Reconstructing Sexuality after Excision: The Medical Tools

ABSTRACT

Clitoral reconstructive surgery is not sufficient to restore women’s sexual pleasure after excision. If the surgical technique aims at reconstructing the cut clitoris after type 2 female genital mutilation, the surgery alone cannot reconstruct other dimensions invoked by women in their requests for the procedure. In France, where clitoral reconstructive surgery since 2004 has been entirely covered by national insurance, a multidisciplinary approach precedes the surgery. Ethnographic fieldwork in one public hospital contributes a wider comprehension of the entire process of clitoral reconstruction, as well as the tools elaborated by the medical team. In particular, analysis of the assessments of the psychologist and sex therapist compiled in the medical folders shows how the multidisciplinary medical team developed specific tools. These tools are oriented at reconstructing the patient’s sexual sensibility, at breaking through psychological blocks such as self-esteem and body image, and/or at addressing abusive intimate relationships.

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KEYWORDS:

• Clitoris
• counseling
• female genital cutting
• reconstruction
• sexuality
• surgery

Acknowledgments

Data use in this article belong exclusively to the author and result from doctoral research conducted between 2007 and 2012. There is no conflict of interests. The PhD thesis was awarded with the Prize of the City of Paris for Gender Studies. Special thanks to Ylva Hernlund for her precious advice.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Notes

1. In this article, I use the term FGM/C for discussing the literature, and the specific term “excision” for discussing the findings, as it is the only term used both by women and clinicians in France.

2. Refer to the national quantitative research study “Excision and Handicap” conducted in France between 2007 and 2009, reported in Andro et al. 2009.

3. Additional psychological and sex-therapy counseling may be offered in the post-operative stage per the woman’s demand.

4. See the web page of the European Network. The picture of razor and needle and thread is still used, see the video – https://www.endfgm.eu/female-genital-mutilation/what-is-fgm/.

5. This refers to abnormalities in the process of voiding urine, including bladder control, frequency of urination, the volume and composition of urine.

6. Aller à gauche et à droite literally means “going around without discernment” and refers to dissipated sexual behavior or promiscuity.

Additional information

Funding

I acknowledge funding from: Graduated Women International, Association Suisse des Femmes Diplômées des Universités (ASFDU), 2012 (CHF 8 000); Société Académique Vaudoise (SAV), University of Lausanne, 2012 (CHF 8 000) and Prix de la Ville de Paris pour les Études de Genre, 2013 (EUR 5 000); Société Académique Vaudoise (SAV), University of Lausanne [2012/ Grant]; Association Suisse des Femmes Diplômées des Universités (ASFDU) [2012/ Grant].

Notes on contributors

Michela Villani

Michela Villani, PHD, is senior researcher at the University of Fribourg, Switzerland. Her work focuses on the institutional treatments of individual desires and social aspirations related to sexuality. In particular, she has worked on clitoral reconstruction in France, IVF procedures in Italy, the management of HIV status in a migratory context and the socialization to sexual norms of young people of African origins in Switzerland.