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Lithium What sex and healing are like for survivors of female genital mutilation

Feb. 24, 2022
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I first heard of female genital mutilation as a hypothetical. It served as solid evidence of how the patriarchy punishes women, perceived as something that only happens in the backward Third World. (In reality, FGM is present in every continent except Antarctica.) It’s a feminist exercise—we know nothing about the practice beyond the notion that it must be condemned. 

This treatment of FGM as an ideological battleground reveals what is fundamentally missing in our conversations: the 200 million women and girls around the world who have actually undergone the harmful practice. The World Health Organization’s declaration of FGM as a human rights violation in 2008 was a big step, but what’s next? More and more countries are passing laws prohibiting the practice, but what happens to survivors who were already cut, who can no longer benefit from these prohibitions?

One reason why it’s so difficult to hear from survivors is that FGM remains largely underground. Because of this, prosecutions are scarce, despite 68 countries having some form of anti-FGM policy, including the U.S. and the UK. The secrecy of the practice is so severe and pervasive that some survivors don’t even realize they underwent FGM when they were younger. Rosse, who lives in Singapore, was 20 years old when she found out she’d been cut. “When I spoke to a few friends of mine, they didn’t know that this procedure occurred in Singapore,” she shared in a Reddit AMA about FGM. “When they asked their parents about it, they confirmed that it [had] happened to them too.”

Rosse shared that the procedure was performed at a clinic; her parents had granted permission, which is often the case. “I felt a mixture of disbelief, confusion, rage, and disappointment,” Rosse, now 25, told me via email. Upon confrontation, her mother reasoned that “it’s for religion,” and that it’s supposed to ensure women “don’t become adulterers or promiscuous.” 

Contrary to popular belief, FGM is not prescribed by any religion. While the factors behind its perpetuation are contextual and diverse, it always boils down to misogyny—a universal language. Like Rosse, many young girls in heavily patriarchal societies are cut to preserve their virginity prior to marriage or to guarantee monogamy, thus affirming that the children they conceive are legitimate heirs of their husbands. Women who are not cut are seen as unfit for marriage and are ostracized by other women in their community. 

Ultimately, being cut affords women better marriage opportunities and social support, and in communities where marriage and childbirth are the only viable paths for women, FGM unfortunately becomes a small price to pay for survival. The rhetoric that FGM exists because of religion or that it only happens in far-flung corners of the world distracts us from the fact that it's yet another cog in the complex machine of systemic sexism and body policing. It is, at its core, a means of objectifying women—hardly a phenomenon reserved for far-flung areas. 

Many anti-FGM activists are changing their language regarding the practice to put more emphasis on its roots in gender-based violence. After all, its effects are more clearly understood when we call it what it is: sexual assault. Psychotherapist, writer, and anti-FGM activist Farzana Doctor encourages people to think about FGM survivors the same way we might think about any survivor of sexual trauma. “There’s this full spectrum,” she told me over Zoom. “And we want to respect where everybody is in their experience.”

Doctor explained that while cuts vary from person to person—there are four types of FGM—the way a survivor responds to their experience is linked to how traumatic a particular event was and how much support a survivor received afterward. Because FGM involves a delicate area, extra damage can easily occur if the person being cut is not lying still or if the procedure is performed by amateur cutters. (That said, FGM is unsafe whether it’s practiced by medical professionals or not.) 

Rosse underwent Type 1, which involves a cut to the clitoral hood. This has caused clitoral stimulation to be “too painful to experience” for her. In her Reddit AMA, she recounted difficulty in receiving oral sex, and said that during masturbation she rarely focuses on her clitoris. Globally, there is already very little room for the exploration of female sexuality, especially for women of color like Rosse. This is true even for women who were never cut; the long-standing physical consequences of FGM simply exacerbate many women’s existing perturbations in getting sexual pleasure. “It’s an added learning curve when trying to learn your own body,” Rosse said.

Doctor mentioned that around 30% of FGM survivors say they don’t know if FGM has affected their sex life and that they aren’t aware of where specifically they were cut. She attributed this to a global lack of comprehensive sex education and unchecked misogyny that render female sexuality invisible, noting, “Often, [women] don’t know anything about their body. They often believe they don’t have a right to robust sexuality.” After all, FGM is essentially the eradication of such “robust sexuality”—it’s meant to be painful, to discourage women from having sex outside conception. Survivors of Type 3, the most severe form of FGM, which involves the complete closure of the vaginal orifice aside from a small opening for urine and menstrual blood, have to go through additional cutting to prepare their bodies for sex after marriage. 

And because FGM is done at a young age, often in duress and then kept a secret—like what happened to Rosse—there can also be psychological consequences that manifest long after the procedure is done. Doctor often discusses how trauma gets stored in survivors’ bodies as a stress response, which can interfere with pleasure. She said some survivors in her community experience pain during penetration, which can be unexpected since their cut is usually higher up in the clitoral hood. “We have all these muscles that could tighten up. Even if none of [the trauma] is conscious, the body is like, ‘it doesn’t matter that 40 years has passed [since the cut]’—the body says, ‘it could happen again, so tighten up,’” she explained. 

This is a notion that has gained popularity in the past decade, thanks mostly to Bessel van der Kolk’s book The Body Keeps the Score. The book argues that many people who have experienced trauma chronically feel unsafe in their own bodies; that “the past is alive in the form of gnawing discomfort.” This is further complicated by taboo: the brain is likelier to suppress traumatic feelings if they can’t be spoken about.

