F.A. Cole was hoping to feel ‘whole’ again when she was flown to Los Angeles for clitoral reconstructive surgery last September. She never knew such a procedure was possible – not since she was taken at the age of 11 to “the local cutter” in Sierra Leone, where she was stripped, blindfolded and had her hands tied behind her back.  To contain her screams, she was gagged.

Her stepmother had arranged the brutal ritual, calling female genital mutilation “a rite of passage to womanhood.”

In reality, it’s a procedure that removes part of the clitoris and wounds the genitalia.  Dating back to the Pharos, it carries a range of risks, from infections and cysts, to problems with childbirth, excessive bleeding, and death.

Now, more surgeons provide reconstructive surgery, but even skilled specialists can underestimate the breadth of care and expertise necessary to help victims recover.

Thirty-three years after her harrowing experience, Cole had a chance to reverse the damage.  She’s one of few women worldwide to have undergone a surgery that reconstructs part of the clitoris, as well as nerves that can restore sexual pleasure.

But not everything went as planned.

After the operation, she had a nervous breakdown.

Cole had suffered through seven weeks of itching, and pain.  The surgeon’s office, she said, told her not to worry.  But the itching got worse, and the youthful 44 year-old started taking sleeping pills.

Then by chance, Cole – an activist who campaigns against FGM – met veteran French surgeon and urologist Dr. Pierre Foldès at an FGM conference in Washington last fall.

“When he found out I was using soap, Dr. Foldès almost had a heart attack!  He said, ‘Soap? Who told you to use soap?’”

They discovered that the sutures (medical stitches) used after surgery caused an allergic reaction, something that Cole says would have been spotted if she had been given proper post-op care.

BETRAYAL OF TRUST

“I felt betrayed,” she says, “because this was somebody I trusted with my life.”

Cole, a software trainer for patent engineers, was the first woman to be sponsored for clitoral reconstruction by Virginia-based Global Woman P.E.A.C.E foundation, which campaigns against FGM.  The organisation has a waiting list of women it was planning to send to the same L.A. surgeon.

But Cole’s ordeal prompted a rethink.  She and other patients would be sent instead to a pioneering women’s health care centre west of Paris, which used a multi-disciplinary approach.

“After visiting Dr. Foldès’ facility I saw we were doing it the wrong way.  It’s not just the surgery woman should go through,” says P.E.A.C.E. co-founder and President Angela Peabody.

“When they’re mutilated as little girls, they go through a lot of trauma. They’re greatly affected psychologically. That’s why we put a package together. And we’ll be sending women to Dr. Foldès whenever we can – for surgery, psychological care and physical therapy care.”

Since the avuncular surgeon devised the ground-breaking reconstructive surgery in 1978 – he carried out his first operations in West Africa – Foldès has conducted more than 6,000 such operations, with the number of patients rising every year.

“Our work has sky-rocketed,” he says. “And because we provide free services – even the surgery is reimbursed – we need more funding to keep up.”  Not least, to cope with growing international demand.

Foldès and Frédérique Martz, who co-founded Women Safe Institute, were received by President Emmanuel Macron at the Elysée in December – not the kind of invitation typically extended to anti-FGM activists and health professionals.

Damage Done by Unqualified Surgeons

 Their work also includes fixing mistakes and surgical missteps of other health practitioners in Europe, Africa and the US, many of whom lack the necessary training.

Women at the mercy of unqualified surgeons and charlatans are thus doubly traumatised, first by the mutilation itself, and again by botched operations. Foldès says he has corrected such surgeries for at least 30 women, and with his colleagues, he has provided countless patients like Cole with post-op treatments and care.

A prescription for hormonal cream – and time to talk – has finally put an end to her suffering.

“He showed me he cared,” says Cole, “like a father who’s protective of his daughters, like ‘I don’t want anything to hurt my girls.’”

Surgeons trained by Foldès now work in medical centres that have opened elsewhere in France.

But he too, has learned on the job.  Having worked in the business of health care, Martz urged him to take a more holistic approach.  Setting out to treat the emotional and psychological ramifications of FGM, they launched the institute in 2014.

The team has expanded to include more than 20 staff, including psychologists, therapists, gynaecologists, and a team of lawyers.  Discussion circles allow girls and women to share stories and advice.

“Women help each other here,” says Martz. “So you’ll have a victim of violence at work, an FGM survivor, a woman who has been raped, an incest victim.  What do they have in common? They are all suffering, and this space allows them to talk it through.”

“FAMILY VACATION”

Halimata Fofana, author of “l’écorchée vive”

Genital mutilation is illegal in France, but activists say it’s still carried out in secret. Halimata Fofana was excited to go on holiday in Senegal when she was five years old, but she discovered the secondary meaning of ‘family vacation’ when she was put in her aunt’s care. The 36-year old author of Mariama, l’Ecorchée Vive – or “Flayed Alive” – says FGM is a product of family pressure, a lack of education and brainwashing.

“Little girls disappear for weeks off to the home country, and their schools don’t even ask any questions,” says Fofana. “Schools should have to raise the alarm.”

According to UNICEF at least 200 million women and girls alive today in 30 countries, mainly in Africa and Asia, have been subjected to some form of FGM, from clitoral cutting, to infibulation: cutting and sealing the vaginal opening.  This extreme form of mutilation leaves only a tiny hole for urination – a practice used to control female sexuality.

Martz and Foldès receive women who have been victims not only of FGM, but of all forms of violence, including sexual harassment, conjugal violence and forced marriage.

“Some of them tell us, ‘We never had a childhood,’” says Martz. “We realised that mutilation wasn’t limited to controlling their sexuality. It aims to control the woman’s entire life.”

A version of this story first appeared in the New Internationalist on 8 March, 2018.