An Exclusive with Dr. Marci Bowers
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This week, we profile Dr. Marci Bowers in An Exclusive.  Learn more about her extraordinary practice in the U.S. and the world for post-FGM patience.

GWPF:  Dr. Bowers, tell us how long you have been a practicing pelvic and gynecologic surgeon.

Dr. Bowers:  I graduated from medical school in 1986 (University of Minnesota), completed obstetrics and gynecology residency in 1990 (University of Washington) and gradually developed a reconstructive practice as my experience in gynecology and women’s healthcare evolved.

GWPF:  There have been some misconceptions about clitoral restoration.  Since you are a renowned specialist in that area, please share with us what such a procedure entails.

Dr. Bowers:  The persistent myths about FGM are that the clitoris is very small. In fact, the clitoris is larger than commonly understood. A second myth is that once FGM is performed, the clitoris is gone and that the sensory deprivation that comes with FGM is due to that ‘absence’. In fact, the damage done as a result of genital cutting is infibulation (sewing together of the labial skin in the severest form of FGM) and the burial of the remaining clitoris beneath scar tissue and skin. When restoration is performed, the clitoris is found 100% of the time. True, there may be damage to the tip but the tip is, literally, the tip of the iceberg. Restoration is possible by not only dividing the infibulation (if present) but clearing the remaining clitoris of scar tissue and securing it to the surface skin. The sensory clitoral majority remains after FGM—fortunately, thanks to Dr. Pierre Foldes, there is now a technique to access those portions.

GWPF:  What are the benefits of the restorative surgery for a woman in post-FGM life?

Dr. Bowers:  There are many potential benefits of restoration after FGM. Division of the infibulation (so-called defibulation) allows for less painful sexual interactions. More basic, it allows for the right of unobstructed urination, tampon placement and labors that do not result in horrific injury to the bladder and intestine. From a sexual standpoint, besides lessening the pain associated with sexual encounters, surgical restoration can allow the perception of actual sexual pleasure. Many women, once the psychological trauma from having been subjected to FGM by those most trusted family members is overcome, can achieve orgasm and increased sensation. Many are able to achieve orgasm for the very first time in their lives. Sexual pleasure is a basic human right. Returning that right to someone who has been cut is as powerful as if returning sight, sound or touch.

GWPF:  How many restorative surgeries have you done here in the U.S. and how many have you done in other parts of the world?

Dr. Bowers:  We have completed approximately 150 restorative surgeries here in the US and another 38 as part of our surgical mission to Burkina Faso, West Africa 2 years ago.

GWPF:  You once mentioned on a television show that when the clitoris is cut off, there is still the extension that does not lose its sensation.  Would you please tell the readers how you restore that sensation?

Dr. Bowers:  Again, the marvelous truth about FGM is that it is never possible to remove all of the clitoris— even in the severest of mutilations. With what remains, if it is cleared of the overlying scar tissue and sewn to the skin surface, sensory restoration is quite possible. For a man to understand, imagine if his penis was buried beneath the skin and there was a surgery to open the skin and bring it above the surface?

GWPF:  The primary reason why female genital mutilation is done on the girl is to keep her a virgin until marriage.  Do you think it is really a guarantee that she will remain a virgin until marriage?

Dr. Bowers:  There are many false promises and claims made by those who perpetuate FGM—in addition to the ‘promise’ of virginity. Frankly, sex after FGM can be so painful, it is a wonder anyone is ever sexually active. FGM is also alleged to support fidelity in marriage but men often seek sexual partners who are uncut and do so through infidelity. Urinary tract infections are more common after FGM, not less common, etc. etc.

GWPF:  How many physicians have you trained to perform clitoral restoration?

Dr. Bowers:  We have had several doctors interested in learning the practice of clitoral restoration in addition to many who come to learn about the practice in gaining better understanding in how FGM can be overcome. To date, we have trained one doctor in Canada and another local OB/GYN in Burkina Faso with plans to extend the training regionally here in the US. More importantly, restoration needn’t be a Western cause but one of empowerment that is adopted from by the women and men who are its victims.

GWPF:  Do you have a special training program in which Obstetricians and Gynecologists may enter for training in clitoral restoration?

Dr. Bowers:  We welcome any provider, particularly OB/GYNs, to learn or be trained here in our San Francisco clinical facility. The surgery is not technically difficult but is subtle and does require repetition.

GWPF:  Are there any special qualifications for performing clitoral restoration?

Dr. Bowers:  The major useful recommendation—beyond training as an OB/GYN—is to assure that there will be enough clinical exposure that the technique is employed regularly, allowing for greater expertise.

GWPF:  As an OB-GYN, what warnings do you have for excisors against the dangers and health risks of female genital mutilation on girls?

Dr. Bowers:  FGM is bad for women and it is bad for men—No one benefits from FGM. Its promises are false. Those who choose to cut, do so because they are able to mislead in isolation within the tiny towns and villages of Africa.  Cutters benefit economically from the practice. But the truth is coming. Women are talking about their bodies. Truth and justice will ultimately prevail and cutting will soon be no more. Traditions must retain respect but cutting must end.

GWPF:  Beside the surgery, what do you say to the women who come to you seeking clitoral restoration?

Dr. Bowers:  There are so many of the aspects of healing from FGM that occur as women come forward to be restored. By assuming control of their lives, there is power in making change. There is also healing by being able to share their experience, come to grips with betrayal, anger, shame and other emotions that result from FGM. Speaking about those feelings, sharing with their provider and with other women is in itself restorative.  The most difficult aspect of full recovery is to associate positive feelings with sexual contact rather than pain or an utter lack of feeling. These new feelings after restoration will surprise and, for some, cause alarm. It is exciting and it is often new but alien. So there comes learning and growth following restoration that is likely to last for years. The measure that is most affected by restoration is a feeling that identity has been regained, cited by nearly 80%.

GWPF:  The U.N. Secretary General has set a goal that 2030 is the year the practice of FGM will be eradicated.  Are you optimistic about this goal?

Dr. Bowers:  I am incredibly excited about this goal and I do believe it will happen. All I—and others— can do is to be a small, supportive part of this change. Most importantly, the change will come from within—parents and siblings who say no, cutters who no longer cut, aunts and cousins who finally acknowledge honestly the misery inflicted on themselves, not wishing to further that agony by inflicting it on others. Communication—cellphones and the internet— is allowing truth to push forward, even into the remote regions where FGM still predominates. The truth is coming.

GWPF:  Do you have advice for activists and advocates against FGM?

Dr. Bowers:  Continue to raise this issue whenever possible, continue to fight legislatively against ‘vacation cutting’, continue to support those who seek restoration, arm yourselves with information and truth. Be willing to talk. Encourage others to tell their stories. Come forward. Stand together.

GWPF:  Where do you see clitoral restoration in the next ten years?

Dr. Bowers:  I believe restorative techniques will only improve.    More importantly, I hope that expertise will be available regionally anywhere in the world and that we will be able to return soon to an Africa that sees sexual rights as a human right—-for everyone.

Dr. Marci Bowers Dr. Marci Bowers2

Coming Up in Next Week’s Edition:  Author, journalist, activist, advocate, Hilary Burrage of the United Kingdom.