Cut (24 page)
Authors: Hibo Wardere
For others, there isn’t much that doctors can do, as they can’t restore flesh that has been taken away. At the reversal clinic in Tower Hamlets, she has also come across cases where
reconstruction has not been clinically appropriate, and some women can experience this as another loss – they have come to the clinic hoping that it can all be undone and are told that
unfortunately it can’t. What Amanda is keen to stress is that any kind of deinfibulation achieves the best results when it is treated in a holistic way, addressing both the medical side and
the psychological side.
Taking that next step to deinfibulate myself completely is not something that I’m willing to go through now. It’s possible that I might never feel ready. For me, there is a barrier
in my mind when it comes to that part of my body, and I worry that any kind of surgical procedure in that area might trigger the trauma of the cutting and the memory of the pain as I slowly healed
the first time. Even today, when I have an infection down there I find it difficult because it is another thing that triggers terrible memories. To some extent, perhaps I have divorced myself from
my own vagina. But perhaps it is time to finally make friends and reconnect. And there are a lot of people out there to support me, and other women like me, in starting that process.
At her clinic at St Thomas’ Hospital in London, Dr Comfort Momoh carries out deinfibulations every single day. Surprisingly, in her clinical experience, 50–60 per cent of women who
have had Type 3 FGM do still in fact have an intact clitoris underneath their scar tissue, so a procedure can be done to expose it, allowing the patient some sensitivity around the area during
sexual intercourse. Obviously this is very positive news for survivors. There is still a relative dearth of information and research when it comes to FGM, but Comfort’s theory for why the
clitoris is still present in such a significant number of cases is that it comes down to a lack of anatomical knowledge in the village circumcisers – they might not know what the clitoris or
the labia actually are; they just know that they have to remove certain things from the body. Comfort has worked with communities from different countries, and she believes that in those where FGM
is performed on girls as babies, there is little that is obvious to remove. Perhaps, then, what takes place is only a partial clitoridectomy, and as the baby develops, whatever is left develops
too.
I also tend to think that the circumcisers are not stupid. They have done this for many years – some might have been circumcisers for thirty or forty years. It is
their job and their livelihood, and perhaps they are aware that, because of the vascularity around the area, a girl can bleed to death if you remove the clitoris. If they remove the less
vascular area, which is the labia, and then cover everything together, the cutter has still satisfied the cultural needs of the procedure.
It is not just Comfort who has reported this finding. A few years ago, American gynaecological surgeon Dr Marci Bowers started working with Clitoraid, a charity that seeks to help FGM survivors
all over the world to undergo reversal operations. It should be mentioned here that this charity has courted some controversy because of its links to the Raëlian religion, which backs it.
Raël preaches that humans were created by extraterrestrials to enjoy untrammelled sexual pleasure, which indeed does raise some eyebrows, and yet there is no doubt that the cause they’ve
taken up helping FGM survivors is a noble one, so it’s worth hearing what they have to say. Dr Bowers is keen to point out that she is not a ‘Raëlian’ but a doctor, and since
her training was sponsored by the organisation she has performed reconstructive surgery on 150 patients, many of whom had travelled from Britain to her clinic in California for help, for which she
does not charge. Like Comfort, Dr Bowers has noted that a full reconstruction isn’t always necessary – one in five of the women she sees has a clitoris that is completely intact.
‘The cutters are not trying to injure the girl, they are doing it as a rite of passage. These are often their loved ones, their friends’ children, their nieces. They are doing it to
control sexuality, and they know not to go very deep and put the girl’s life in danger.’
Dr Bowers gained her expertise from training with the pioneering and well-respected French urological surgeon Pierre Foldès, who developed a technique that would help reconstruct victims
of FGM. Like many doctors, before she joined Clitoraid, Dr Bowers had very little understanding of what FGM is, and was sceptical about the possibility of clitoral reconstruction, in part due to
having only a superficial knowledge of the nature of the clitoris.
