Important publications on clitoral reconstructive surgery
In 2006, he published his first article about clitoral reconstructive surgery. In 2012, he published a very important study in the Lancet about the operation. They included 2,938 women in the study that were operated in France between 1998 and 2009. The 1-year follow-up visit was attended by 866 patients. The vast majority of women reported an improvement, or at least no worsening in pain (98%) and experienced an improvement in clitoral pleasure (98%). After 1 year, 51% of the women said they experienced orgasms. So far, Dr. Pierre Foldès has operated more than 6.000 women in France and has a wealth of knowledge about the operation. I was very honoured that he invited me to his clinic and had time to meet me.
Visit together with Dr. Karim
I traveled to Paris together with Dr. Refaat Karim, who is a plastic surgeon from the Netherlands who has operated about 50 women in the Netherlands since 2010. We wrote an article (in Dutch) together with Judith Dekker (gynecologist at the University Medical Center Amsterdam) a few months ago in Medisch Contact. Our main point is that this operation should be covered by health insurance in the Netherlands, as is currently the case in Belgium, Germany, France, Sweden and Switzerland.
It was very nice to meet Dr. Foldès and his wife Frederique Martz in person. We started early morning with a cup of coffee and moved into deep discussions from the very first minute we met. We shared our thoughts, opinions, experiences and knowledge about clitoral reconstructive surgery (of course!), but also hymen reconstruction surgery, labiaplasty, sexual violence, vulvar cancer, and so on. I also had the opportunity to ask all different kind of questions to Dr. Foldès in relation to the different surgeries that he performs. It was super interesting!
Knowledge Platform on Clitoral Reconstructive Surgery
I was also excited to visit the clinic of Dr. Foldès and to meet him in person, because I am currently developing a Knowledge Platform on Clitoral Reconstructive Surgery. The aim of this knowledge platform is to share scientific evidence and knowledge in a way that is easily accessible for women who have an interest in undergoing the operation as well as health professionals who want to know more about the surgery. I also had the first version of the flyer that I developed (currently only available in Dutch) with me and gave it to Dr. Foldès to ask his opinion.
We also had a discussion about Type IV FGM/C. What I found very interesting to hear is that Dr. Foldès also operated women from India and Indonesia, who - on paper - underwent a less severe form of FGM, namely 'pricking' which we qualify as Type IV FGM. He explained and showed us that from the outside, you only see a small scar just above the clitoris. The rest of the vulva looks ‘normal.' However, he explains dat he needle with which they prick in the clitoris, sometimes goes very deep and causes more harm than a type I FGM (when the tip of the clitoris is cut off). The scar tissue caused by the prick damages the nerves, which could result in no sensation in the clitoris, Dr. Foldès explained.
In addition, we also spoke about complication rates of the surgery, as many guidelines (both at the World Health Organization as well as national guidelines, for example in the UK and the Netherlands) mention an 'unacceptable high complication rate,' which does not correspond with current evidence in scientific research. In addition, we discussed the effectiveness of the surgery and the possible reasons why the established order of health professionals seems to be dismissive of clitoral reconstructive surgery.
The clinic of Dr. Foldès
Dr Foldes then showed us around in his clinic and introduced me to his staff. It was really nice to see, especially his holistic approach that is clearly visible in his clinic. He has a nice living room in the clinic, which feels very ‘African’ when you enter. I found it also interesting to see that the clinic closely work together with psychiatrists, acupuncturist, sexologists, jurists, lawyers and also the police. Women could report cases of sexual violence to the police immediately and the clinic facilitates that. I think this is very important and it was great to see that it works out so well.
In addition, it was interesting to hear that clitoral reconstructive surgery is only 10% of the women that Dr. Foldès operates in his clinic. All the other cases include women who suffer from other types of violence. Lastly, it was noteworthy that only a relatively small percentage (about 30%) of the women who enter the clinic who have an interest in clitoral reconstructive surgery, are - in the end - operated. As all women have to go through the whole holistic process, many women will find alternative ways to cure their problems. After all, an operation is in most cases not (yet) the answer to the problem that women with FGM/C face.
However, for those women for whom the operation is a solution (so far Dr. Foldès has operated more than 6.000 women), it is great that it is possible and available without any costs in France.