Sexual and reproductive health

WHO joins the world in marking the International Day of Zero Tolerance for Female Genital Mutilation

Women in Egypt hold up their hands in the 'peace' sign, during a session on the dangers of Female Genital Mutilation.
Women in Egypt hold up their hands in the 'peace' sign, during a session on the dangers of Female Genital Mutilation.

6 Feb 2016: WHO joins organizations and people worldwide to mark this year’s International Day of Zero Tolerance for Female Genital Mutilation (FGM) and to stand in solidarity against this practice.

More than 125 million girls and women alive today have undergone some form of Female Genital Mutilation in the 29 countries in Africa and the Middle East where the harmful practice is most concentrated. It is however, a global health issue affecting women and girls in other parts of the world as well, and can have devastating physical, psychological, and social consequences for women and girls.

WHO is opposed to all forms of FGM which can cause a wide range of both short- and long-term health risks, and which is a grave violation of the human rights of women and girls.

On the occasion of this year’s International Day of Zero Tolerance, Dr. Jasmine Abdulcadir – a gynaecologist working at a specialized clinic that provides services for women who have experienced FGM – shares her insights with WHO.

Interview of Dr Jasmine Abdulcadir

Dr. Abdulcadir is gynaecologist at a specialized clinic in the Department of Obstetrics and Gynaecology at the University Hospitals of Geneva (HUG), Switzerland, that provides services for women who have experienced female genital mutilation/cutting (FGM/C). For the last two years, she has also supported the work of WHO/RHR in development and implementation of a research agenda that aims to address the needs of women and girls who are at risk of and who live with FGM towards improving the evidence-base for effective policies, and their implementation.

Photo of Dr Jasmine Abdulcadir
Dr Jasmine Abdulcadir, University Hospitals of Geneva (HUG), Switzerland

Why might a woman living with FGM consider clitoral reconstruction?

Women living with FGM might consider this surgery for different reasons. Some consider undergoing it to reduce chronic clitoral pain or to improve sexual pleasure. Others see clitoral reconstruction as a way to improve their body image and female identity. They may want to reverse a procedure that was performed without their consent or to regain a genital appearance similar to uncut women.

What can women expect from the surgery?

When FGM involves the cutting of the clitoris, it affects the clitoral glans (the visible and more external part of the organ). The majority of the clitoris (the body and crura) lies anatomically deeper and is therefore not affected by the procedure. Additional structures responsible for sexual pleasure, such as the bulbs, also remain intact. This explains why women who have undergone FGM, and do not have psychosexual or other long term physical health complications, may still experience orgasm and sexual pleasure.

Clitoral reconstruction is a surgery that consists of re-exposing the clitoral body that is hidden beneath the scar tissue and recreating a more accessible clitoral glans, which can facilitate its stimulation.

Reduction of clitoral pain and improvement of sexual function are chief among reported positive outcomes. However, the surgery is not without its complications: hematoma, wound breakdown, and post-operative decreased sexual function have been reported in the literature. The rate at which these complications occur ranges from 5.3% to 40%.

Your review found very little evidence on the immediate, short or long-term effects of clitoral reconstruction surgery. What implications does this have for women considering clitoral reconstruction and their providers?

There is still much we do not know about the outcomes of clitoral reconstruction. Providers should make women who consider the surgery aware of this scarcity of scientific evidence.

Whether considering the surgery or not, women should be offered comprehensive, multidisciplinary care including health education on female anatomy, physiology and sexuality, as well as psychosexual therapy. Often, adequate psychosexual care and counselling can improve women’s sexual function, body-image and identity with no need for more invasive interventions. Female sexual function is multifactorial and depends on more than the genital anatomy.

Prior to undergoing any surgery, it is crucial to explore women's pre-operative symptoms, expectations, beliefs and misconceptions on the clitoris, their anatomy and sexuality. Other possible psychological or physical comorbidities that can affect sexual function should also be screened and treated. If possible, partners should also be included in the care.

What alternative therapies exist for improving the sexual health and wellbeing of women living with FGM?

Women with FGM type III (infibulation) can suffer from superficial dyspareunia (pain during intercourse) and should be offered deinfibulation, a procedure to re-open the vaginal opening after infibulation has been performed. This helps facilitate penetration during sexual activity, hence reducing painful intercourse. It also facilitates urination, menstruation and childbirth. Health education focusing on cultural myths on the clitoris, women's anatomy and physiology, and FGM, as well as associated psychosexual therapy are alternative and effective therapies to improve sexual health that can be proposed to women living with FGM and their partners.