FGM is not as destructive medically as you first think because what it does more than anything is obscure the clitoris by burying it under scar tissue. There is a lot of
clitoris, it isn’t a 2mm piece of tissue, it’s much larger – just as in males, where the erogenic area of the pelvis when mapped out is much larger than advertised, so the
clitoris is literally the tip of the iceberg. There is an 8 per cent mortality rate overall from FGM – the cutters know only to go very superficially, mainly removing the labia minora and
the clitoral hood, and not to go too deeply into the clitoral body. The clitoral body is where most of the sensation is from, so the reversal process means we’re trying to locate that
clitoral body and bring it to the surface. You just need to dig beneath the surface and it’s always there, one hundred per cent of the time.
Prior to talking with Dr Bowers I’d had no idea just what a huge and deep organ the clitoris is. ‘It just goes to show that such superficial attention is paid to a woman’s
sexuality,’ she says. ‘Socially and globally, people just don’t talk about it. This is due to vestiges of past Victorian attitudes which are dismissive of women’s sexuality,
but if you understand that area of the body then you realise that there is so much more to it. We shouldn’t be so afraid of it.’ Dr Bowers admits that reconstructing the labia
isn’t always possible – once skin is gone, after all, it’s gone. For her, finding the clitoris is, in her words, ‘the money spot’. However, while surgery offers so
much hope to women, she’s also very mindful of the trauma it can cause too, and acknowledges that the reactions of patients vary from individual to individual.
Women don’t usually come forward because they want any kind of restoration of pleasure; they come forward because they feel their identity was stolen by FGM. They
want to reclaim their identity, and many psychological effects can be gained by doing that – they receive validation for what they went through; it can be an opportunity to connect with
other women who have gone through it; they can often feel more engaged sexually after surgery. But women can find it difficult too; they can be surprised by the sensations that they are left
with because the clitoris is fairly unprotected and they can be surprised by how sensitive that area is. Mostly that can be a good thing, especially if prior sensations in that area were
associated with negative feelings. It’s very complicated because there is also a risk of re-traumatising women.
It’s important, therefore, that women also have psychological support when they go through any kind of reconstruction; although Dr Bowers offers her surgical skills for free, and a number
of psychotherapists have offered their time to her team, it can still be harder to secure as much voluntary psychological assistance as she would like. Nevertheless, the fact that this service is
free is an acknowledgement of how important this issue is worldwide. ‘We don’t charge patients because Pierre Foldès did not charge for his work,’ says Dr Bowers. ‘He
feels FGM is a crime against humanity so therefore it would be unethical to charge for reconstructions. In my work I’m able to pay my bills through other means. It’s a beautiful thing
to be a part of.’
Thirty-eight-year-old Pamela Okah-Bischof from Nigeria is one of those women living in Britain who has sought reconstructive work. She says that undergoing this surgery was, for her, a way of
resolving the anger she felt at the fact that she had been subjected to Type 1 FGM when she was a young girl.
I remember clearly what happened to me. I was eight or nine at the time. I had been sleeping that morning in my brother’s room because I had watched a movie that was
scary the night before and I didn’t want to sleep alone. Between 5:30 and 6am, my father and stepmother came to get me out of my brother’s room. My father told me I was going to do
what my sisters had done and I was going on my journey towards being a woman. I said to him, ‘What does it mean to be a woman?’ and he said, ‘Don’t worry.’ There
were two hefty women there and one smallish one, and she carried the little bag with her. They asked me to go into my room and already there was a mat on the floor. They asked me to take off my
bottoms and lie down, and just as I hit the floor the two women jumped me. One of them sat on my chest and held my arms down, the other two tore at my legs . . .
I didn’t think anything about FGM as I was growing up. At first, when it happened, I didn’t think about culture or anything like that. For me at that time FGM was not a crime; it
was just something they had to do to you. It was later on when I started having the flashbacks, and when I came to the UK and I started to research it, that I had a lot of anger issues. I
didn’t care that it was a traditional or cultural thing – my father was a very educated man and I didn’t expect that he would have gone down this route. For me there was a lot
of anger, but my father passed away so I never had the opportunity to speak to him about it.
