The Cut

The cut - a traditional rite of passage into womanhood: genital cutting.  Or an issue that should concern us all.
 
Some of my longer-standing readers will remember Papillon's story which I translated from her French blog. It was all about her quest to have reconstructive surgery for the genital cutting she had suffered at the age four.  If you haven't read it, please at least consider reading the first two or three posts which tell of how it happened.  "When I was 4 my mother had me circumcised. It ruined my life". 

It was over two years ago when I found the blog and asked her if she would allow me to translate it so that young English speaking women could benefit from her experiences.  Since then, I've had numerous enquiries from people asking if the surgery is available in the UK (no), and how to go about contacting Dr Foldès, the surgeon who developed the procedure.

Recently I've heard that a Spanish surgeon, Pere Barri of the Instituto Dexeus, has spent some time in Paris with Dr Foldès, and now operates two or three times a month.  Not only that, he is hoping to share the knowledge and skills with other clinics in Spain so that more women "can leave their ghosts behind".

The practice of FGM used to be more or less confined to sub-Saharan Africa and a few parts of the Middle East and Asia but nowadays, with migration and population movement, the incidence in Europe and elsewhere has been increasing.  It is illegal to carry out the practice in Europe but it is so very hard to counteract traditional beliefs.

There are various initiatives in progress.  One in the UK is a survey which is funded by the Health Department to increase knowledge and understanding about FGM and to try to find out how much training might be required by health practitioners.  France had an informative and educational campaign in April.  There are initiatives in a number of African countries: Ethiopia, Burkina Faso, and several others.

Now from Norway there is a project to educate and raise awareness which has produced a documentary film called "The Cut".  This, the first episode, shows two girls from different villages in Kenya where FGM is still practised in spite of its being illegal.  One girl has rejected the practice and is actively working to help educate people, the other is about to undergo this traditional but harmful rite of passage. It goes some way to explaining the tradition, incidentally showing unequivocally that it isn't specifically an Islamic practice, and suggests a way it can be eradicated.

If you wish, you can download the film, less than 15 minutes in length, from the project website.  It doesn't make the most pleasant viewing, but nor does it go out of its way to shock.

Dr Sébastien Madzou

Dr Pierre Foldès, although probably the most well know, is not the only surgeon in France to perform reconstructive surgery for women who have undergone female genital mutilation (FGM): in Angers there is Dr Sébastien Madzou.

He had originally read an article about Dr Foldès in a women’s magazine. Although Dr Madzou originally comes from the Congo, where FGM is not practised, he frequently comes across circumcised women in his gynaecology clinics so he got in touch to find out more. Dr Foldès asked if he would like to be trained in the technique and now Dr Madzou himself trains others.

The first surgeon he trained was a colleague, Dr Ouedraogo, with whom he had studied in Tours. Dr Ouedraogo suggested Dr Madzou go with him to Burkina Faso where he has now trained about 25 surgeons in the technique. Of these, 6 or 7 are women, though there appears not to be any concern amongst patients over having a male surgeon.

In an article by Habibou Bangré on Afrik.com (in French), Dr Madzou tells of his time in Burkina Faso. His patients of all ages came from all levels of society, having heard about the operation by word of mouth. Although he worked without charging fees, there nevertheless was a cost to the patients, however it was obviously considerably less that travelling to France. He even had one patient from Belgium who travelled specifically for the operation, and another from the USA who happened to be visiting relatives when she heard about it.

In France he works at Centre Hospitalier Universitaire d'Angers, 4, rue Larrey 49933 Angers. His own contact details.

Dr Pierre Foldès

The clitoris is now known to be much larger than the external glans, a relatively small structure which is removed during many forms of female genital mutilation or FGM, and so the possibility is there for reconstruction.

