DAKAR (Thomson Reuters Foundation) – Doctors in Senegal have been overwhelmed by demand for clitoral reconstructive surgery from victims of female genital mutilation after the U.N. agency for women launched a pilot scheme in the West African country, a surgeon said.
Currently, the surgery is only available privately and costs around 350,000 cfa ($700) - putting it beyond the reach of all but the elite in Senegal, where an estimated one in four women are cut.
The pilot scheme ended last year and U.N. Women hopes to reduce the costs of surgery so that it could be offered as standard procedure by Senegal's national health service. However, a lack of testimonials has raised questions about whether the technique works.
"We treated around 45 women in Senegal during the three-month U.N. Women pilot scheme, but we turned away well over 100 more because we didn't have the funds," Dr Abdou Aziz Kasse told Thomson Reuters Foundation in an interview.
He said previous methods of tackling FGM, a traditional practice that removes all or part of the female genitalia, have focused on prevention through changing society's attitudes towards FGM or implementing laws banning it.
"That's wonderful. But what can we do for all those women who have already been cut?" said Kasse, who was trained in France by French urologist Pierre Foldes, who pioneered the procedure.
SURGERY NOT SUITABLE FOR EVERYONE
FGM affects around 140 million girls and women throughout Africa and in pockets of the Middle East and Asia. It is usually arranged by the women in the family and performed by traditional cutters who use anything from scissors to broken glass and tin can lids.
It can cause haemorrhaging, shock, chronic pain, recurrent urinary tract infections, cysts, menstrual problems, infertility and even death. It also increases the risk of labour complications and newborn deaths.
"We'd like to make the surgery cost the same as giving birth (around $100), but we have to be careful how we proceed, as continuing without evidence may undermine the prevention efforts that are in place," Marie-Piere Raky Chapin, U.N. Women's Senegal country programme coordinator, told Thomson Reuters Foundation.
The reconstructive surgery involves breaking open the scar formed by FGM and pulling the clitoris, the majority of which lies beneath the surface, back to the surface, removing the chronic pain associated with the practice and restoring the sensitivity, Kasse explained.
"Women are happy," said Kasse, who funded a proportion of the pilot scheme out of his own pocket. "However, you can't perform the surgery on everyone.
"In some parts of the world, the cutting is too severe to be able to reconstruct and restore the clitoris. Women also have to be psychologically ready to undergo the operation and learn how to use a new part of their body," he added.
PREVENTION STILL KEY
Not all women undergo the surgery to experience clitoral orgasms though. Some women opt for surgery because they want to get back something that was taken from them so that they can feel complete, Kasse said.
Even then, there can be misunderstandings.
"The problem is that the women don't know about their own anatomy, so they thought that I would give them a big clitoris. After the surgery, some women complain they can't find their clitoris. I tell them, 'you're not meant to see it, you're meant to feel it'," Kasse said.
Efua Dorkenoo, head of the FGM campaign at women's rights group Equality Now, was cautious about the effectiveness of clitoral reconstructive surgery.
"We need more robust follow up on if it works. Some women I have talked to say it has improved things, but others say they haven't seen much change," Dorkenoo said by telephone from London.
"If there is a medical discovery to support women who have had this lack of pleasurable sensation then more women should be able to access this kind of care. But emphasis should always be on prevention," she said.
She also said that there was a need for psycho-sexual counselling not just for women, but for their partners.