The 20th of October 2020, I was invited by the FGM Specialist Network in the United Kingdom to give a presentation during a webinar on clitoral reconstructive surgery and psychosexual services for FGM/C survivors. The FGM Specialists Network was set up by the Royal College of Midwives, with funding from the Department of Health and NHS England. Its goal is to set up a virtual forum to support primary health professionals and anyone else working to end FGM/C. They also created an e-network, which acts as a confidential platform for discussion of issues or specific problems, and for sharing information and best practices in a safe space.
The webinar focussed on the challenges in the UK when it comes to offering clitoral reconstructive surgery and psychosexual treatment for survivors of FGM/C. You may already know that I have worked together with Dr. Pierre Foldès, the founding father of this operation. I visited his clinic in Paris earlier this year. I was invited by the FGM Specialist Network to share my experiences and research research results of a review of academic literature on clitoral reconstructive surgery that I conducted recently. But I was not the only one who was invited to speak to share my knowledge! I found myself in the ranks of Soheir El Neil, consultant urogynaecologist and uro-neurologistat at the University College Hospital and the National Hospital for Neurology and Neurosurgery in London; Jasmine Abdulcadir, obstetrician and gynaecologist at the Geneva University Hospitals who has performed the operation; Hoda Ali, Community Outreach Project Manager for Safeguarding; Leyla Hussein OBE, who is a activist, psychotherapist and founder of the Dahlia Project; and Astrid Fairclough, NHS England FGM/C Expert Advisor. The webinar was moderated by Juliet Albert of The Sunflower Clinic, Imperial College Healthcare NHS Trust.
Clitoral reconstructive surgery in the UK?
In the UK, clitoral reconstructive surgery is unfortunately not (yet) offered, meaning that FGM/C survivors who are living in countries like France, Belgium, Germany, Sweden and Switzerland could be able to undergo this operation (and have it covered by national health insurance), but women in the UK currently do not have access to this type of surgery...
The webinar started with a warm word of welcome of Janet Fyle, Policy Advisor at Royal College of Midwives in the UK. Afterwards, Juliet Albert provided a brief introduction to the topic and why they organized a webinar on clitoral reconstructive surgery and psychosexual services for FGM/C survivors. She explained that in her clinic, women often come to her and say: "I don't feel whole" or "I just want put back what's been taken away" or that women directly ask if they can get clitoral reconstructive surgery. However, she also explained that some health professionals in the UK keep on telling women that their whole clitoris has been completely removed, while this is anatomically incorrect. Many people, including health professionals, are not even aware that when FGM/C is performed, only the external part of the clitoris is removed, but that the rest of the organ (inside the body) stays intact. For this reason, the FGM Specialist Network decided to organize a webinar to start a discussion among professionals based on evidence around this topic. A lack of knowledge and understanding of this surgical procedure seems to be the issue at stake in the UK.
Therefore, Juliet asked the presenters to provide answers to the following four main questions:
- Why do these services exist in Europe, Africa, Australia, USA, but not in the UK?
- Do women want this type of service?
- What model of care is preferable?
- Should this be provided by NHS?
Inspiring presentations of all speakers
First of all, Soheir El Neil gave a presentation about the consequences of FGM/C, more specifically female sexual dysfunction and the role of surgery. She confirmed Juliet's statement before that they get "asked about the surgery all the time." Jasmine Abdulcadir gave a presentation entitled 'The experience of the specialized clinic in Geneva: surgery and psychosexual care after FGM/C.' She explained the type of patients she receives in her clinic, how she interacts and works together with other professionals and illustrated some clinical cases with the audience to further explain her approach towards clitoral reconstructive surgery. She also provided more background information about the clitoris, the types of FGM/C and the surgery. Hoda Ali provided the survivors perspective and her position on clitoral reconstruction and (sexual) health care provided for women with FGM/C and Leyla Hussein provided the mental health perspective. She first explained about the Dahlia project and afterwards the psychological effects of FGM/C. She emphasized that we must not forget the major psychological trauma that FGM/C can cause.
After Leyla's presentation, it was my turn to give my presentation. First of all, I explained to the audience how I got involved in clitoral reconstructive surgery and why I decided to do more research in this field. I showed some pictures of my visit to the clinic of Dr. Pierre Foldès earlier this year and shared my experiences. In addition, I explained how I conducted my research and presented current evidence, including the motivations for the operation, the effectiveness of reconstructive surgery, complications, methodological limitations and my reflections on current guidelines (WHO, UK, the Netherlands) - namely that they are not aligned with scientific evidence. I concluded that the medical establishment is very sceptical, but that their sceptism is based on wrong assumptions and lack of scientific knowledge of FGM/C. I believe that any well-informed and competent adult women should be free to make a choice for clitoral reconstructive surgery (and that it should be covered by national health insurance).
I explained in the webinar that reconstructive surgery should not be seen as a form of ‘beautification’ to conform to some set ideal; the aim is to reconstruct an organ that has been damaged, not to modify one that is unharmed. I of course agree that different types of care are possible and necessary, surgery is not only solution. However, I find it peculiar, to say the least, for European states to argue that FGM/C is a human rights violation and spent a lot of money on combatting and preventing FGM/C in Europe and outside of it, but not let women who have tried everything have that option covered by insurance, while its effectiveness is proven.
Of course all of the speakers had their own ideas, experiences and stories to share, it is always interesting to hear different perspectives on a subject.
We didn't have enough time to fully start the discussion. However: the ball is rolling and plans for a follow-up webinar were made so we can further hear from everyone and answer more questions!
After the webinar, I had a nice virtual coffee with Jasmine Aldulcadir, where we further discussed the effectiveness of the operation, including her publications and her views as well as my research findings. I really enjoyed our conversation and brainstorm session and I am thankful for the FGM Specialist Network to organize this event.
Around 75 people joined our webinar, which was great. And after the webinar, we received a lot of positive responses of these participants, see some of their responses below: