CAIRO (AP) – She remembers it all: How female relatives held her down when she was 11, legs spread and genitals exposed. The fear that stiffened her body. The stranger in black with the scissors. And the pain.
Like so many others, the 34-year-old Egyptian has lived with the emotional and physical consequences of the day she was subjected to a practice many activists call “mutilation.”
For NS, who asked to be identified by only her initials to discuss the sensitive issue, the trauma that persisted into adulthood was accompanied by a desire to regain control of her health and body.
“I felt like I was incomplete and that I’ll never feel happy because of it,” she said. “It’s a terrible feeling.”
A global goal aims to eradicate the entrenched practice by 2030 and protect the next generations of girls, although activists acknowledge the difficulties in reaching that goal. The United Nations has declared an International Day of Zero Tolerance to Female Genital Mutilation, or FGM, to be observed every February 6th.
Meanwhile, some women living with the consequences have embarked on a deeply personal journey of healing. They search for answers, sometimes scouring the internet, amid treatment gaps in many countries or shame and possible sexual complications that may arise.
Widespread in parts of Africa, the Middle East, and Asia, pruning was performed in communities of diverse cultures and beliefs. It can be seen as a rite of passage or associated with beliefs about chastity or femininity and cleanliness and fueled by social pressures from generation to generation.
“It’s an ingrained social norm and it’s really ingrained in cultural beliefs and sometimes religious beliefs,” said Nafissatou Diop, an official with the United Nations Population Fund. “So in order to change something, people have to be convinced that it doesn’t threaten their culture.”
It is estimated that at least 200 million women and girls are living with the effects of the practice, which include partial or total removal of their external female genitalia and can cause excessive bleeding and even death. Long-term it can cause urinary tract infections, menstrual cramps, pain, decreased sexual satisfaction and childbirth complications, as well as depression, low self-esteem and post-traumatic stress disorder.
The story goes on
Some faith leaders have worked to eliminate the practice, while others condone it. In Egypt, where genital cutting has been widespread but illegal since 2008, leading Islamic authorities have condemned the practice. In online edicts or TV appearances, they cite medical evidence of its harm and say it is a custom with no solid religious basis. Still, there is resistance to the bans in Egypt and elsewhere.
Alongside opposition from some religious leaders and other “traditional gatekeepers,” Diop said the rethinking campaign is being hampered by limited funding, a lack of political will by some governments and a perception that ending the cut reflects a “Western-led agenda.”
Meanwhile, some women suffering the aftermath are posting anonymously online in search of a cure. They express feelings of desperation, discomfort in their own skin, embarrassment, or fear that circumcision will prevent them from getting married or doom their marriage. Some want information about medical procedures.
Some who consider medical intervention have found specialized treatment, including in the United States and Europe, where resistance to the practice has long existed. But in many countries, options can be scarce or too expensive.
“There are so many treatment gaps in many countries where FGM is really widespread,” said Christina Pallitto, a researcher who leads work on FGM at the World Health Organization. “Many healthcare providers receive no training at all.”
NS reached out to a private clinic in Egypt, Restore FGM, which opened in 2020 and has been promoting treatments on Instagram and other social media.
dr Reham Awwad, a plastic surgeon and clinic co-founder, said many patients’ first visits are emotional. “One of the first things they’ll say is, ‘I’ve never spoken to anyone about this,'” she said.
The clinic, which also attracts clients from Sudan and other countries, offers surgical and non-surgical therapies. Psychological therapy is recommended, but many don’t pursue it, Awwad said.
NS struggles with anger at her parents and low self-esteem. She wrestles with tough questions: Will sex hurt? Will cutting cause sexual problems in a marriage? What about pregnancy and childbirth? She struggled with pain and difficulty reaching orgasm.
At Restore FGM, she opted for “reconstruction” surgery to remove scar tissue, exposing uncircumcised portions of the clitoris and making it more accessible. But some experts are cautious about the process.
Surgeons who support it say it can improve function and appearance and reduce pain. Others, including the WHO, are calling for more research, saying there isn’t enough evidence to assess benefits, potential complications, or long-term outcomes.
“We don’t currently have a recommendation for it due to a lack of evidence on safety and efficacy,” said WHO’s Pallitto. “Any woman who has clitoral reconstruction should be offered sexual health counseling in conjunction with it.” Neither the procedure nor such counseling is widespread in countries with high prevalence, she added.
It has been more than a year since NS was operated. After treating the post-operative bruises, she is doing better. “I’m no longer in pain,” she said. “Sensitivity has also greatly improved.”
But her journey is not over yet. “I still have to work on accepting myself, accepting that this happened to me and that it was treated,” she said. “The operation alone is not enough. … I don’t feel like I’ve fully overcome the trauma, and I’m still struggling with the idea of physical touch.”
She wants to do psychotherapy but says she can’t afford it and worries about finding someone to confide in with such intimate details.
Basma Kamel recalled that she bled profusely days after she was cut – by a doctor – at the age of 9. For a long time, the 30-year-old Egyptian could not trust her mother. Eventually, she came to the conclusion that her mother didn’t know any better and didn’t mean to hurt her. But the feeling of being “different” remained.
After moving to England from Egypt, she began looking for answers, turning to an FGM clinic and charity group for talk therapy. She has made progress, but her work on self-acceptance continues.
“The goal is to find peace with myself and accept my body and accept that I’m a normal person,” she said. “Even if I’m missing part of my body, I’m still a normal woman.”
dr Jasmine Abdulcadir, a gynecologist at Geneva University Hospitals, treats women, mainly from East and West Africa, who have undergone genital cutting.
Women have options for medical interventions, including a procedure to reopen a narrowed vaginal opening to help with everything from urination and menstruation to natural childbirth.
Surgery to reconstruct the clitoris is also an option. Abdulcadir said the process for doing this involves meeting with a psychologist, who is also a trauma-trained sex therapist, and making sure patients are prepared if the surgery ends up being psychologically unnerving.
She said some patients said they felt “born again” after the surgery, which she attributes to her practice’s holistic approach.
“What’s very important is that you don’t just focus on the clitoris,” Abdulcadir said. “It’s really about the health of the person.”
NS has yet to tell her family about her surgery. One day she might; She especially wants to tell her sister who was circumcised on the same day as her.
But she speaks when she can.
She threatened to call the police after learning that some relatives were considering female genital mutilation for their daughters, despite the practice being illegal in Egypt.
“I didn’t want anyone else to be tormented like I was,” she said. “Someone has to step on the gas and say, ‘Enough.'”
___
Deepti Hajela in New York contributed to this.
___
The Associated Press’s religion coverage is supported by AP’s collaboration with The Conversation US, funded by Lilly Endowment Inc. AP is solely responsible for this content.