Second chance against FGM

Ochieng’ Ogodo

Journalist – Kenya 

[NAIROBI] There is something happening in Burkina Faso that other African nations could borrow a leaf from. Doctors are offering a second chance for women to repair the damage caused by Female Genital Mutilation (FGM). 

This is what Professor Michel Akotionga, a gynecologist and obstetrician teaching at Ouagadougou University in Burkina Faso, calls medical rehabilitation.

Medical rehabilitation is a series of processes that restore some of the damage caused by FGM. This enables women to attain a higher sense of sensation that will make sex as enjoyable to them as it is to women who are not circumcised.

“It is [a method] to give back a woman the possibility to use the functions of the genital organs for menstruation and sexuality,” Akotionga explained. 

Types and Severity

FGM is widely practiced in Africa and some Asian countries. Among the practicing communities, it is a highly valued ritual carried with a near religious enthusiasm. But beneath this enthusiasm and a firm commitment to FGM lie devastating health consequences.

The World Health Organization (WHO) has categorized FGM into four types:

Type I – excision of the prepuce (a fold of skin covering the clitoris), with or without excision of part or all of the clitoris. This is often called clitoridectomy.

Type II – excision of the clitoris and prepuce along with partial or total excision of the labia minora (the inner folds of skin of the external female genitalia). According to WHO, this type accounts for 80% of FGM cases in Africa.

Type III – excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening. This is called infibulation. WHO estimates that 15 percent of women subjected to FGM have undergone this severe form.

Type IV – other practices including piercing, cauterizing, scraping, or using corrosive substances designed to scar and narrow the vagina.

The surgery, explained Akotionga, can be performed on all the different types of FGM. However, it is most constructive in cases of Type III. The stitched and narrowed vaginal orifice, characteristic of this type of FGM, causes major problems for women.

WHO estimates that between 100 and 140 million women in more than 28 African countries have undergone some type of female genital mutilation. Each year, three million girls are forced to undergo the practice.

In some practicing communities, such as among Somalis, the part remaining after circumcision is further sewn up, leaving only a very small opening for urination. This causes adverse health consequences during the menstrual cycle, sexual intercourse, and child delivery. These health hazards may include severe pain, hemorrhage, urine retention, ulceration of genital tissues, and injury to adjacent tissues.

Fetal distress during labor in circumcised women is another of the health consequences FGM poses. Dr. Jaldesa Guyo, an obstetrician and gynecologist at Kenyatta National Hospital, Kenya, explained that the stitching can inhibit the baby’s head from coming out. This leads to brain damage and can also cause problems in the automatic breathing system of the newborn. “There is increased death [of babies] at birth because of FGM,” he added. The risk of loss of a baby at birth is placed as high as 22 percent among circumcised women.

Medical Rehabilitation

According to Akotionga, for a woman to undertake the rehabilitation process, a doctor must first establish the need for the operation. He explained that there are two different types of interventions that may be performed.

The first medical intervention involves the widening of the vagina. This is done under the effects of a local anesthetic. The doctor slowly begins to undo the sewing done to the vagina during circumcision until it reaches the normal size. This is measured as the opening being wide enough to allow two fingers inside. Once this is done, the right and left sides are sewn and held separately so that the vagina stays open. This intervention allows women who have stitched and narrowed vaginal orifices to enjoy sexual intercourse normally.

The second level of intervention, Akotionga explained, is reconstruction of the clitoris after widening the vagina. This takes place by pulling out the inner parts of the clitoris that have not been cut during circumcision. These are then sewn and held to the upper part of the vaginal orifice.

“The FGM process entails the cutting of mostly the outer clitoris. This leaves inside tissues intact. It is this inside tissue that a doctor pulls out in the reconstruction exercise,” said Akotionga.

“FGM denies women the natural ability to enjoy sex which each and every human being is entitled to. The restored clitoris has high sensitivity making sex fulfilling for the woman,” explained Akotionga.

The choice of which type of operation a doctor performs depends on the type of FGM performed on the woman. If the vaginal orifice has been narrowed, then the first intervention is used. But if the clitoris was damaged, then a doctor may operate on the reconstruction of the clitoris.