Dr Foldès is the surgeon in St Germain en Laye who is one of the few who perform clitoral reconstruction after FGM. There are plenty of others who perform repairs, or reversals, but do not rebuild the clitoris. Even reversal though, is a great step forward for women who have undergone more extreme forms of FGM. One report follows up some women who have had reversals done and found them very happy with the outcome.

As mentioned in one of Papillon’s posts, Dr Foldès has trained some Burkinabe surgeons in the techniques. There is an interview of one of them published online in January by the journalist Ochieng' Ogodo. He himself has now trained 50 surgeons in Burkina Faso to do the operation and is happy to pass on his expertise to surgeons in other African countries.

Christine Aziz has interviewed two women who have been patients of Dr Foldès, one French, originally from Somalia, and one Sudanese living in London. Their accounts are similar but well worth reading. A French journalist has written a book, Victoire sur l'excision, about this "modest and profoundly humanitarian doctor".

It is evident from all these stories that his patients have nothing but praise for the doctor.

Contact details for Dr Foldès:
Clinique St. Germain
12, rue Barone Gerard
78100 Saint Germain En Laye.

• tél : 0033 1 39 10 26 26
• tél : 0033 1 61 30 22 15

Don't forget to read Papillon's story.

Hip hip hooray!

Thursday 5 July 2007

It was raining very heavily on Tuesday afternoon when I left Paris for going to my second post-operative consultation at the Louis XIV Clinic. My feet were soaked but nevertheless I was feeling tranquil. In the RER which was taking me to St Germain en Laye, I felt nothing particular.

However as the station approached an irrational tension took hold of me. As I walked towards the clinic, through the sunny town, the tension grew and my legs started to go numb.

As I had arrived early I stopped at a café, the same one that I had waited in before my first consultation. The tension that gripped me changed into a more diffuse fear.

What concerned me most was that the healing was possibly too slow and that I was perhaps going to have to return to St Germain en Laye. I didn’t want to return. Not for a long time anyway.

There were very few people in the waiting room. Few people and no black women. I was surprised with that but I didn’t have time to think about it because, hardly had I sat down than I noticed Dr Foldès who was moving towards his secretary. And strangely, I wasn’t as worried or concerned to see him as I was the times before.

I almost didn’t have to wait at all. Leaving his secretary’s office, he came into the waiting room and called me. It was at that moment that I noticed my fear had returned.

In his office, he started by joking about my guitar (I was to have a lesson a bit later in the day so I had to cart it with me to the clinic). He was smiling and seemed in an excellent mood.

He started by asking me the date of my operation.

He was in the process of consulting a multicoloured file carrying my name when a telephone call interrupted him. Apparently it was about a woman who wanted to arrange a date for an operation. He turned the pages in his diary and I could see that every Wednesday and Friday were full of African-sounding names, circled in light blue ink. Perhaps they were the names of the women he was going to operate on?

After turning several pages, he asked the person at the other end to contact him again at the end of July. Then he put the phone down and gestured me towards the end of the room where his examination table had pride of place.

As he got up, he asked if I still had a discharge. “Almost none” I answered. “That’s normal. It will stop altogether soon” he assured me.

After a rapid examination he enthused: “Perfect! You have a magnificent clitoris! Good position, good size, good colour. It is per-fect! Are you happy?” “Oh how I am” I replied, really proud. In truth I was more than happy. I felt delighted and strangely relieved that all went so well.

“From now on you are no longer a circumcised woman”. That sentence brought tears to my eyes. I considered I was no longer a circumcised woman once I left the operating theatre but to hear that, from his mouth, that really touched me. It was as if he were liberating me from something. As though he were absolving me.

He explained that the first part of my healing, the most difficult, was over. I now had to approach the second part which would give sensitivity to my clitoris.

This second part, he told me, was at least as important as the operation itself.

And the good news had started to flow.

So, finished with the iodine cleansing four times a day.

Yippee!!!!

Goodbye to the roving washbag! Goodbye sterile swabs! Goodbye washbottle! Our history stops here! I am free of you!

