WUNRN
The Atlantic
FGM - TRYING TO REBUILD WOMEN'S
BODIES AFTER FEMALE GENITAL MUTILATION
A small number of surgeons are performing clitoral reconstruction
procedures in the
About
30 miles northwest from
Getting to this town is
no easy task. From
Fadima
Ali—who asked that her name to be changed to avoid identification—is a
26-year-old woman from Brooklyn by way of
Ali is a tall woman with
a dark complexion. Her saucer-large eyes move around slowly, taking in the
environment around her. Her already-soft voice often drops to a whisper. Though
her demeanor is meek, her life hasn’t been. She left her parent’s conservative
home and the sexually repressive environment of
It was a frigid morning
in December 2013 when Ali landed in
FGM, or female
circumcision, is the practice of removing parts of a girl’s genitals. The
procedure varies in extremity—from removing a thin
slice of flesh to removing the entire labia minora and/or the labia majora. In
these cases, the “cutter” leaves nothing but a pinhole sized opening surrounded
with scar tissue. The most common type of FGM involves the removal of the
clitoris. Girls subjected to this practice often grow up to face severe health
complications with menstruation, sexual intercourse, pregnancy, and childbirth.
According to estimates
from World Health Organization, between 100 and
140 million females worldwide live with the consequences of FGM. At least 30
million girls under the age of 15 are at risk. But what’s most surprising is
that, according to The Centers for Disease Control and
Prevention, nearly a quarter of a million of those girls live in the
While independent
organizations all over the world have been working to raise awareness about
female genital mutilation and decrease the number of women at risk, those
already subjected to the procedure tend to have no recourse. They simply have
to live with the results of what was done to them. This is where Dr. Harold
Henning, a doctor practicing out of his home in
Harold J. Henning, 58,
was born and raised in
Henning is an active
man. He runs marathons, swims, and plays tennis. There are 12 plaques and
various medical degrees and awards on his wall. There is also a map of
Henning is a practicing
OB/GYN and dedicates one day a week to working with survivors of female genital
mutilation. His venture into clitoral restoration found unlikely inspiration in
a controversial religion known as Raëlism. Claude Vorilhon, a French man now
known as Raël, founded the religion in 1973 after an alleged encounter with
extraterrestrials. The Raëlian messages, which are on their website,
dictate their doctrine. They state that aliens called Elohim (a Hebrew term for
God) put humans on Earth and sent down 40 prophets to spread a message that has
somehow gotten lost in translation.
“The fact is, I’m
Raëlian,” the doctor confessed, toying with a silver medallion hanging around
his neck that he wears as a symbol of his faith. The symbol on his medallion,
the Star of David superimposed with a swastika, has drawn controversy. Some call Raëlism a
cult, but for Henning it’s a way of life. He says the religion has provided him
with truths he never found in Catholicism (his family religion). “I know it
sounds crazy,” he admits, laughing “But I have no reason to deny anything the
messages say.”
Raëlism
first piqued Henning’s interested in 2003 because of its work on cloning. Clonaid,
an organization founded in 1997 by Raëlians on the basis of their belief that
humans can achieve immortality (another tenet of Raëlism), attracted
controversy in 2001. Dr. Brigitte Boisselier, Clonaid's research director,
claimed to have successfully cloned humans but this claim remains unsubstantiated since Boisselier has yet
to reveal the results. “I had heard someone talking about how the founder of
the religion had an encounter [with aliens] in 1973 and I kinda just
pooh-poohed it,” he said. But after reading about Clonaid, he wanted to know
more.
“I read everything I
could find on [Clonaid] and got in my car drove the four hours to Valcourt,
Canada where they were having a convention and ended up staying the entire
week,” said Henning. “I learned a lot about myself. My background is really
religious but nothing I learned seemed to be answering my questions about
religion and I was looking for the truth.”
