Two girls during a female circumcision ritual in Liberia, 2008.
As a young child Aïssa could not understand how she could conjure up such horrific images. No one had ever explained to Aïssa what her parents had allowed to take place. “All I could remember was being in a bath full of blood,” she says grimacing. “I thought I had made it all up in my head”. Like millions of women all over the world, Aïssa was a victim of female genital mutilation (FGM) – her clitoris was cut off, and her labia sewn up, all before she could even talk. For years, Aïssa, who was born in France but whose family is originally from Mauritania, says she denied what had happened and suffered as a result. “Even when it made me feel empty, or it made me to lose my confidence, and even when I had relationship problems, I still did not accept what had happened to me.” Up until May this year, like so many other women, in America, in Europe, and around the world, Aïssa suffered in silence. Then she met another woman who said the effects of genital mutilation could be reversed. After doing research, Aïssa contacted Dr. Pierre Foldes, the French urologist and surgeon who invented a technique which she says has not only given her back a clitoris but also a voice and identity.
The World Health Organization (WHO) estimates between 130 – 140 million women have undergone FGM in the last 10 years. As well as significant psychological effects, it is estimated that one third of females who undergo FGM are at risk of death. It was in Africa, working as a doctor on a humanitarian mission, that Foldes first learned of the damaging effects it had on women. “They would come in flocks complaining of pain and difficulties,” he told TIME half way through an operation at his clinic on the outskirts of Paris. “For hundreds of years we have known about the penis but we never knew anything about the clitoris. So that was the first step, to return to Paris and study the clitoris like the organ it is.” In the beginning the doctor simply conducted cosmetic reconstructions to reduce the pain, but soon discovered it was possible to also reconstruct the nerve network and allow the clitoris to regain sexual functions. “It took years to study the best method, to make it simple, and easily reproducible.”
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Speaking outside the operating room, Aïssa, now 25 and married with one child, says the surgery completely changed her life. “I now feel like a confident, happy and whole woman.” Testimonies like Aïssa’s, of women suffering no more, have spread across the world. Already this year, Dr. Foldes has operated on over 600 women. As blues music quietly played away in the background, he says, “Women are coming from all over the world. Not only have women come, but also doctors are coming to France to learn the technique and take it back to the U.S., Africa, U.K., or wherever they are from.”
He performs the surgeries like clockwork. Most of the operations are finished in under 30 minutes and by lunch time of the day of our interview, he has already finished procedures on six women. “The advantages of this technique are that it has very low costs, is reproducible and there are very few complications.” The innovation, the doctor says, was the realization that, like the penis, the clitoris has a root that is not taken out during mutilation. When the scar tissue is removed, in most cases, the clitoris can be found again.
In June this year, a study of the technique was published in Lancet, a highly respected medical journal, making it “officially recognized” says Dr. Foldes. The study examined the impact the procedure had after one year for 866 patients he operated on between 1998 and 2009. Of these patients 821 reported a decrease in pain, 815 an increase in clitoral pleasure, and 430 reported experiencing orgasms. After the year no patient had experienced complications. Since the study, Foldes says 85% of women now make a full recovery. While the surgery does make huge changes, Dr Foldes stresses it is only the beginning of recovery and most of the work is done in the weeks and months that follow – with the help of sexologists and psychiatrists. “The women have to learn to have something they never had.”
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It should be noted that the measurements of pain and sensation were self-reported based on a scale devised by the researcher himself. The placebo effect, therefore cannot be eliminated. The mere act of traveling a long way for a potentially life-changing surgery after such a traumatic experience has to have some effect. Many of the women could be willing themselves to feel less pain.
Foldes believes the surgery is a huge pillar in the fight against FGM, which he considers a crime primarily perpetrated by men against women. “Since the beginning men have been scared of women’s sexuality, and mutilation is just a way for men to control women.” Once healed, Dr. Foldes says the women are given a voice, and are able to speak out against it. “The women can then discuss the mutilation in medical terms, when they discuss it like this, this is the way to free the problem, they are no longer silent.”
While the results of the technique must be further validated, the surgery is already having a significant impact on the women who receive it. “I have recovered my identity and feel I can now speak out, I want to tell all the women in my community how it can improve their lives,” says Aïssa, sitting in a square outside the hospital. “This technique will change women’s mentality to mutilation, and give them the confidence to build a united path to stop this culturally accepted violence towards women.”