Can women who have lost the ability to experience sexual pleasure due to female genital mutilation/cutting (FGM/C) ever regain it?
For some women, surgical treatments offer hope.
Dr. Marci Bowers is one of a few gynecologic surgeons who performs clitoral reconstruction surgery on women who have undergone FGM/C.
She primarily treats women who have undergone type 2 FGM/C, in which part or all of the external clitoris, labia minora, and sometimes labia majora are removed.
For many women who have undergone type 2 FGM/C, sex can be unpleasant or even painful.
“It can really diminish the desire for sexual contact,” Bowers told Healthline. “And after all, that’s kind of what it’s meant to do. It’s meant to control women’s sexuality.”
Clitoral reconstruction surgery can potentially help improve sexual function by repositioning the internal portion of the clitoris that remains intact.
“The surgery is really simple in its design,” Bowers explained. “It’s meant to uncover the clitoris, bring it forward, and then suture it into place so that it can be accessible during sexual contact.”
“The operation takes less than an hour,” she added. “The two keys to it are removing the scar tissue and releasing the suspensory ligament, which is the key component in allowing the clitoris to come down.”
While all surgeries pose some risks, Bowers reports high success rates.
“It works virtually every single time,” she said. “The woman’s [sexual] feelings are overwhelming improved when this is done.”
More cultural than religious
According to the World Health Organization (WHO), more than 200 million girls and women who are alive today have undergone FGM/C.
About 500,000 of them live in the United States.
FGM/C includes any procedure that intentionally alters or injures female genital organs for nonmedical purposes.
It is performed as a cultural practice in many communities around the world, particularly in parts of Africa, the Middle East, and Asia.
In the United States, performing FGM/C on a minor or transporting them to another country to undergo the procedure is a federal crime.
Last month, the first federal case involving FGM/C was filed in Michigan.
Dr. Jumana Nagarwala, an emergency room physician, stands accused of performing the procedure on two 7-year-old girls.
Charges have also been filed against Dr. Fakhruddin Attar and Farida Attar, who are accused of assisting Nagarwala. Attar owns a medical clinic in Michigan where the procedures were reportedly performed.
While all three defendants are members of the Dawoodi Bohra, a Muslim sect based in India, FGM/C is a cultural practice that crosses religious lines.
“If it was a Muslim or religious practice in general, then all Muslim women would have to undergo it, and that’s not the case,” Haddijatou Ceesay, a program coordinator for Safe Hands for Girls, a nonprofit organization led by survivors of FGM/C, told Healthline.
FGM/C is practiced by members of some Muslim, Christian, and Jewish communities.
Holistic support is needed
FGM/C is widely considered a human rights violation.
It has no known health benefits and many risks.
In the short term, it can cause bleeding, infection, and even death.
In the long term, it can lead to many chronic health problems.
“Girls and women can end up with painful periods, difficulty urinating, a really difficult time having sex,” Ceesay said. “A lot of them end up having a lack of sexual sensation. It can cause infertility, difficulty giving birth, and obstetric fistulas. It can also lead to PTSD, depression, and anxiety for some.”
Given the wide-ranging effects that FGM/C can have, Ceesay suggested that multiple types of care and support are often needed.
Dr. Jasmine Abdulcadir, a gynecologist in the Department of Obstetrics and Gynecology at the University Hospitals of Geneva (HUG), Switzerland, agreed.
“If you want to promote sexual health, you need to focus not just on a woman’s genitals, but on her whole person. On her mind and body,” she told Healthline.
Although Abdulcadir has conducted clitoral reconstruction surgeries on some patients, she warned that more research is needed on the safety and efficacy of the procedure.
She added that surgery is not always the best approach.
“We do a lot of health education and counseling because many of the women who request clitoral reconstruction still have a functional clitoris but don’t realize it,” she said. “Many of them don’t know much about their own anatomy, and after being exposed to messages about the negative effects of FGM, they assume they can’t experience sexual pleasure.”
She suggested that the needs of many patients are better met through education and counseling, rather than surgery. For those who do undergo surgery, additional follow-up care may be needed.
“A multidisciplinary approach is really important, not only for deciding whether surgery is needed, but also for providing follow-up care,” she said. “The genital pain caused by reconstructive surgery can recall the pain of genital cutting and traumatic memories from a woman’s past.”
To help prevent future cases of FGM/C, Abdulcadir and organizations like Safe Hands for Girls emphasize the importance of community education.
“Turning survivors into advocates of ending FGM is a huge thing that we’re working on,” Ceesay said. “For a lot of them, it gives them a sense of inspiration and empowerment, knowing that they’re able to help stop the next generation from going through what they went through.”