Amid high demand from victims of female genital mutilation and cutting (FGM/C) for clitoral reconstruction surgery available in Burkina Faso, the procedure remains unaffordable for most.
“The demand is very high in Burkina Faso and from neighbouring countries,” said Michel Akotionga, one of the first gynaecologists in Burkina Faso to perform the reconstructive surgery. “Last week two women from Côte d’Ivoire came for the clitoral surgery,” he added.
Pioneered by the French urologist Pierre Foldes when he worked in Burkina Faso with victims of FGM/C, the surgery has been offered in Burkina Faso since 2006.
Since 2001 975 women have had state-funded genital repair surgery, which did not include clitoral reconstruction, according to the National Commission against Excision (CNLPE). The general surgery entails repairing the vaginal opening to alleviate menstrual and urination pain but does not reconstruct the clitoris.
During FGM/C the external tip of the clitoris is destroyed, leaving behind up to 10 centimetres of the embedded sexual organ. In 2006 doctors in Burkina Faso started operating on the hidden part of the clitoris; in 90 percent of the reconstruction procedures, women recover sexual sensation, said Akotionga.
Satisfaction with the surgery depends on why a woman wants it, said Ouagadougou-based surgeon Charlemagne Ouedraogo. “They [FGM victims] have lost something and feel incomplete at all levels.”
For women who want the surgery as a form of justice for a human rights abuse, Akotionga said the surgery can offer relief. But for those who seek sexual fulfilment the surgery can disappoint, he said. “Some 10 percent of the women do not recover sexual sensation because it is not always linked to FGM.”
Ouedraogo added: “Pleasure is relative because there are women who have not had the surgery who can still enjoy their sexuality. But there are others who are so wounded psychologically and physically they may benefit from the surgery.”
Since 2006 Akotionga said 150 women have had the surgery, which is offered in Burkina Faso’s two largest cities, the capital Ouagadougou and Bobo-Dioulasso.
In public hospitals the procedure costs about US$140 whereas private clinics charge up to $400. Ouedraogo and Akotionga said the cost is still “prohibitive” for those in West Africa where the average annual salary was US$600 in 2007, according to the UN Children’s Fund (UNICEF). “People think it is free, like a simple repair, but when they learn the cost they go back home,” said Akotionga.
He said he has helped train 20 doctors to perform the 30-minute operation but “lack of equipment prevents them from [performing] the surgery.” Ouedraogo said were it not for the equipment problem, surgeons could reconstruct clitorises during genital repair operations. “We are right there before the clitoris – why not reconstruct it?”
Félicité Médah, a member of non-profit Voices of Women said some women see clitoral reconstruction as a “luxury” because of its cost.
FGM/C victims are at risk for childbirth complications, crippling pain during urination or complete loss of sensation during intercourse, in addition to psychological distress. Lifelong genital itching, scarring, cysts, infections, infertility and urinary disorders are common, for which women have sought relief through genital surgery that did not involve clitoral repair.
“But if a woman has the money to go one step further and reconstruct her clitoris, it is not a luxury, but rather a reparation of an injustice,” said Médah.
Jeanine Sawadogo, 25, said she has been unable to have sex since her clitoris was cut when she was 12 years old. “I live with my frustration. No man will stay with me because I cannot have sexual relations.”
She said she has not been able to get an appointment with the often overbooked Akotionga – despite repeated attempts.