Hope on the International Day of Zero Tolerance for FGM

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My Thoughts on FGM

From a western upbringing, it is easy to pass judgment on the seemingly inhumane practice of Genital cutting, otherwise known as Female Genital Mutilation (FGM). The notion of excising the genitalia of young women seems, at first blush, to be cruel by any standard of decency. That a trusted family member would allow and encourage their young daughter to undergo ritualistic cutting, even if done by scalpel under anesthesia in the hands of a doctor (most of the 130 million excised women worldwide were NOT given anesthesia of any kind), seems to be of a barbarism reserved for a long ago era and regimes of torture.

It is perhaps even more ironic that a woman of my western upbringing would bother to comment on the practice of FGM when I, in fact, was not even born female. Then again, I too came by my present genitalia through genital cutting, albeit of a voluntary choice when my birth gender conflicted with my inner sense of femaleness. Yes, at age 38 I underwent a “sex change”—-a change I have never for a minute regretted. I value my femaleness and sexual anatomy as sacred and hard earned and not without considerable pain. But I controlled my destiny throughout the process. My status was a gain and not at all forced upon me.

Women who have experienced genital cutting are victims. Their destiny was never their own. And their genital cutting came with a loss, the loss of a part of their anatomy. Rather, to be accurate, among the many misunderstandings regarding FGM, the clitoris is not completely removed. The clitoris is actually quite large, making it physically impossible to remove all of it. But, what is removed is the sensation associated with the clitoris because the excision leaves it buried beneath skin and scar tissue. This loss of erotic sensation is why most women who have experienced FGM describe a “loss of identity”.

Thanks to the pioneering efforts of Dr. Pierre Foldes in Paris and surgeon followers, Drs. Barri in Barcelona, Henning in Rochester and myself in San Francisco, women are able to regain that identity by uncovering the clitoral body—without cost— and escape the pain and lack of sensation associated with sex attributable to FGM. Like any surgery, clitoral restoration is inherently imperfect. But in a large majority of patients, the surgery is a success on some level, often allowing orgasm and/or pain free sexual experiences for the first time in these women’s lives.

With a reversal of FGM possible, the end of genital cutting, however, is not in reparative surgery. Rather, it is in changing the cultural imperatives that facilitate so many young girls experiencing such potentially lifelong misery. Central to my argument that FGM will end in my lifetime is the fact that the husbands and sexual partners of women who have experienced genital cutting are also not happy. A sexual partner who cannot feel pleasure and does not enjoy sex in any way places great challenges in a relationship through no fault of either partner. FGM benefits no one.

In this era of increased communication, phone and Internet connectivity are allowing for greater honesty amongst people all over the world. There is already a trend against FGM in countries and in larger cities as communication spreads. As this hopeful trend continues, it is important to respect the cultural traditions that underlie FGM. The intent of genital cutting is not malicious. Like a Quinceanera or Bat Mitzva, FGM is a “joyous” celebration for most who view the excisions as a coming of age. What are misguided are the effects and the process of FGM as its “cutters”—women, generally— continue to deceive with promises of enhanced desirability, reduced bladder and pelvic infections, and improved lives. These are the lies of isolation and of persons, the cutters, who benefit economically by an industry clinging to the past.

The world is awakening and slowly coming to terms with many of its injustices. Honesty and communication about sex, about identity and about happiness are the keys to the world moving forward in a world without genital cutting—-in my lifetime. On this International Day of Zero Tolerance for FGM, there is hope.

Marci L. Bowers MD

6 February 2015