Pamela’s way of dealing with the anger was to take back control of her own body by searching for help. She attended Comfort’s clinic, where they cut open the scar tissue over her
clitoris in order to expose it. But this, for Pamela, was not enough of a reversal. She felt something had been taken away from her and that perhaps someone could give it back. It wasn’t
about her sex life – she had always been able to orgasm – but about her psychological wellbeing. As a midwife, she sees vaginas on a daily basis, and she wanted to be able to look at
herself and feel that she also had a normal vagina. ‘If I didn’t know what normal was it wouldn’t have been an issue for me, but for me it was done at an age when I remember so
many things and I can’t forget what happened. It was the fact that I knew something had happened that was killing me more than anything else.’
At first, Pamela travelled to Paris for surgery. When they were unable to reconstruct the clitoral hood, which she dearly wanted, she contacted the Desert Flower Foundation in Berlin. There, a
plastic surgeon was able to give her the vagina she wanted.
Women think that it’s traumatic to have surgery, but . . . when you wake up you feel like a different person. You wake up knowing that something has changed. The
experience psychologically for me was completely different. When they carry out FGM, they don’t put you to sleep; you don’t have people around you, talking to you, or counsellors
like they had in Berlin. [When you’re having the reconstructive surgery] nobody is pinning you down or cutting you against your will – this is someone trying to help you. You tell
them what you want and they do what you ask. I had complete control over the situation. It is very empowering, and there wasn’t any pain when I woke up.
Pamela had her surgery in July 2015, and she has now set up the Revive Foundation, which aims to fund women travelling to Berlin for reconstructive surgery. She is a strong advocate of women
following their hearts, and pursuing reconstructive surgery if they feel that it will help them come to terms with their circumcision. ‘It hasn’t given me complete closure. I
don’t think you can ever get closure because mentally you know that you’ve been touched. You still get that flash of anger once in a while. You will always regret that you were made a
victim of your parents. But it’s one more step, for me, towards reconciliation with my father, my stepmother and with myself.’
Aside from the potential psychological benefits of deinfibulation, there is often a very practical need for the procedure. Joy Clarke remembers the first time she came across FGM in her clinical
career as a midwife, twenty years ago. A woman turned up on Joy’s ward in the very last stages of labour, having suffered Type 3 FGM. As mentioned, some women fall pregnant without ever
having been deinfibulated. Joy’s patient, a dentist from Sudan, was already fully dilated when she arrived. ‘The reason we knew this was because, through the tiny hole that remained of
her vagina, the baby’s long black hair was twisting and turning.’ The baby was there, waiting to be delivered, but it couldn’t get out because the woman was still entirely
infibulated. The woman was obviously in great distress, and she was not alone.
The woman was yelling, and you want to be calm and to be able to console her, but everyone was panicking. The room was full of doctors and midwives, and I was so shocked,
my back was against the wall. The doctor was frightened, the woman was frightened, and the doctor had no choice but to do an anterior episiotomy – that is, he cut her up the front,
upwards of her vagina – and the second he did, the baby just fell out. The baby had been pushing against a closed door, and the minute it was open, it fell out on to the bed.
It is impossible to imagine the fear that woman must have felt as she tried to give birth to her baby, and this is why clinics like Joy’s and Comfort’s aim to identify women before
they get to that stage of pregnancy. If that doctor hadn’t opened the woman there and then, both her life and the baby’s might have been lost. Imagine a similar scenario taking place
out in rural communities – it’s no wonder that FGM is linked to both maternal and infant death. Today, the procedure at many antenatal clinics is to identify FGM survivors early on in
their pregnancy, so they can be opened between twenty and thirty-two weeks, allowing time for them to heal before the birth. Of course, pregnancy should be a time of happiness, when a woman enjoys
the way her body changes and grows as she feels the baby kick inside her, rather than a process that involves undergoing yet more surgery and potentially reliving the initial trauma in the recovery
period following the deinfibulation. But at least a partial deinfibulation, like I had, is a necessary thing to do, even if the woman hasn’t had a full Type 3 cutting. If her urethra is
covered by scar tissue, this could cause huge complications in an emergency situation, particularly if she needed to undergo a Caesarean and had to be catheterised.
