exposing the nerves buried underneath and grafting on fresh tissue. The procedure reduces the chronic pain associated with FGM/C, allows women to regain clitoral sensitivity and even permits some to attain orgasm. 

In Burkina Faso, where Dr. Foldès has trained several surgeons, the procedure has been offered since 2006. Previously, in 2001, the government sponsored and introduced a more general genital repair surgery, reports the National Commission Against Excision. Meanwhile, in an effort to make the clitoral repair surgery readily available in Africa, seven surgeons in Dakar, Senegal, recently received certification after training under Dr. Foldès and Senegalese oncologist Dr. Abdoul Aziz Kassé.

Dr. Bowers was also Dr. Foldès’ pupil and has now volunteered to do similar work. She will be operating on Tonte Ikoluba for free, and has pledged to match every donation to the cause with her own money. Together with the Campaign Against Female Genital Mutilation (CAGeM), an international network devoted to countering FGM, she will help make the surgery available in Africa too. The organization was established in 1998 by a group of women doctors in Africa, in response to the high rate of infant and maternal deaths in communities that practice FGM/C. It is also working in New York: the practice is becoming more common in the US because of a growing population of immigrants from such communities. 

CAGeM is building a hospital in Port Harcourt, in southern Nigeria. To be called Restoration Hospital, it will provide the surgery for free and be open to any patient from West Africa. Dr. Aberie Ikinko, director of the organization’s US branch, explains: “We have already 400 women on the waiting list. We are also training the local doctors so that when we leave, they can continue to perform the surgeries for free.”

Most women in Africa cannot afford the surgery, nor are they able to travel far. Dr. Ikinko told Africa Renewal that funds are being raised in New York to send supplies in preparation for the hospital’s opening. CAGeM hopes Restoration Hospital will also be able to offer other free medical treatments for women, including operations for fistula, a hole that can develop over many days of obstructed labour, which is often caused by FGM/C.

Campaign for change

A high-level event at the UN General Assembly in September 2012 called for increased commitment and concerted action from governments to end the practice of FGM/C. A UN resolution aimed at intensifying global efforts to end FGM/C was approved for the first time on 26 November. Chantal Compaoré, the first lady of Burkina Faso who championed the resolution, hopes that African countries will sign it and take ownership of the ban. 

After two decades of global efforts to end this practice, many communities are also now embracing change. Close to two thousand communities across Africa abandoned the practice in 2011 alone, according to a report by the Joint Programme for the Acceleration of the Abandonment of FGM/C. Set up in 2008 by the UN Children’s Fund and the UN Population Fund, the programme seeks to spur change through a culturally sensitive, human rights–based approach that promotes collective abandonment of the practice. 

Some previous strategies that regarded the rite as “barbaric” and “backward” met with resentment and backlash from local communities. Rather than ending FGM/C, such campaigns pushed supporters to simply hide the practice and scared them from seeking medical care, thereby placing young girls’ lives at continued risk. Recently, educational efforts have been playing a more central role in campaigns to end the practice, with many activists choosing to present FGM/C as a public health issue and concentrating on the harmful and sometimes deadly effects it has on young girls and women. 

Although there is renewed hope for a global ban on the practice, so far there has been little focus on solutions for the many girls and women who have already undergone cutting. The possibility of reconstructive surgery is therefore a godsend to young women like Tonte. “They took away part of my womanhood,” she says. “I just feel very deprived. I want to be whole again.”