Henning became hooked
after the conference and started attending events hosted by Raëlians all over
the
Vorilhon, aka Raël, had
recently been in
Besides Henning, Clitoraid
has one other volunteer providing free clitoral restoration surgery to
women—Dr. Marci Bowers in
For the past few years,
Clitoraid has been working on building a women’s hospital in
Henning, Bowers, and two
anesthesiologists arrived in
Setbacks aside, Bowers
plans to continue working with Clitoraid. “I don’t know what’s going on with
the hospital, I know there’s been talk of obtaining legal representatives. But
for me, I’m going to keep performing the surgeries. Not only does the surgery
work in restoring sensation, [but] after my last visit to
After signing on with
Clitoraid in 2007, Bowers traveled to
Henning says that the
surgery is only the first step in healing from female genital mutilation. “I
always tell the women to see a sex therapist once they get home,” he said.
Since most of these women were cut when they were young, feeling anything can
be uncomfortable and confusing, and they can mistake stimulation for pain.
One of the women he
performed a clitoral restoration surgery for had her procedure reversed. “She
came here on a bus, had her surgery done, and went back on her own. She was so
sensitive because I restored the shaft of the clitoris. It felt like pain to
her,” said Henning. He thinks all she needed was sex therapy. He gave her
numbing medicine but she didn’t have much support from friends or family. “It’s
often the women that don’t have a support system that suffer.”
Henning has had
women scheduled for surgeries cancel because the people that were supposed to
be supporting them backed out. "It’s tough," he said. "The ones
that have worked out pretty good are the ones whose boyfriends or husbands have
known what’s going on and they’re supportive.”
Located off Route 48, a
28-mile stretch of highway in
Ali arrived at Henning’s
office six hours late. He was still waiting for her when she got there. Sitting
in his small office, she continuously fiddled with the sleeves of her purple
Ralph Lauren sweater, pulling the ends down to her knuckles.
"People come to
Ali has the most common
type of female genital mutilation, which the World Health Organization defines
as Type II. That is, she has no clitoris. She thinks she was two years old when
her parents had her “circumcised” in
It wasn’t until she was
22 and already living in the
Ali was too young to
recall her own cutting but does remember some of the cutting ceremonies that
she witnessed in
Female genital
mutilation is an African cultural practice. Tribes that do practice it consider
uncut women to be promiscuous and ridicule them, Ali said. And so, the practice
is passed down from generation to generation, from mother to daughter. “My mother,
she follows the rules. I know she wants something completely different for us
but she doesn’t want to go outside of what is supposed to be,” Ali said.
“Mothers in general, I think they worry about the daughter and who she is going
to be because if she’s a wild girl, that’s going to show the bad in the family.
The daughter might not be able to get married later even.”
The purpose of female
genital mutilation is to keep a firm grasp on a woman's sexuality. In this
case, it means squashing it before she can even consider becoming sexually
active and bringing shame to the family. It is a conditioned thought that runs
deep—one that even Ali can't seem to shed. “My friend [who isn't cut], I can
see she’s wild," she said mentioning her friend's various boyfriends and
likelihood of being sexually active.
Ali first learned about
clitoral restoration surgery in the same classroom where she learned about the
reality of FGM. “Someone in my class mentioned that there’s this surgery they
do for women to fix it and I couldn’t wait to go home and get on the Internet
to do research,” she said. It was then that she stumbled across Clitoraid. She
first got in touch with the organization in 2011 but Bowers had not yet trained
Henning at the time, so her only option was to travel to
But she continued her
research and even consulted with doctors in
Three years after
initially contacting Clitoraid, Ali finally set up an appointment with Henning
at the end of 2013. Going to upstate
Foldès
developed clitoral restoration surgery about 20 years ago. He published a paper
about his work in The Lancet in 2012.
Between 1998 and 2009 he performed the surgery formally known as clitoroplasty
on nearly 3000 women, he wrote. Results on the long-term effects of the study
may be unreliable though. Of the roughly 3000 women he performed the surgery
on, only 866 of the women returned for a one-year follow-up examination. Most
of those women reported an improvement of clitoral pleasure and no increase in
pain, though some did report pain.
The
surgery itself is fairly simple. As the science community has recently learned,
the clitoris is much larger than the small accessible part. An unerect clitoris
can be up to 9 centimeters long, meaning that most of the clitoris is actually
within the body and inaccessible without surgery. So theoretically, underneath
the scar tissue on a woman who has experienced female genital mutilation is
more clitoris.