It comes as no surprise, then, that most of the questions Doctor receives for her Dear Maasi column (“maasi” means “aunt” in Hindi) are about dealing with sex and sexual pleasure post-FGM. In the column, which is published monthly on Sahiyo (the Bohra Gujarati word for “saheliyo,” or friends), Doctor discusses how FGM impacts survivors’ bodies, minds, sexuality, and relationships. In an installment about the clitoral hood and sexual pleasure, she cites studies revealing that 33-35% of survivors say FGM has caused them to experience shame, low self-esteem, difficulty trusting sexual partners, low sex drive, oversensitivity in the clitoral area, and inability to feel sexual pleasure. Along with having to navigate the physical and psychological impact of the procedure, FGM survivors must also work to unlearn the indelible deletion of their sexual agency.

Doctor asserts in multiple installments of her column that sexual pleasure is a birthright, regardless of the fact that across cultures, women and non-binary people are taught that sex is shameful and not to be discussed. She encourages survivors to reimagine sexual pleasure beyond genital stimulation—FGM-related clitoral oversensitivity doesn’t entirely eliminate the possibility of pleasure. Rosse, who reported a similar oversensitivity, agreed: “There are so many ways to arouse a person, to receive and give that sexual experience. It’s more about the mental space than the physical body for me, though both are important.”

Rosse shared that she’s trying to be more communicative about her needs with sexual partners, which also helps in overcoming her difficulties with body confidence. She does nude modeling for art classes, and says it feels liberating to be in tune with her own body. When asked if FGM impacts how she sees herself as a sexual being, Rosse responded, “I’ve always been in touch with my sexual side even before the revelation [that I’d undergone FGM]. So why should that change?” While she previously worried that partners would see her body as weird, she doesn’t feel the need to disclose her experience with sexual partners. “It isn’t something that I fixate on, and I think that’s a healthy thing,” she said. 

She did mention that because many women undergo FGM in order to “be ready for marriage,” she no longer sees marriage positively. Associating FGM with a woman’s marriageability signifies that in a (heterosexual) couple, the husband always disproportionately wields the power. After all, a woman who has been mutilated, who will experience pain and discomfort every time she has sex or give birth, is easier to make subservient. 

Marriage may have been the end goal of FGM, but at no point is it easier. Activist and FGM survivor Sadia Hussein revealed in a Guardian feature that she had to bear children yearly despite the pain, in compliance with social expectations and the desires of her husband. Doctor said that survivors of Type 2 and 3, which entail more extensive damage to the clitoris and labia, often encounter more difficulty in childbirth.

In terms of medical treatment, Doctor said that many healthcare professionals are already familiar with Types 2 and 3, but the same cannot be said for survivors of Type 1. Cliterodectomy is admittedly harder to recognize; in some cases, there is no visible scarring. Doctor said this can often lead Type 1 survivors to feel invalidated in medical settings. She added that many healthcare sectors globally have no mandated action plans for survivors, perhaps because FGM’s covert nature creates the false belief that it is no longer being practiced. 

Besides, survivors may not always be open to the idea of treatment, especially if they do not have the social or financial capital to freely seek it. Some survivors unwillingly forego treatment and support because of financial insecurity or their lack of legal immigration status. Survivors are also often minors whose parents and adult relatives are pro-FGM, rendering them powerless in the aftermath of their assault.

It is clear that FGM is not only an issue of gender rights but of race and class. In many communities, midwives, who are paid poorly by the state, compensate for their low earnings by performing FGM. It is only when presented with alternative sources of income that cutters give up the practice. Further, FGM gets passed down from mothers to daughters because women have not been emancipated from the systemic abuse teaching them that being cut is a prerequisite for social acceptance. They do not come forward because there is no way they can do so without risking ostracization. International intervention efforts usually fail because community leaders and authority figures, who are often pro-FGM, are treated as the official spokespeople on the issue. As activist Nimco Ali said to British magazine New Statesman, FGM persists because, within certain communities, men of color dominate women of color’s lives, and “the largely white (and largely, though not exclusively, male) mainstream condoned that domination.”

Progress has certainly been made, however, with many anti-FGM activists worldwide being given bigger platforms to talk directly about their experiences. “Five years ago, people were saying [FGM] happened in 30 countries. Now we’re seeing 92,” Doctor said, attributing this recent uptick in awareness to the #MeToo movement. That said, she noticed that many activists—who are often survivors themselves—have not had access to healing resources. “They get burnt out or retraumatized very quickly, and that makes it hard to have a stable survivor-based movement.” Many activists also get bullied by pro-FGM people in their own communities. Rosse deemed mental health support “crucial” for FGM survivors, especially in terms of healing psychological trauma and unlearning the notion that they are “sexually disabled.” 

Global organizations and activists, including Rosse and Doctor, are adamant about ending FGM. “The best way to support us is to create awareness of this practice and why it must be stopped,” Rosse said. Many health providers and non-FGM survivors are hesitant to address this issue because they feel it is not their place to speak on such a ‘cultural’ practice, but FGM is not mandated by a culture other than that of patriarchy and sexism—something we are all part of. “I try to always link [FGM] to this continuum of sexual and gender-based violence; it’s not that different from rape culture,” Doctor said.

Similar to many forms of sexual assault, there’s a very real culture of silence around FGM, making it all the more challenging to put an end to it. We can help combat this silence by supporting anti-FGM groups and activists, especially locally. Rosse encourages us to support Orchid Project, a UK-based organization supporting grassroots anti-FGM efforts in America, Africa, and Asia; and Asia Network to End FGM/C, where membership is free. Doctor currently volunteers with We Speak Out, a global group advocating against FGM in the Dawoodi Bohra community. She also recently published the novel Seven, which explores FGM, and can be purchased here.

Illustration by Eutalia de la Paz.