Abdulcadir who specializes in providing services for women who
have experienced FGM/C, urges them to consider this surgery for reasons ranging from reduction of chronic clitoral pain
or to improve sexual pleasure.
For the last two
years, she has supported the work of WHO/RHR in development and
implementation of a research agenda that aims to address the needs of women and
girls who are at risk of and who live with FGM towards improving the
evidence-base for effective policies, and their implementation. Several women that have been cut see clitoral reconstruction as a way to
improve their body image and female identity.
"They may want to reverse a
procedure that was performed without their consent or to regain a genital
appearance similar to uncut women," she argues.
On what can women expect from the surgery, she says: "When FGM involves the cutting of the clitoris, it affects
the clitoral glans (the visible and more external part of the organ). The
majority of the clitoris (the body and crura) lies anatomically deeper and is
therefore not affected by the procedure.
"Additional structures responsible for
sexual pleasure, such as the bulbs, also remain intact. This explains why women
who have undergone FGM, and do not have psychosexual or other long term
physical health complications, may still experience orgasm and sexual pleasure."
Abdulcadir describes clitoral reconstruction as a surgery that consists of
re-exposing the clitoral body that is hidden beneath the scar tissue and
recreating a more accessible clitoral glans, which can facilitate its
stimulation.
"Reduction of clitoral pain and improvement of sexual
function are chief among reported positive outcomes. However, the surgery is
not without its complications: hematoma, wound breakdown, and post-operative
decreased sexual function have been reported in the literature. The rate at
which these complications occur ranges from 5.3% to 40%.
On implications for women considering clitoral reconstruction and their
providers, she says there is still much unknown about the outcomes of
clitoral reconstruction and urged health providers to make women who consider the surgery
aware of this scarcity of scientific evidence.
"Whether considering the surgery or not, women should be
offered comprehensive, multidisciplinary care including health education on
female anatomy, physiology and sexuality, as well as psychosexual therapy.
"Often, adequate psychosexual care and counselling can improve women's sexual
function, body-image and identity with no need for more invasive interventions.
Female sexual function is multifactorial and depends on more than the genital
anatomy."
Abdulcadir says prior to undergoing any surgery, it is crucial to explore
women's pre-operative symptoms, expectations, beliefs and misconceptions on the
clitoris, their anatomy and sexuality. "Other possible psychological or physical
comorbidities that can affect sexual function should also be screened and treated.
If possible, partners should also be included in the care.
"Alternative therapies for improving the sexual
health and wellbeing of women living with FGM/C
Women with FGM type III (infibulation) can suffer from
superficial dyspareunia (pain during intercourse) and should be offered
deinfibulation, a procedure to re-open the vaginal opening after infibulation
has been performed.
"This helps facilitate penetration during sexual activity,
hence reducing painful intercourse. It also facilitates urination, menstruation
and childbirth. Health education focusing on cultural myths on the clitoris,
women's anatomy and physiology, and FGM, as well as associated psychosexual
therapy are alternative and effective therapies to improve sexual health that
can be proposed to women living with FGM and their partners," she argued.
