The 11th of December 2019, I gave a webinar about clitoral reconstructive surgery after Female Genital Mutilation/Cutting (FGM/C). It was an honor to give this webinar together with Dr. Foldès. We were both invited by Fiona Coyle, the Director of the End FGM European Network to give this webinar. Clitoral reconstructive surgery is an important topic for women who have undergone FGM/C. In addition, since there is a lot of misinformation, we found it important to share scientific knowledge and expertise to a wide audience.
Over the past year, I have conducted a lot of research on this surgical procedure. The technique of clitoral reconstructive surgery is discovered and developed by Dr. Pierre Foldès in Paris. The operation is not to be confused with de-infibulation (opening up a women who is infibulated). Clitoral reconstructive surgery focuses on the clitoris as an organ that is damaged during FGM/C. Since the clitoris is much larger than many people think, it is possible to reconstruct a part of the clitoris that is - although not visible from the outside - still present inside the body.
Explanation of the surgery
After a short introduction by Fiona Coyle, Dr. Foldès started off with his presentation. Thus far, he has operated more than 6.000 women who had undergone FGM/C. He explained what happens during the surgery: scar tissue that has formed over the clitoris due to the cutting is removed and the remainder of the clitoral organ is pulled to the surface. With this technique, the clitoris could become visible and (more) sensitive again. It is also possible to reconstruct the small labia, however this is not part of the standard clitoral reconstruction and not applicable to all women interested in the surgery.
How I got involved
After Dr. Foldès presented the surgical technique, I gave a presentation about the existing scientific research that is available about the surgery. I started by explaining how I got involved in this topic. In June 2014, I wrote an article for the Conversation UK, entitled: 'The pleasure doctor fighting to restore clitorises after female genital mutilation.' For this article, I interviewed Marci Bowers, a surgeon from the United States who performs this operation in her clinic in California. Ever since, I have been very interested in clitoral reconstructive surgery after FGM/C.
I then explained that there is an increasing demand for the surgery, both in Western countries as well as in African countries. A small, but growing number of surgeons is performing the surgery.
Current scientific evidence about the surgery
My next step was to present current evidence about the surgery. I explained how I conducted my research, because I believe that it is very important to be transparant. I clarified misconceptions concerning the surgery and concluded that current evidence shows a positive trend in results. There results include:
- Visibility of the neo-glans
- Improvement of sexual function
- Decreased vulvar pain
- Improvement of clitoral function
- Improvement of body image and psychological well-being
The motivations for clitoral reconstruction includes in the first place restoration of female identity. Very often, the focus is placed on restoring sexual pleasure or reducing pain, but research shows that the wish to feel 'complete' or a 'real women' again is the number one reason why women want the surgery. The surgery is therefore very important in relation to women’s bodily autonomy: they are deciding over their own bodies again.Interestingly enough, the surgery is not only offered to women who survived FGM/C, but also to women who had vulvar cancer. The experience of women who suffer from vulva cancer and the resulting amputation of larger parts of the female genitals, are highly similar to women who have undergone FGM/C. In both cases, the loss of a sense of female identity is at stake.
Where the surgery is offered
The surgery is offered in many different countries in the West, but also in African countries, such as Senegal and Burkina Faso. Clitoral reconstructive surgery is covered by health insurances in some European countries but certainly not all of the countries where the surgery takes place. Surgical techniques may differ per country, however, the golden standard is the surgical technique introduced by Pierre Foldès. In the Netherlands, over 55 women have undergone the surgery. Strikingly, this surgery is not covered by health insurance in the Netherlands.
Clitoral Reconstructive Surgery Knowledge Platform
During the webinar, I also took the opportunity to announce the initiative that I took to develop a clitoral reconstructive knowledge platform. The Dutch version of this platform will be launched in the Netherlands at the Zero Tolerance Day, Februay 6th in Nijmegen. I designed an informative brochure about the surgery for every woman, key figures and health professionals who wish to know more about the surgery.After an enriching two hour-webinar where we were able to answer most of the questions, the webinar was closed by Fiona with an essential message: “This surgery is not a solution but part of a broader mission to end and prevent FGM.”
The webinar was recorded and available here: