To repair excised women, surgery is not enough

"What I experienced, small, excision, c is a tradition that still exists. It happens to many girls, often between 12 and 18 years, during the summer holidays, "says a woman, in the clip of the badociation Excision, let's talk about it . Every summer, when traveling to their home country during school holidays, girls are at risk of FGM. FGM is mainly in Africa: in Egypt and Mali more than three-quarters of women are affected, according to UNICEF (United Nations Children's Fund). In France, even if excision abroad is prohibited since the law of April 4, 2006, there would be about 53,000 women circumcised, according to a survey of the National Institute of Demographic Studies (INED) published in 2004. And it did not take into account minors.

The World Health Organization (WHO) distinguishes 4 types of badual mutilation: clitoridectomy, excision, infibulation, and finally all other harmful interventions such as piercing, incision, scarification and cauterization. Excision is the most commonly performed: it is a partial or total removal of the clitoris and / or labia minora, with or without excision of the labia majora.

This ancient traditional rite can be practiced for various reasons. In some communities, the operation precedes marriage for its alleged ability to increase women's fertility. In Dogons, a Malian ethnic group, the clitoris is perceived as a male organ that must be cut. And for the Nubians of Egpyte, the clitoris is the center of the badual appetite of the woman: excision is considered as being the only way to preserve the chastity of the young girls, as Alice Nicole Sindzingre, researcher at the CNRS and professor at the University of London, in Cahiers d'études africaines .

»READ ALSO – Excision: social pressure counts more than the choice of parents

L excision, a dangerous practice

"The extreme pain of excision is an integral part and not a" failure "of the ceremony."

Alice Nicole Sindzingre

Most of the time, these operations are performed by professional "excisers" who cut the clitoris with a razor. Hygiene conditions are often very poor and girls do not receive medical treatment to prevent the occurrence of bacterial infections or to reduce pain. "The extreme pain caused by excision is an integral part and not a" failure "of the ceremony. Sometimes pain, when not considered inevitable, is consciously sought, "says Alice Nicole Sindzingre.

In addition to this pain – the risk of haemorrhage and infection or shock following the procedure – FGM exposes women to many dangers throughout their lives: chronic pain, increased badually transmitted infections, or risk of complications during childbirth. In addition, "desire and badual satisfaction are diminished in mutilated women and painful intercourse is significantly more common," note sociologists Armelle Andro and Marie Lesclingand, in their inventory on female bad mutilation commissioned in 2016 by INED.

The invention of a clitoral reconstruction operation

In the late 1980s, while a humanitarian doctor in Burkina Faso, urologist Pierre Foldes discovers the devastation caused by excision. That's when he comes up with the idea of ​​developing a clitoral reconstruction operation. "It's a simple operation," he explains. "There is a part of the clitoris that is still alive: you have to isolate it and put it back in the right place."

Indeed, the clitoris is not only external: two branches come around the bad. The part cut during excision does not reach this internal clitoris. The surgeon cuts the suspensory ligament of the clitoris, which attaches the clitoris to the pubis, so that the clitoris can be advanced several centimeters. "You also have to remove the sick part," says Dr Foldes. Scar tissue is removed to clear the previously advanced clitoris. "The main nerves of the clitoris are always present, which in 80% of cases can recover sensations that allow normal baduality."

»READ ALSO – Clitoris: how the organ of female pleasure has been erased from the books of anatomy

"A woman excised is above all a woman victim of violence"

Between 1998 and 2009, Pierre Foldes returned to France operated more than 2900 patients. But in 2008, his meeting with Frédérique Martz, who seeks to reconvert after 25 years of running a publishing company, is shaking his concept of treatment to women excised. "An excised woman is first and foremost a woman who has been the victim of violence," recalls Dr Foldes. "She lost a lot of things, not just her clit. The psychological violence of this mutilation is marginalized, while the post-traumatic suffering is at the center. If we do not put it back in the foreground, we can not cure these women, even if we give them a functional clitoris! "

" Excision is a global trauma: the woman victim is in his being, in his personality, in his identity. "

Dr. Pierre Foldes

The doctor then realizes that the reconstructive surgery is insufficient. "When I discovered it, it changed my practice. Before, I did my operation alone in my corner. But excision is a global trauma: the victim is affected in his being, in his personality, in his identity. You have to listen to these women, take stock of all the trauma they have suffered. Surgery takes place in a much more complete approach. With Frédérique Martz, he founded Women Safe in 2014, the first French badociation that deals with women victims of violence. The patients meet surgeons for free, but also psychologists, badologists and lawyers. Since it opened in 2014, 6,000 circumcised women have been operated, approximately 50 per month.