In some countries or regions, the treatment offered by health centres (public or private) to women and girls who have undergone FGM was for a long time limited to purely medical aspects: treatment of a complication, surgical operations (deinfibulation, removing a cyst…). However, we believe that it is important to consider the individual as a whole and that it is preferred to take into account the general wellbeing by proposing complete and varied support to the persons concerned, thus not only physical, with medical care, but also psychological and sexual. Indeed, the World Health Organization defines « Health » as «a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity » .
Sexual mutilation can have both physical and psychological consequences. The latter are manifested either immediately i.e. during the cutting or a few days later it, sometimes even longer i.e. several months or even years afterwards. When we talk about the immediate impact, we can cite fear, feelings of helplessness, strangeness, death, a sense of betrayal of peers, but also, in the longer term, the feeling of not being « normal » – especially for women who migrate to countries where FGM is not the norm, negative impact on self-esteem, pleasure and sexual desire, post-traumatic stress disorder…
Moreover, the World Health Organization (May 2016) advises professionals to go beyond the treatment of the physical consequences of FGM and recommends treatment of depression and anxiety disorders as well as specific attention to the sexual health of women.
What psycho-sexual and social care is provided for women and girls affected by FGM?
Our definition of a therapeutic approach is broad and may include a variety of various practices carried out by professionals as well as community groups. «So who is a therapist? What is therapeutic for women affected by FGM?». We propose the following definition: « the therapeutic process must allow for the advancement of identity (re)construction and allow the person consulting to repossess and become conscious of their experiences, feelings, resources and autonomy » (GAMS, 2015, p.83). As part of the sexological support we can add that it includes not only « treatment » but also the promotion of female sexual pleasure by allowing women to discover themselves and to find their active sexual role.
All initiatives favouring the psychological and sexual well-being of women affected by FGM are interesting to share, regardless of the initiator of the project. We therefore propose that the people filling out this survey define their therapeutic approach themselves.
On the one hand, we see professionals, especially but not only, psychologists and sexologists, adapt ‘classic’ therapeutic tools to the specific issue of FGM or and to women having gone through the practice. On the other hand, associations and Women groups set up activities to promote wellness and communication to deal with the psychological and sexual consequences of traumatic experiences.
Multidisciplinary medical centres for support to women with FGM have existed in some European countries for a few years (e.g. Belgium, Germany, Holland and France). These centres offer not surgical care (removing cysts, deinfibulation …), but also psychological and sexological care, as well as physiotherapy. Some centres offer surgical reconstruction of the clitoris. Non governmental organisations also offer community workshops as well as social and psychological support to individual women and girls.
To our knowledge, there is little documentation on experiences of multidisciplinary care in other regions, particularly in Africa. The treatment of FGM has long been regarded only from a medical perspective and in some contexts it may be difficult or impossible to obtain psychological or sexological support after excision. Several problems also arise where psycho-sexological services exist, including difficulties in availability, access to services and lack of information. Nevertheless, some medical centres, such as in Burkina Faso, work with psychologists to ensure comprehensive care.