Psycho-sexual health of FGM survivors

How does FGM affect mental health and wellbeing?

Health is defined by the World Health Organisation (WHO) as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (WHO, 2018) The WHO also underlines that being exposed to traumatic events during childhood has a crucial importance on mental well-being. It defines mental health as follows:
“A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. With respect to children, an emphasis is placed on the developmental aspects, for instance, having a positive sense of identity, the ability to manage thoughts, emotions, as well as to build social relationships, and the aptitude to learn and to acquire an education, ultimately enabling their full active participation in society” (WHO, 2018, p.7)

In studies on the links between FGM and mental health, women having undergone type I and type II FGM and those having undergone type III (infibulation), are often distinguished. WHO includes consequences on mental health and well-being in “FGM sanitary risks” and identify within the psychological risks post-traumatic stress disorder (PTSD), anxious disorders and depression (WHO, 2018).

In 2018, in it’s guidelines on the management of health complications from FGM (WHO, 2018) as well as in it’s clinical guideline (GAMS Belgium, 2020), the WHO emphasized the importance of adopting a holistic approach and bringing psychological support to women in need.

Furthermore, the scarce development of mental health system and psychological support in some countries, above all in Africa, have imposed an important limit to our research and explain why our data and analysis focus more on Europe. Indeed, more studies, therapies and solutions are developed in Europe and the situation is very different in Africa where it is harder to find services and reports on this matter.

The purpose of this thematic note is to discuss the psychological consequences of FGM, present the current solutions and highlight what is at stake. If it is possible to identify psychological consequences directly linked to FGM, it is crucial to understand this event in the larger context of a women’s life path and a broader social, cultural, economic context which also influences mental well-being. This dimension has to be integrated into solutions put in place and / or recommended to cover FGMs psychological complications and resolve a main issue, namely (re)construct a positive self-image and (re)connect with others. Finally, there is still much to be done to enhance psychological support to women and girls affected by FGM and to offer them support which is adapted to their needs.

Two Web conferences (Webinars) were organized within the frame of this thematic discussion, one in English and one in French. In the first Webinar, on June 9th 2020, Farzana Doctor (Canadian-Indian psychotherapist and writer) and Venoranda R. Kuboka (Kenyan youth therapist) shared their views on mental health, wellbeing and FGM. Venoranda addressed the issue both in terms of the mental health of FGM survivors themselves and of therapists and anti-FMG activists who support survivors. Farzana, who is from the FGM-practicing Bohra community, shared her personal healing journey as a FGM survivor and her perspective as a therapist.

Find the recording below, and the summary of the webinar here.

In a second webinar, held on June 17th 2020, in French, three speakers shared their view on therapeutic care of survivors with FGM:  Sokhna Fall (psychotherapist), shared her experience working with affected women from migrant communities in France, Joanny Bassolé (Clinical psychologist, Burkina Faso) stressed the importance of intergenerational dialogue for mental health of FGM survivors, and, finally, Marie-Justine Diallo (Program Officer for Fraternité Médical Guinea Conakry) shared her experience of working on mental health in a context where there are few trained psychologists. The recording is available in French on our Youtube channel and the summary of the discussion can be downloaded here

Adelufosi et al., 2020, Cognitive behavioural therapy for post‐traumatic stress disorder, depression, or anxiety disorders in women and girls living with female genital mutilation: A systematic review, Access here

Ahmadu F., 2007,  Challenging Myths of sexual dysfunction in circumcised women, Access here

Berg, R. et al. 2010, Psychological, social and sexual consequences of female genital mutilation/cutting (FGM/C): a systematic review of quantitative studies. Access here 

Coho C., Sepulveda R. P., Hussein L. and Laffy C., 2019, Female Genital Trauma: Guidelines for Working Therapeutically with Survivors of FGM, Access here

Doctor,  F. “My experience of healing by attending the 2019 Sahiyo Activist Retreat in the U.S.”, April 18, 2019. Access here

GAMS Belgique, – Femmes, excision et exil – Quel accompagnement thérapeutique possible ? Access here  (French)

International Center for Research on Women, 2017, Mental Health and Ending Female Genital Mutilation and Cutting: Opportunities in U.S. Foreign Policy and Programs, Access here

Johnsdotter, Sara (2019): “The growing demand in Europe for reconstructive clitoral surgery after Female Genital Cutting: A looping effect of the dominant discourse?” Forthcoming, in Droit et Cultures. Access here

Köbach et al., 2018, ‘Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations’, Access here

Knipscheer et al., Mental health problems associated with female genital mutilation, Access here

Lansana Gberie, “Mental illness: Invisible but devastating. Superstitution often blamed for acute mental health diseases”, Africa Renewal, December 2016 – March 2017. Access here

Nawal M. Nour, Karin B. Michels, Ann E. Bryant, “Defibulation to Treat Female Genital Cutting: Effect on Symptoms and Sexual Function”, in Journal of Obstetrics & Gynaecology, Vol.108, No.1, July 2006, pp.55-60. Access here

NICABM, “Treating the Trauma That Lingers in the Body”. Access here

Norwegian Knowledge Centre for the Health Services, 2010, Psychological, social and sexual consequences of FGM/C: a systematic review of quantitative studies,  Access here

Osman S., Sevalie S., Weston M., 2018, Mental Health in Africa, The Lancet. Access here

Peyton N., 2019, FGM Survivors Across Africa Call for Mental Health and Trauma Support”, Access here

Sharif Mohamed, F., Wild, V., Earp, B. D., Johnson-Agbakwu, C., & Abdulcadir, J. (2020). Clitoral reconstruction after female genital mutilation/cutting: a review of surgical techniques and ethical debate. Journal of Sexual Medicine, 17(3), 531–542. Access here

Smith H. and Stein K., Psychological and counselling interventions for FGM, International Federation of Gynecology and Obstetrics. Access here

Venoranda R. K., 2020, Long-term mental effects of FGM not addressed enough, Access here

Vloeberghs E., Knipscheer J., Van der Kwaak A., Naleie Z., Van Den Muijsenbergh M., 2011,  Veiled pain. A study in Netherlands on the psychological, social and relational consequences of FGM, Access here

WHO, 2020, FGM fact sheet, Access here

WHO, 2018, Care of girls and women living with female genital mutilation. Access here

WHO, 2016, WHO guidelines on the management of health complications from female genital mutilation, Access here

28 Too Many, 2016, The psychological effect of FGM, Access here

“The Community of Practice on Female Genital Mutilation” is part of the “Building Bridges between Africa and Europe to tackle FGM” project, supported by the “UNFPA-UNICEF Joint Programme on the Elimination of FGM”.
The project is coordinated by AIDOS in partnership with GAMS Belgium.

The views expressed on this website are those of the authors and do not necessarily reflect the official policy or position of the UNFPA, UNICEF or any other agency or organization.

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