The first operation Akotionga performed in 1999 was the first type of intervention that widens the vagina. The second type, which involves reconstruction of the clitoris, was only commissioned in 2006. He has started training other doctors in this technique as well. “We have 50 doctors in Burkina Faso trained and are now doing the same [operation]. Other African countries are free to get in touch with us about the expertise,” he said during an interview.

So far, 519 women have been treated by Akotionga by widening of the vaginal opening. He has also managed 50 successful operations involving the reconstruction of the clitoris. The doctor explained that the first medical intervention process was his own development after a thorough study of FGM. The second type of intervention, however, was inspired by Dr. Pierre Foldes who is renowned for having developed the technique which restores the clitoris, thus becoming a savior to thousands of women.

New Hope

Akotionga, who hails from Kasena in southern Burkina Faso, explains that in his community, women are almost always circumcised. Even if they are not circumcised while alive, they are circumcised when they die.

“It is the scope of the problem in my community that made me develop a strong sense against FGM. As a practitioner I have also seen what those who have been mutilated go through, especially what happens during delivery. There are terrible tears, bleeding, and even death can occur. Sometimes the babies die during the process because of complications arising from the mutilation,” he said.

It has been a tough experience for him. Due to the level of poverty among the majority of the Burkina Faso population, Akotionga performs the first type of intervention for free. For the second type, he charges KSh 10,950 ($150) if it is performed in the First Lady’s Clinic where he works. In private hospitals and clinics, the operation can cost up to KSh 29,200 ($400).

According to Akotionga, the response has been extremely good. Many Burkinabè women are now turning to reconstruction procedures to correct the damage committed to them by this harmful traditional practice. “The feedback has been that of tremendous appreciation and many children are now named after me,” he commented, obviously touched by the gesture.

But there has been vigorous opposition from traditionalists who see him as going against the grain. Although Burkina Faso has some very strong laws against female circumcision, they have not been very successful in deterring the practice. It has strong cultural roots and many people have refused to give it up. Akotionga explained that his detractors have been launching heavy media campaigns against his practices under the freedom-of-expression right to ban them.

Medicalisation

However, while surgical repair is now offering these women a chance at a better life, another emerging practice is rather disturbing. Certain medical professionals are resorting to the “medicalization” of FGM. They perform it illegally for monetary gains.

The interest in the medicalization of FGM is increasing, especially among the Somali population in Kenya. In a poll, 15 of the 26 health workers interviewed in Nairobi reported having been approached to perform female circumcision. Most of them even claimed having been asked more than once (USAID February 2005).

The increased interest is attributed to the increased awareness of the health complications of FGM. This has been facilitated among those living in Nairobi by the media and by interactions with other cultures.

“Medicalisation of FGM legitimizes a procedure that is harmful to the health and well-being of girls and women. Furthermore, it is a violation of the ethical code governing the professional conduct of nurses, midwives, and other healthcare workers,” said Dr. Guyo, obstetrician and gynecologist at Kenya’s biggest national hospital.

“WHO has expressed its unequivocal opposition to the medicalization of female genital mutilation, advising that under no circumstances should it be performed by health professionals or in health institutions,” he told the journalists.

Meme Isaac, a Nigerian citizen, rounded up how she feels about the issue. “For me, [FGM] has meant excruciating pain, miscarriages, and other numerous health complications. For my sister, it meant death as a young child. For my aunt, it meant death from complications related to her mutilation during a pregnancy. For my cousin, it also meant death.”

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Ochieng’ Ogodo is a Nairobi journalist whose works have been published in various parts of the world including Africa, the US and Europe. He is the English-speaking Africa and Middle East region winner for the 2008 Reuters-IUCN Media Awards for Excellence in Environmental Reporting. He is the chairman of Kenya Environment and Science Journalists Association (Kensja). His biography will be published in the 2009 Edition of the Marque’s Who’s Who in the World. He can be reached at ochiengogodo@yahoo.com or ochiengogodo@hotmail.com.