Female Genital Mutilation Reconstructive Surgery .. Can what was amputated be repaired?

I went through years of insistent thinking about what the difference was between the normal appearance of women’s and girls’ vaginas and the appearance of a vagina post-mutilation.

And how could a tragic accident that happened years ago be able to change my life so much?

All of them are questions to which I did not find an answer, but I grew up, and it grew with me.

Years ago, female genital mutilation for girls became criminalized in Egypt, “Khitan”, amid ceaseless campaigns against this crime.

However, the percentage continued to rise, preserving the distorted cultural heritage with regard to women.

At that time, “clitoral reconstruction surgery” for circumcision deformities appeared, which was founded and directed by Dr. Amr Seif El-Din and Dr. Reham Awwad, to revive hope in the hearts of women and girls.

I kept following the matter from afar, reading about it and listening to the experiences of the women undergoing this restoration, perhaps my feet would obey me and take me to the restoration center, if only to learn from the doctors how bad my condition is, or more accurately, I may learn that broken things can be fixed.

According to the United Nations, “Khitan” means “the mutilation of the female genital organs.” It includes all practices that involve partial or complete removal of, or other injury to, these organs for reasons not intended for treatment.

The organization estimates that nearly 200 million women in the world are now living with the effects of FGM in 30 countries in Africa and the Middle East.

Psychological and physical consequences of circumcision

Serendipity came to play its part in my going to the center by virtue of my work as a journalist. After meeting the specialist, I found myself talking to her about my pain and my fears.

I became more curious to know the practicality of the operation and its consequences as well. The doctor tried to reassure me, and soon the conversation turned to a medical examination.

The examination was conducted with Dr. Reham Awwad, a plastic surgeon, who performs plastic and reconstructive surgeries for women who have undergone khitan, and helps them to overcome this experience, both physically and psychologically.

Lying on the examination bed and opening my legs was enough to take me back to 16 years ago..

And my experience with khitan was different, and what I believe is the silver lining of my dark cloud, because the one who mutilated me is a doctor who still practices the profession in his clinic in a Cairo neighborhood. I am not one of those who have been mutilated by hacks in the villages or “midwives”.

The doctor told me not to be afraid of lying on this bed, and that what happens in the medical examination room stays between the two of us.

She asked me about my age now, and at what age I was mutilated, if I was married or not, and other similar questions.

Then she asked me to speak frankly about my feelings and what I feel during intercourse. Have you ever had an orgasm before or was it something that never happened?

According to Awwad, “with a large number of cases that I examine daily, I discovered that they are completely ignorant of what is known as an orgasm.”

She told me a lot about what happens to us as women while undergoing mutilation or “khitan”. And how it causes psychological trauma that may haunt us for a lifetime.

The medical examination is beginning to take another turn, the practical part. At first I was almost trembling, unable to be touched.

I remembered the scene of being drugged in a similar bed, and hours later I woke up in pain.

Moments I couldn’t forget, the cries that didn’t stop, the weeping hysterically, amid the endless blessings of my mother and grandmother.

The doctor asked me not to think of anything besides answering her questions. She was trying to distract me so that I could complete the practical part of the examination to determine my condition.

After finishing, she assured me that it was simple, and that I was one of the lucky ones in this misfortune.

She gave me some information which I hadn’t known before, such as the necessary medical procedure for my condition, steps to take to relieve the pain that always accompanies me during movement, and other tips.

But she confirmed that the bulk of my ongoing misery and pain until now is psychological and not physical, and that I need psychological support sessions with the center’s psychotherapist.

And when she asked me why I wanted restoration, I stopped at this question a lot. I replied that I did not know the exact reasons.

Is it to restore my sensation to normalcy? Or a desire to beautify what has been distorted? Or maybe to not feel broken and lacking, or to prove to myself that sometimes broken things can be fixed.

Perhaps to encourage many others or to forget what I went through and start over. And maybe to see the natural shape of my body before it was slaughtered.

 

What is genital mutilation?

Khitan often occurs between infancy and 15 years of age. It is usually carried out using old-fashioned tools such as razors or knives.

There are several types of Khitan, and the ritual usually involves the partial or total removal of the external genitalia, including the clitoris.

Girls may also undergo suturing of the vaginal opening, and other procedures of genital cutting and mutilation.

Although this dangerous mindset and its practices are related to belief systems and religions, it is not mentioned in any of the scriptures. It is likely that it dates back to the traditions and customs of ancient times. However, many still see it as a religious sunna.

In 2021, the Egyptian Parliament approved a draft law that increases the penalty for female genital mutilation to reach a maximum prison term of 10 years.

This law opened the door to punishing the guardian, who tries to have a khitan performed on their daughter, with imprisonment for a period of no less than 5 years.

If the act results in a permanent disability, the penalty shall be imprisonment in a high security facility for a period of no less than 7 years.

If the act results in death, the penalty shall be imprisonment for a period of no less than 10 years.

For its part, the United Nations Children’s Fund (UNICEF) ranked Egypt as the fourth country in the world, and the third in the Arab world, in the prevalence of female genital mutilation.

Knowing that there is no accurate number of victims of these operations, because they are often carried out in a non-medical setting, in addition to the parents’ fear of reporting any death or injury, as a result of these operations.

Plastic and reconstructive surgeries

In an exclusive interview with “Sharika Walaken”, plastic surgeon Dr. Reham Awwad said that she was “surprised by the number of women who were subjected to khitan, and who suffer from major psychological problems that affect their physical health.”

She added that “that’s why the aim of the restoration operations is to repair what was removed in the khitan, and some call it the restoration or orthodontics of the genitals, and it includes treatment, beautification, and orthodontics of the clitoris and the girl’s genitals.”

Dr. Reham performs cosmetic and reconstructive surgeries for women who have been subjected to this crime, and helps them to overcome this experience, both physically and psychologically.

I stopped at the goal of the operation a lot, and wondered: Is my main desire to restore my self-confidence, or to try to know a feeling that I have not been fortunate enough to know yet? Most importantly, perhaps, it’s the desire for improvement in my mental health.

Research conducted on these operations has proven that it helps girls and women who have been subjected to this crime to regain self-confidence, the feeling that they are complete, and there is no difference between them and other girls who have not undergone khitan.

According to Dr. Reham: “many girls and women affected by khitan suffer from several health problems and are looking for a solution to this issue. But, they are not aware of the existence of these operations, and perhaps that is because there are very few doctors who perform them around the world.”

The financial aspect is also considered the worst aspect of the process, especially as it is expensive and not affordable for everyone.

Although the damage has affected the largest segment of Egyptian women, the treatment will not reach all of them. The operation costs tens of thousands of Egyptian Pounds, which is not something that all girls and women can afford, especially in light of the difficult economic conditions they suffer from.

Dr. Reham explained that “the operation is financially costly in many parts of the world, but there is something positive about it. Not all girls and women need surgical intervention, but some of them need some treatment, such as plasma injections into the clitoris or vagina. Or they may only need psychological support to overcome the effects of this humiliating experience, and the lack of self-confidence and acceptance of their body, in addition to the inability to express their sexual suffering.”

Dr. Reham told me that the women who came to the center were of different ages. There are girls under 20 years old, and women over forty years old. And they were unanimous in the need for restoration again, whether surgical or non-surgical intervention. In addition, all of them need psychological support.

As she put it: “No woman has come to me who was able to erase the memories of that day from her mind.”

She also confirmed that khitan causes a lot of chronic pain, menstrual problems, frequent urinary tract infections and infertility. Some girls may bleed to death, or die from infections.

It can also cause fatal obstetric complications later in life. It is associated with post-traumatic stress disorder, depression and other mental disorders.

Most importantly, in Dr. Reham’s opinion, “husbands cause a lot of psychological pressure on their wives with their comments, which makes them feel frustrated.”

Therefore, this surgical step must be preceded by a confirmation from a psychiatrist stating that the woman is psychologically ready, after which the two of them will examine how to solve the problem.

Genital mutilation is one of the abhorrent violations of human rights that women and girls are subjected to all over the world.

It is a practice that robs them of their dignity and endangers their health. It unnecessarily causes pain and suffering. It may even lead to death.

Female genital Mutilation is rooted in inequalities and power imbalances between the sexes, and perpetuates them by limiting opportunities for girls and women to obtain their rights and realize their full potential, according to UN Secretary-General Antonio Guterres.