Female Genital Mutilation is a crime and a huge violation of women’s rights. Not only does it cause enormous physical harm to its victims, but it also leaves behind massive psychological damage. Restore FGM attempts to heal this damage; it’s the first center offering a multidisciplinary treatment for survivors of Female Genital Mutilation in Egypt and the Middle East.
Its founders are Dr. Amr Seifeldin and Dr. Reham Awad. Seifeldin is the first cosmetic gynecologist in the Middle East, who specializes in vaginal and genital reconstructive surgery (among other things). He founded and directed the Urogynecology and pelvic surgery unit at El Galaa Teaching Hospital from 1986 to 2018. Seifeldin is a member of several international medical academies in Europe and the USA (including the American Aesthetic Association) and has many international publications to his name.
Awwad is a half Saudi half-Egyptian plastic surgeon with a determined passion to aid survivors of female genital mutilation. She graduated from medical school in the UAE and trained in Saudi Arabia and the US. In 2012, she moved to Egypt to complete her masters at Kasr-Al-Aini Teaching Hospital. We spoke to them to know all about their work with FGM survivors.
What is FGM is and what are its types?
FGM is the cutting of a part of the clitoris, clitoral hood, and/or the labia minora, the parts of female genitalia that allow women to experience sexual pleasure, for non-medical reasons. According to research, it began in the time of the Pharaohs and is most prevalent in Africa, parts of the Middle East, and some countries in Asia. According to the World Health Organization, there are 4 types of FGM.
Type I involves the partial or total removal of the clitoris and/or clitoral hood. Type II, the partial or total removal of the clitoris and the labia minora (inner lips), with or without excision of the labia majora (outer lips). Type III is the narrowing of the vaginal orifice (cavity) and creating a covering seal by cutting and apposition (pushing together) of the labia minora and/or labia majora, with or without excision of the clitoris. Type IV is any other mutilation done to the genitalia for non-medical purposes such as piercing or scraping.
The most common types of FGM in Egypt are Types I and II, Type III is less common but often practiced in Aswan and the Sub-Saharan regions.
Which groups in Egypt are most vulnerable to FGM?
According to a 2017 report by UNICEF, the prevalence of FGM in Egypt is 87%. Which means that it is practiced by most Egyptians.
Although studies show that it occurs more frequently among those with lower educational levels and socioeconomic backgrounds, it is also practiced among the educated, but less frequently. Hopefully, with more awareness and education FGM rates will decrease in the future.
What are the physiological and psychological ramifications of FGM?
FGM is a destructive procedure, performed with the intent to do harm and curb sexual pleasure. It has no health benefits and causes colossal damage to the victim on the psychological, sexual, emotional, and physiological levels.
The greatest ramifications are on the psycho-sexual level. They include feeling incomplete, having low self-esteem, sexual phobia, and embarrassment with a partner. Other disorders include Post Traumatic Stress Disorder (PTSD), affective disorders, anxiety, depression, and psychosomatic disorders. Furthermore, it reduces sexual desire and creates difficulties in reaching orgasm. It also causes vaginismus and may lead to suicidal tendencies.
Physically, it causes hemorrhage, neurogenic shock, trauma, and injury that can lead to death. It can also cause infection with HIV, Hepatitis, and Tetanus. Other physical ramifications include urine retention, clitoral cysts, and keloid (scar) formation, painful intercourse, decreased clitoral response and orgasmic capacity, urinary tract infection, painful menstruation, and increased fetal and maternal morbidity and mortality during labor.
What inspired you to open up Restore FGM?
Dr. Reham Awwad: I became interested in the topic of FGM while doing my internship in the UAE. While doing a pelvic exam for a pregnant patient who was coming for a check-up with a case of type III FGM, I was shocked and confused at what I saw.
I initially thought what I was seeing was a deformity. The doctor later explained what FGM was. That day, I knew I wanted to take part in helping these women.
I did my thesis about “Clitoral Reconstruction After FGM” and I started dreaming about opening a center for FGM survivors that would help completely heal them, not just surgically. That’s when I knew about Dr. Amr Seifeldin, the only surgeon who was doing reconstructive surgeries and who had been working with FGM survivors for over 20 years. He shared the same dream. So, we joined forces and began our journey to open Restore FGM.
