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Monday, February 22, 2010

Life after female genital mutilation

February 17, 2010
By Mark Gould - The Guardian

Consultant gynaecologist Geetha Subramanian is one of only a handful of medical professionals in the UK to carry out FGM reversals

In a calm voice, Ann relates how, at the age of 12, she was drugged, blindfolded, stripped naked and held down by a singing and chanting group of women, who then used a surgical blade "to hack off my ­clitoris like it was a piece of meat".

Ann (not her real name) is one of tens of thousands of women in the UK who has undergone female genital mutilation (FGM), which can cause a host of health problems, infertility and even death. FGM – generally referred to as "cutting" – is illegal to carry it out on a UK citizen and punishable by 14 years in jail. Yet ­latest research gives a conservative estimate that 77,000 women and young girls in the UK have been mutilated, and around 24,000 young girls are at risk.

Anecdotally, it seems that cutting is on the increase, either being carried out in the UK or on "cutting holidays", like Ann's to Sierra Leone. One explanation is that it reinforces cultural ties of migrant communities with their countries of origin.

Cutting can mean anything from removing the hood of the clitoris to cutting off all the external genitalia and sewing up the wound, leaving only a tiny opening for menstruation. It can be ­performed using razors, metal, glass, string and thorns, often unsterilised.

Consultant gynaecologist Geetha Subramanian is one of only a handful of medical professionals in the UK to carry out FGM reversals, known as deinfibulation. From her NHS clinic at Mile End hospital in east London, she sees women whose families originate in sub-Saharan Africa, Yemen, the United Arab Emirates, Malaysia and Indonesia.

Subramanian, who has carried out more than 200 reversals, first saw the problem over 20 years ago when a young Somali woman came for an abortion. "She had been assessed by another doctor, who had not spotted the FGM," she says. "So many doctors and nurses are simply ­ignorant of it.

"I knew the woman was unmarried and that it would be important for her to be stitched, but it would be illegal and unethical for me to do it. I left it open and explained what I had done. She was happy and spread the word."

Last month, at a conference held by the FGM National Clinical Group, a DVD paid for by thriller writer Lady [Ruth] Rendell, who is a passionate campaigner against FGM, was launched to show health workers how to perform a reversal. Ann, who was about to undergo surgery to undo the damage done 13 years ago, bravely agreed to talk at the conference.

On the day she was cut, she says, the women of the village invited her to a celebration of becoming an adult. "They promised it would be wonderful – I would get new clothes, my hair would be done, and there would be music and all kinds of food," she recalls. "But I was stripped. They rubbed stuff on my body and gave me leaves to eat that made me feel woozy. Then they blindfolded me and led me along with a lot of other girls. There was a lot of chanting and singing. They held me down and opened my legs and I said, "This is not what you said would happen. Don't do it.'"

They gave her a local anaesthetic and used a sterile surgical blade – both supplied, she later learned, by her father, who is a doctor.

"Then they hacked at me like a piece of meat until it was off," she recalls. "They said that cutting would make my vagina flat and beautiful and not dirty or smell bad and would not itch. They said that if it didn't happen then no man would touch you, and they also told me not to tell ­anyone."

Ann tried to blot out the trauma, but finally went to a counsellor at school, who referred her to hospital. When she confronted her father, his response was: "I did what was best for you. If I did not, you would not be respected as a woman."

Because many men in cutting cultures say they will only marry a woman who has been cut, Subramanian says it is women who perpetuate the abuse.