February 6, 2020 By: Dr. Reham Awwad
I will never forget the first time I saw a case of female genital mutilation. It was during my OB/GYN internship rotation. A pregnant patient came in for her 38-week checkup. Following the gynecologist’s instructions, the woman lay down on the examination table. What I witnessed next left me in shock. The woman’s labia majora (the outer lips of her genitalia) were sewed shut! I could not even comprehend what I saw. It wasn’t until she left that I had the chance to discuss her case with the gynecologist, who was also my trainer. I stood there listening in horror and disbelief as the doctor explained to me what female genital mutilation is. Then and there I made up my mind to help women who underwent this terrifying experience, if I ever had the chance.
I was shocked to learn that 87% percent of women in Egypt between the ages of 15-49 had undergone genital mutilation/cutting. The more women I spoke to who had experienced this horrendous act, the more I was adamant to seek a way to help them. I ended up choosing plastic surgery as my field of specialty and I was given the opportunity to choose between several thesis topics for my Master’s. When I found out about the clitoral reconstruction procedure that could help so many women who had undergone FGM, I was inspired. Without hesitation, I selected it as my thesis subject.
This magnificent procedure was first performed by the French doctor, Pierre Foldes. He introduced clitoral reconstruction after FGM in France in 1992 and completed his research in 2009. He performed the surgery on over 3,000 patients. For the majority of them, the surgery resulted in improvement of pain and sexual function as well as recovering their personal autonomy.
I was fortunate enough to get assigned to my advisors, Dr. Adel Wilson, Professor of Plastic Surgery, Cairo University, who was not only supportive of my thesis subject, but had also suggested it. It was fate! I was also lucky to have Dr. Heba Kotb, Professor of Forensic Medicine, Cairo University, as my second advisor. Her expertise provided a different perspective and insight to the subject. My third advisor was Dr. Amr Zaki, Lecturer of Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University.
When I talked to people about my thesis topic, their reactions varied between confusion and shock. Almost everyone told me that it was an important topic, but I would never find patients, not to mention that I was treading on dangerous waters since FGM is a taboo subject. Nonetheless, I decided to proceed with my plans because I knew someone had to take the lead to bring change to the women who suffered from FGM.
I struggled a lot and found many obstacles in my path. Barely anyone knew about the procedure, for it had never been discussed or brought to the general population’s knowledge or attention before. For several months, I failed to find a platform from which I could introduce this medical breakthrough to Egyptian women and announce its availability in Egypt. I finally decided to announce it on Women of Egypt Facebook page, I couldn’t believe the reaction and responses I received. The phone calls I received from women inquiring about the procedure elated me. They sounded hopeful and happy to hear about this procedure. I was overjoyed!
Clitoral reconstruction surgery benefits women who underwent FGM. Most people are unaware that the clitoris is not just what is seen externally; the majority of it lies internally. In clitoral reconstruction surgery, the surgeon takes a part of the internal clitoris and brings it outward to replace the cut clitoris. Reconstructing the clitoris restores the anatomy and allows the patient to regain a sense of identity. In many cases, it has also shown success in restoring sensation.
This procedure is not new in Egypt. It has been performed before but only by a handful of doctors in private practices. I am proud to say that because of my thesis, we were able to provide this procedure to the women involved in my study, for free at Kasr Al Aini Hospital. We performed the reparative surgery on 20 women and the results were very positive. From an anatomical point, we were able to restore the anatomy of the clitoris for all the patients. The women who suffered from pain due to the genital cutting/mutilation were relieved of their pain and the majority of the women also experienced an improvement in sensation. Aside from the anatomical and functional results of the procedure, we saw a massive improvement in the psychology of these women.
They all expressed how happy they were to have done the procedure because it restored both their autonomy and psychological well-being. Seeing the effect of the procedure on these women motivated me to continue my work in this field to help many more.
It is important to state that treatment for victims of FGM starts with education, psychological care and emotional support. The surgery is the last step in treatment, if required. These aspects of treatment must be available to all women who suffer from FGM ,and I hope to be a part of providing this care to the women in Egypt in the future.
I could not be more proud of the work we have done and I look forward to what comes ahead. And I grateful for my mentors and advisors who believed in me throughout this journey. I would not have been able to achieve any of this without their support. I also thank all the patients who trusted us and who will forever be dear to my heart.
Dr. Reham Awwad, Resident of Plastic Surgery at Kasr Al Aini Hospital. Thesis for masters degree on clitoral reconstruction after FGM
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