Restore FGM’s website stipulates that the FGM Care you provide includes Clitoral Reconstruction, FGM Restoration, Non-Surgical treatments, Psychological Care, and treatment for Female Sexual Dysfunction. Can you explain these treatments and the differences between them?
Dr, Amr Seifeldin: We are a multidisciplinary center that provides patients with holistic and personalized medical care for FGM complications.
Our protocol entails first having a medical specialist examine the patient. If the main problem is psychological or sexual trauma, the patient is referred to psycho-sexual counseling. If it’s functional (has to do with clitoral sensitivity), the patient undergoes non-surgical therapy. If the problem is aesthetic genital appearance and severe functional disorder, then surgery is required and is the last resort.
Personally, I prefer the word restorative surgery, since we can NOT reconstruct or repair a body part that has been cut or amputated. The clitoris is an 8-12 cm organ. Only the palpable part is removed during genital cutting, the rest lies within the body.
We can remove peri-clitoral adhesions (tissues around the clitoris), and with a delicate surgical technique, make the clitoris more accessible to stimulation and thus able to function (as close as possible) like the uncut clitoris.
What is the price range of the treatments you provide at Restore FGM? Do you offer any free support?
It is very difficult to determine prices for any treatment because we must examine the patient and do a consultation before determining what she needs. Many women just need reassurance that their sexual function has not been affected by the mutilation they were subjected to.
We are currently registering as a nonprofit so we can receive donations and funding because lack of funds is a big challenge.
Our goal is to have a center open at all times where victims of FGM can come for consultations, psychological therapy, support groups, and even educational classes on sexual health.
We strive to have enough funds to treat every patient at an affordable price. We’ve been lucky to have some people donate money to help a patient get surgery.
We perform some surgeries at hospital cost, with no doctor’s fees. Once we have our papers registered, we hope more people will donate to our center.
How many FGM survivors have you treated so far? What are their ages and social backgrounds?
Dr. Amr Seifeldin: The average number was about 120 cases a year, maybe more. However, when we started treating cases privately, the numbers went down. Most FGM victims in Egypt are unaware of the availability of restorative surgeries for FGM complications.
Patients are usually between the ages of 18 to early 40s.
Egypt has the highest number of global FGM cases, and it has been practiced for over 3000 years.
So, I examine cases from all walks of life. However, most patients are from rural areas, with moderate to high education levels.
What changes after an FGM survivor undergoes Clitoral Reconstructive surgery? And how important would you say psychological care is?
It is difficult to explain the transformation that occurs after an FGM survivor undergoes clitoral reconstructive surgery. What I can say is that it is seeing this transformation that pushes us to continue our work in this field.
The procedure can have a great impact on the woman’s life. It doesn’t just improve her sexual function and the aesthetic appearance of her genitalia; it also grossly improves her psychological state.
She becomes more confident, develops a sense of fulfillment, and feels like she can move forward in life. It is truly incredible.
However, we prefer to keep surgery as a last option. If the patient has an acceptable sexual function and cosmetic appearance of the external genitalia, she does not require surgery.
We always encourage our patients to get psychological support because it improves their quality of life. The psychology of a woman is intertwined with her sexual function. So, improving her psychology improves her sexual function. That’s why it is a core part of our protocol at the center.
What are the challenges-personal and professional-that you face by running Restore FGM?
On a professional level, it is difficult to achieve what we envision for this center without funds. We want to have a staff and be open all week to be able to give these women the care they need. We want to expand and involve sexual health education and support group therapy and many other things.
Currently, we are working out of a clinic in a hospital that gives us affordable rates for our patients, but most of the patients cannot afford to pay the costs of treatment. We use the donations we’ve been lucky to receive to cover the costs of those who cannot afford to pay for the treatment in full.
This month we are offering three surgeries at hospital cost and our team psychologist is offering three free therapy sessions for those most in need in honor of International Day of Zero Tolerance for FGM.
Another challenge we face is people’s disapproval of what we do. FGM is still considered a bit of a taboo subject. Hopefully, this will get better with time when people start realizing that FGM is harmful and nothing else. I believe we’re heading in the right direction.
What would you say to an FGM survivor who wants to visit Restore FGM but is hesitant to take the step?
I would tell her that there is absolutely nothing to fear.
We will always provide a judgment-free space and all the support a survivor needs.
We do what is in the best interest of the patient, supporting these women is the main reason why we started Restore FGM.