To restore part of the
clitoris, the doctor opens up the scar tissue, brings some of the clitoris back
up into position, and sews it in place. The recovery process for the surgery is
long, painful, and arduous; it can take up to a few months for skin to grow on
top of the newly restored clitoris leaving the woman very sensitive for some
time. Foldès says he cannot guarantee orgasms from the restoration but it does
have the potential to bring back some sensation.
Still, the surgery has
not gained much traction in the
Nonetheless, the
American Congress of Obstetricians and Gynecologists does encourage survivors
of female genital mutilation to work with “a physician with special interest in
pelvic or vaginal reconstructive surgery or a clinician practicing in an area
of high prevalence of female genital cutting.” The main point is they want the
doctors to inform any woman they perform clitoral restoration surgery on that
it may not work.
Even though the surgery
is not popular in the
Back in Henning’s office,
one of Ali’s first questions him is why he does what he does and in particular,
why he does it for free.
"The reason is
because you didn't ask for this. It was done to you. If I can help you and I
charged you for it, then it would be like I'm making a profit off of your
misfortune, which isn't right," he said leaning back in his chair. Ali
listened to him intently, sitting upright, making sure to absorb everything he
said.
As the consultation
continued, Henning approached the topic of sexual pleasure and feeling. “I
think I don’t feel the excitement other people feel,” Ali said, describing her
lack of interest in sex.
“That’s because the
ability to feel those things were taken away from you at a young age,” said
Henning. He described the surgery to Ali and what she should expect to feel
over the next few months. While she doesn’t need to come back to see him for
follow-up appointments, she is required to see a doctor in
“Once my surgery is
over, I’m going to share information about [Clitoraid] on Facebook,” said Ali.
Her logic is that casually posting a link to the organization’s website on her
Facebook profile would draw interest but not incriminate her. No one talks
about these things, she said, but “all the women I know will secretly
look into it.”
During Ali’s consultation
with Henning, he explained to her the effects of the surgery. Ali, who had done
extensive research on the possibility of the surgery not working or restoring
sexual pleasure for her, nodded as he spoke. Henning pulled out photos of
before and after photos of women to show her what she may look like after the
surgery and Ali, leaned over inquisitively looking at the anatomy. She leaned
back after looking at the photos and confidently proclaimed, “I don’t know
what’s going to happen and how this is going to go but no matter what, I know
I’m going to be happy.”
On the day of the
surgery, Ali took a taxi to
Henning recommends that
patients come with a friend or a significant other. The hospital in
She was also worried
about complications and what that would mean for her. “[My friends and family]
didn’t know where I was or what I was doing, so if something went wrong I don’t
know what would have happened,” she said describing her anxiety about the
procedure.
After reassurances from
Ali that she would have no trouble getting home on her own, Henning decided to
go ahead with the scheduled surgery. It took a total of five hours and a few
hours later when Ali opened her eyes, for the first time in about 24 years, she
had a complete vagina.
Henning tried to prepare
Ali for the pain following the surgery. He talked to her again about the
procedure and how long it takes to heal. He gave her a piece of paper with
discharge instructions on it: Keep ice on your surgery side, 20 minutes on and
20 minutes off for the first 24 hours after the surgery. You may resume bathing
after seven days. Place Vitamin A&D ointment or Neosporin along the
incision lines for the next two weeks.
Even with the
instructions, Ali said she was unprepared for the pain. Three months later, she
recounted the experience. “I couldn’t sleep for the first few nights. The pain
was unbearable, I couldn’t even go to work for a few days.” But the worst of it
is now over. With the surgical incisions healing and the skin growing around
the new clitoris, Ali’s life is getting back to normal. She isn’t seeing a sex
therapist as Henning recommended during their initial consultation. “Sex is
something I’m not really crazy about,” she said.
Nonetheless, Ali is
hopeful about the surgery having a positive impact on her life and no longer
feeling ashamed when she finds herself caught in a conversation about female
genital mutilation. She’s no longer a girl who is a victim, she’s a woman who
took control. Even a few weeks after the surgery, when the incisions were raw
and the pain was unbearable, Ali maintained a positive attitude: “Still feeling
very sensitive,” she said in an email, “But I am very happy.”