Healing the genital wounds from the past

As Ireland’s first female genital mutilation clinic opens this week, Joanna Walters visits a US practice where a surgeon is working to restore victims’ sexual sensation.

Healing the genital wounds from the past

A NONDESCRIPT suburb on the outskirts of San Francisco. A plain, brick building. Seven nervous women wait in the sunlight. They are here for surgery.

The little building doesn’t shout its purpose.

First, this surgery is about female sexuality. Second, it is contrary to the beliefs and traditions of millions of families worldwide.

Then, there’s the delightful surreality of the people who are providing the procedure: the tall, blonde female surgeon — one of the best in the US — who was born male, and the cheerful French counsellor who adheres to the bizarre, 1970s Raëlian sect that believes humans were created by extraterrestrials for unalloyed joy.

One of the first patients, Zaria, 24, is under anaesthetic. “This one’s pretty bad,” says the surgeon, glancing at me from the stool where she sits between the legs of her patients, scalpel poised.

When I’d met Zaria, just before her operation, I was struck by the energy of this funny, feisty, beautiful young medical student with a tattoo and bundles of raven hair. Now, by her invitation, I am looking, from over the surgeon’s shoulder, at her genitals, and trying not to cry.

Zaria looks more like a doll than a woman.

Her genitals are featureless, smooth apart from the opening. Barbie might be more anatomically correct.

The surgeon lifts her scalpel and begins carefully slicing away at the flat skin surface, which is basically a thick layer of scar tissue. It is the second time in Zaria’s life that someone has taken a knife to her most intimate parts.

The first was when she was 11, in Sierra Leone, and then there was no anaesthetic.

Relatives had taken her into the countryside, under the ruse of a day-trip to pick oranges. Once there, she was lined up with 20 other girls and forced to the ground by a cluster of older women.

Her labia and clitoris were sliced off, in a ritual once called female circumcision, but now known more accurately as female genital mutilation, or FGM.

“I remember, I struggled and I was yelling so loudly that one of the women actually sat on my head and practically suffocated me while they cut me,” Zaria told her fellow FGM victims, as they swapped stories before their operations.

According to the World Health Organisation, more than 140m women live with the effects of FGM, which is most commonly practised in northeast and west Africa, but also in places such as Yemen and Indonesia.

But an infinitesimal fraction, those who emigrated to the West, are finding their way to an emerging handful of surgeons who offer a radical attempt at rehabilitation.

This surgery doesn’t just make intercourse and childbirth easier. Controversially, it also aims to give the women the capacity to feel sexual pleasure — most for the first time — by rehabilitating the clitoris.

Zaria has travelled to California from her home on the east coast of America, where she moved from west Africa as a teenager. The wounds from Zaria’s cuts healed long ago, but have formed a layer of thick scar tissue that has left her genitals numb to the touch.

“My fiancé left me two months ago, because I don’t want sex,” she had told me when she arrived at the clinic, her sad and bewildered tone mixed with defiance.

“I did start having sex with him, but I don’t feel anything and I don’t care for it. He’s from Sierra Leone, too, so he understands about FGM and was supportive, at first, but, in the end, he went off with another African girl who hadn’t gone through it and wasn’t inhibited like me,” she had said.

While some of Zaria’s relatives dealt with her heartbreak by telling her she should just “get on with it” and have sex out of obedience, Zaria had a “lightbulb moment” and began searching the internet.

In just seconds, she had an alternative solution.

Next thing, she had taken out a loan, which she has “no idea” how she’ll pay back, jumped on a plane, and found herself in this plain, brick building.

Once at the clinic, she and the other patients were greeted by the two women who were instrumental in encouraging them to break their bonds of cultural taboo. They are an intriguing pair.

One is the surgeon, Dr Marci Bowers, who specialises in sex-change surgery, and was born male before she transitioned. There’s a 14-month waiting list for her $21,000 gender-reassignment surgery, but twice a year she clears her diary to operate pro bono on FGM victims — although they must pay $1,700 to the clinic, near San Francisco airport, where Bowers rents an operating theatre. So far, she’s operated on 50 such women.

The other is Nadine Gary, a Frenchwoman who lives in Las Vegas.

A schoolteacher, Gary was inspired to help FGM victims by her following of the outré Raëlian sect. Founded by Claude Vorilhon (“Raël”), it professes that humans — and all living things on Earth — were created by extraterrestrials using genetic engineering. Followers campaign for world peace, sharing and nonviolence, but also unfettered sexual joy, which is what drives their movement against FGM.

Gary seems a paradox: an unambiguously dynamic, charming, kind and generous person in all our conversations who, until she starts talking about UFOs, seems rational.