From now on, for six weeks, I need do only two washes per day, one in the morning and one in the evening and .. Marseille soap. He made a point over not using either intimate gels or shower gels for washing my clitoris or labia. He said Marseille soap was the only cleanser which wouldn’t harm the area.

Each morning (and only in the morning), after my shower, I have to apply a small amount of cream called JONCTUM to my labia minora and clitoris. It need only be a very small amount to form a fine protective layer.

This miraculous cream is going to be a sort of dressing which will make “the operation zone more comfortable” to use his terms. Moreover it will let the skin form and cover my clitoris again. Finally, the application of the cream will have the effect of making my clitoris more sensitive.

Taking advantage of a pause in the conversation, I told him about my anxiety over my labia minora which I still couldn’t see. He explained that was normal, that they were certainly there at the base of my clitoris but that the latter, which still hadn’t returned to a normal size (excellent news, I found it still to be just too big) was masking them somewhat. What’s more, they are quite small, the process of reconstruction chosen having been to inject the flesh which had escaped the knife of the circumciser. So I will see them better (if I can say that as I have never had the honour of seeing them at all) in a few days.

He carried on by saying that he had given me back my clitoris and that it belonged to me. “It’s as if I had given you a finger or your nose, it would be part of you and, accordingly, it belongs only to you”. He explained that to rediscover its sensitivity, I shouldn’t depend on men or anyone else. “It’s for you to find this sensitivity by familiarising yourself with your clitoris little by little”

He said that the unpleasant sensations that I was feeling currently when touching my clitoris would disappear gradually in the next few weeks and that it would take about six months before it would be completely sensitive again.

I asked him when I could start up sport again and he said I could do it from now on. The same with swimming.

I also asked the question about sexual relations. And I can restart those too from now on. He said it wouldn’t be terribly agreeable to start off but it would soon be more comfortable. Joking, he asked if my man was in a hurry. When I answered that my love wanted to wait for the green light before doing anything, he answered it was to his credit.

Then there was silence. Then I said to him, “Thank you doctor, many thanks”. My voice was faltering as I spoke. I wanted to clarify to him exactly why I was thanking him, explain this “thank you”. But nothing came out, I had a lump in my throat.

He nodded his head, silent and smiling…

Accompanying me to the door, he said, while shaking my hand, “Good, now we have to convince other young women to come for the operation!” So I told him about my blog and its subject. He said it was a good idea, that reading the story of women who undertake the operation could perhaps encourage others to take the plunge.

It’s really because I don’t chat easily in public that I satisfied myself with smiling. Because it was extremely difficult to prevent myself from purring contentedly.

“You can write on your blog that I am only a doctor. I cannot push women to have the operation. It’s their choice. Theirs alone. I will accompany them, operate but the decision to reject this custom and to want to rediscover their bodies belongs to them. I can’t take it for them, “he added.

“Good the, I’ll see you in December for a little update?”. On these words and on my “Yes, of course” rather strangled by emotion that Dr Foldès and I took our leave of each other.

Going to his secretary to pay for the consultation, I was smiling broadly. Sitting down opposite her to write the cheque for 50 euros, I couldn’t stop myself exclaiming that I was so haaappy!!

She asked me why and I explained to her that it was because everything had gone so well. Smiling she said “You doubted it?”

Leaving, ecstatic, I wanted to skip about like a kid. I called my man and I submerged him in my joy, poor thing (he didn’t take anything in, he had to wait until I explained everything again once I had got home).

Then, when I going to the station, I remembered a question that I hadn’t asked Dr Foldès. I called him and told him that in my happiness I had forgotten to talk to him about these dratted stitches which had still not come out. He answered that it was imminent, that it would happen within the next two weeks.

Yippeeeeee!

God I am so happy.

Since the consultation I have the feeling of being incredibly light. There is lively music in my head all the time.

If that is what joy is like, I wouldn’t be at all surprised!

[Original in French]

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