New surgery technique helps mutilated women “recover identity”

June 16, 2012 by
Health   No Comments Yet

Thousands of women who have been subjected to female genital mutilation (FGM) could benefit from a new reconstructive surgery technique that reduces pain and helps them “recover their identity”, research has found.

Super model Waris Dirie admits being ‘cut’ and is a campaigner against FGM

Over the past 10 years, between 130 and 140 million women worldwide have suffered from the cultural practice, but the first large trial assessing the long-term effects of the new surgical method has shown that it can go some way to helping improve victims’ lives. The study of nearly 3,000 mutilated women, published in the Lancet, has also demonstrated that the surgical technique pioneered by Pierre Foldès, of Poissy Saint Germain Hospital in France, could restore the women’s ability to have orgasms by reconstructing the clitoris, which is often damaged or removed during female genital mutilation (FGM).

“Our findings show that clitoral reconstruction after FGM is feasible,” said Mr Foldès. “It can certainly improve women’s pleasure and lessen their pain. It also allows mutilated women to recover their identity.”

FGM, also known as female circumcision, involves the partial or complete removal of the external female genitalia for cultural and non-medical reasons.

The practice is widespread in Africa, although there are estimated to be 24,000 girls under 16 years old at risk of the most severe form of FGM in England and Wales, according to FORWARD, a leading UK charity working to tackle female circumcision.

Traditionally carried out by older women with no medical training and often without the use of anaesthetics or antiseptics, the procedure is commonly carried out on girls aged between four and 10, with infection, severe pain and fatal haemorrhaging among its short-term effects.

The potential long-term consequences are extensive, and include vagina, pelvis and uterus infections, complications with pregnancy, child birth and menstruation, sexual dysfunction and psychological damage.

According to FORWARD, the origins of FGM are complex and numerous, and it has been difficult to find out where the tradition first began, but the practice is generally understood to be associated with ensuring women follow the rules of their communities.

A way of ensuring chastity in readiness for marriage, family honour, hygiene and increasing the sexual pleasure of the man are some of the reasons given for the practice, and many women believe that FGM is necessary in order to be accepted by their community.

Reconstructive surgery for female circumcision has been available on the national health service in France since 2004, but “women with FGM rarely have access to reconstructive surgery to improve their lives and in most developed and all developing countries surgery remains prohibitively expensive”, said two researchers who led the research, Béatrice Cuzin from Edouard Herriot University Hospital and Armelle Andro from Pantheon Sorbonne University.

The study looked at the immediate and long-term outcomes of 2,938 women who had a new surgical procedure to reconstruct both the anatomy and function of the clitoris in France between 2008 and 2009.

The women were then asked about their clitoral pain and pleasure before, and one year after, surgery. Although five per cent of the patients, 155 people, had immediate complications such as a moderate fever after surgery, 98 per cent of the women who attended the one-year follow-up visit said they had an improvement, or at least no worsening of the pain or clitoral pleasure.

The study’s authors said that reconstructive surgery: “needs to be made more readily available in developed countries by trained surgeons. In France, where most of the health expenses are reimbursed, there is only limited provision, because only a handful of surgeons have been trained in this technique and fewer than ten offer this service.”

In a comment piece published in the Lancet together with the study, the need for reconstructive surgery for FGM victims to be reimbursed by national health services was underlined by other researchers.

“Cultural education and specific training of medical professionals are lacking in many countries,” wrote Jasmine Abdulcadir and colleagues from University Hospitals of Geneva, Switzerland.

“Therefore, women with genital mutilation are not usually informed about the possibility of specific health care to address the consequences of mutilation.

“In some countries, the health insurance national health care systems do not recognise defibulation and clitoral reconstruction as therapeutic procedures, classing them as cosmetic surgery.”

Reconstructive surgery is not currently offered on the NHS in the UK, although the Department of Health (DH) told Under the Scope that the NHS “will support anyone affected by FGM and will offer appropriate advice and procedures where needed”.

“There are also specialist clinics acrossEngland that offer specific advice and support to people affected by this illegal act,” a DH spokesperson added.

Julie Christie-Webb, head of UK programmes at FORWARD, told Under the Scope that the charity welcomes “health provision that enables women affected by FGM to live in dignity and free of pain”.

However, she added that although the NHS does not offer reconstructive surgery to women, “we believe that there are greater priorities for the NHS, namely greater security for those UK specialist health clinics for women affected by FGM that provide care with respect to the complications arising from FGM such as urinary tract infection, and to supporting a safe delivery of babies”.

Mrs Christie-Webb warned that these services are often threatened with closure or a reduced service to such an extent that they become inaccessible to those women in greatest need, such as psychotherapy services for those who suffer flashbacks and post-traumatic stress disorder as a result of FGM.

She called on the UK government to produce an FGM action plan, similar to one drawn up inNorway, to enable “a joined up, informed, multi-agency response to FGM of which health services are a key element”.

For more information, contact The FGM National Clinical Group, c/o Elizabeth Garret Anderson & Obstetric Hospital, Huntley Street, London WC1E 6DH

Read Victoria Lambert’s interview with Ruth Rendell on her campaign to end the practice, and see a video of Somalian supermodel Waris Dirie who speaks out on being ‘cut’ and the need to end the practice

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