The charity she helps run is provocatively called Clitoraid. Formed by the Raëlians, it campaigns for the end of FGM and, meanwhile, promotes the surgery for victims and offers free, long-term emotional and sexual counselling.

Gary has driven across from Vegas to support the women, many of whom have not told their families about their journey. The atmosphere in the clinic is more than a little surreal. There is much nervous laughter.

On the operating table, however, everything is clinically methodical. After stripping off old scar tissue, Bowers makes deeper incisions to disconnect small ligaments around the area where Zaria’s clitoris was before it was removed. At the stroke of the scalpel, a prominent nub of raw, pink flesh pops up, suddenly protruding from the tissue surrounding it.

“There. That’s her womanhood right there,” Bowers says triumphantly. “It’s like a magnificent tower in the forest.” What’s barely understood, Bowers says, is that when the clitoris is cut off in FGM, it’s like losing just the visible “tip of the iceberg”.

“The clitoris is much larger than previously advertised. Even after they cut off the tip, about 99% of the clitoris is actually still intact, but hidden beneath the surface. We can access that,” Bowers says.

Apparently, women possess another eight inches of unseen clitoral erectile tissue, which lies under the skin arching around the vagina. “Two inches longer than the average penis,” says Bowers, archly.

By removing the obstructive and often painful scarring, and exposing some of that remaining erectile tissue, then stitching it finely into place, after about two months of healing it can function as a new clitoris, restoring the potential for pleasurable sex.

After that procedure, known as clitoroplasty, Bowers stitches side-folds of spare skin, near the vagina, to give Zaria the token appearance of labia minora.

“It can never be her natural perfection,” Bowers says. But even to my non-medical eye, I can see that this travesty, this sub-Barbie, has been transformed into a fair simulacrum of what Zaria had been born with.

And, luckily, she has not suffered the infibulation ritual that stitches the vagina partially shut.

After 55 minutes, she is wheeled out of surgery.

Between sessions, Bowers checks her emails, gulps a coffee and chats with the nurses in an ante room. She’s exasperated that more surgeons aren’t training, and that research hospitals aren’t adopting this operation, describing progress in the field as “glacial”.

There is disagreement in the medical world about the effectiveness of the surgery. The pioneer of FGM repair surgery is Dr Pierre Foldès, in Paris, who began offering the clitoroplasty two decades ago and has operated on 3,000 women.

Foldès has trained Bowers, 10 more surgeons in France and one in Barcelona, and another doctor who has started offering the surgery in upstate New York.

Bowers tells FGM patients that “there are no guarantees”, but that eight out of 10 report improvements in their sex life after surgery, ranging from the elimination of pain to some pleasure to full orgasm.

Gary organises a pre-surgery workshop about the mental transition needed from lingering trauma to embracing sensuality, and sends them all home with a vibrator. “The physical surgery is just one step of the journey. Many religions repress women’s sexuality — we break the taboo,” says Gary.

The day after her surgery in San Mateo, Ayanna, 23, a marketing assistant from the Pacific northwest who fled the civil war in Somalia, is in a quandary after her clitoroplasty, for she is not in love with her current boyfriend.

“I told him I was coming for the surgery and the way he was talking I’m worried he’s going to expect me to be an instant sex machine,” she says.

Ayanna lied to her conservative mother that she was visiting friends in San Francisco, then sneaked off to Bowers’s clinic with her best friend, Emma, for support. Emma’s parents are from Ethiopia, but she was born in America and was never cut.

The two exude such an all-American, youthful mischief that it’s hard to believe Ayanna was once steeped in a different tradition. They banter about boozy parties and dating.

They order room service, while giggling in their dressing gowns. But, then, Ayanna is suddenly solemn.

“My friends and I will all be in a nightclub having a crazy time, but while they are getting guys’ numbers, I hang back,” Ayanna says.

“Technically, there’s no reason why just because I’m cut down there. I couldn’t feel sexy when a guy is kissing me or touching my breasts [because] my mind leaps to what that leads to next and then I shut down,” she says.

Zaria feels the same and is not in a hurry to find a new man. She turns her eyes to the endless blue sky and lets the sun warm her, 24 hours after the surgery.

Chattering nonstop, she’s on a mental rollercoaster — wanting to be the “face of Clitoraid” one minute, worrying about repercussions from her family the next. Excited about the notion of erotic pleasure, and equally scared. Weeping, laughing.

Zaria finally pauses for breath. “I didn’t do this to get back at my ex-fiancé, or get him back. This isn’t about him or my family any more. It’s all about me,” she says.

* Some names have been changed

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