An Exclusive with Dr. Marci Bowers on Post-FGM/C Surgery

GWPF:  There have been some misconceptions about clitoral restoration.  Please share with us exactly what such a procedure entails.

Dr. Bowers in Surgery

Dr. Bowers:  Current thinking about the clitoris is dismissive and extremely superficial. In fact, the clitoris has been physiologically mapped and measured as much as 11 centimeters. With even the most severe FGM, this means that less than 5% of the clitoris is removed, literally, the tip of the iceberg. The FGM restorative surgery is simply in that it releases the remaining clitoris and brings it to the skin surface where it is secured with stitches. The nerves remain intact. The operation is simple in concept but delicate and quite detailed, taking less than one hour.

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

Dr. Bowers:  Previously buried, the restoration allows the remaining clitoris to be contacted during sexual contact, no longer buried beneath skin and scar tissue. Patients describe their post-restorative state as ‘life-changing’. More than half are able to achieve orgasm and more than 90% report an improvement in sexual function, reporting greatly improved comfort and reduced pain in addition to sexual feeling.

GWPF:  How many restorative surgeries did you perform in the Kenya?

Dr. Bowers:  In two weeks we were able to perform 44 restorative surgeries with hundreds of inquiries and future patients awaiting the process. The problem after two weeks was that our funding was insufficient to perform more surgeries, so this remains an obstacle we are working on. Hopefully with and other NGO’s help.

GWPF:  What was the experience in Kenya like to help so many women?

Dr. Bowers:  This was an incredible experience with patients coming from as far away as Ireland, Tanzania and Nigeria. When news reports of the effort became public, hundreds more arrived with little more than hope. For those we were able to help, we continue to get “WhatsApp” reports of progress and exclaims of joy and thanks.

GWPF:  How many physicians did you train to perform clitoral restoration during your recent work in Kenya?

Dr. Bowers:  The good news beyond individual restorations was that we invited as many surgeons as possible from throughout Kenya. As a result, more than half of Kenya’s plastic surgeons witnessed surgery. We were able to successfully train doctors in Plastic Surgery, OB/GYN, and Urology, 6 in total, which has the effect of expanding capacity. I cannot reach all patients personally so I was able to do more by training others to continue the work.

GWPF:  What did you say to the women who came to you seeking clitoral restoration?

Dr. Bowers:  We say ‘Karibu’ meaning welcome in Swahili. We are here to help you. The team consisted of local doctors, many others and I.  Here in San Francisco, our message is hope. We find the clitoris each and every time we operate meaning, I cannot think of an operation with a higher likelihood of success. We haven’t completely identified why there is skepticism about the procedure, aside from the regressive attitudes regarding female sexuality, also reflected in FGM as global misogyny.

GWPF:  What advice would you offer other health professionals on how to encourage FGM survivors to have their regular check-ups?

Dr. Bowers: I would tell providers, “please do not assume women are happy with this cultural procedure. FGM is done without consent and typically against the child’s will or without parental knowledge. It robs young women a basic human right, as important as if the sense of taste or smell were taken. And there is surgery that can restore what is buried. Discuss options.”

GWPF:  How did the women in Kenya respond to the work you did there?

Dr. Bowers:  Tears of joy, many just wanted to touch my hands even, if surgery was not possible due to the growing queue. There was so much happiness and hope, many accompanied by the men in their lives.

GWPF:  Does this mean that women wanting the restorative surgery anywhere in Africa can go to Kenya?

Dr. Bowers:  Yes, there are doctors now in Kenya who are fully capable of ably performing the surgery, especially Doctors Adan Abdullahi, Dribsa, Matua and others. The only remaining obstacle is cost.

GWPF:  What is the cost of such surgery if it is done in Kenya?

Dr. Bowers:  Unfortunately, hospital costs, even in Kenya, are high with costs that can exceed $1500 USD (150,000 KSH), a very high amount for most of Kenya’s citizens. This is very near the cost here in San Francisco, where we are able to keep costs low by performing the surgeries in an outpatient surgery center and charging no professional fees. In Kenya, we were fortunate to have the costs partially underwritten by the hospitals, doctors and several NGO’s including Clitoraid.

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

Dr. Bowers:  The surgery works and this will be definitively shown to all skeptics as more science backs us up. Eventually, the surgery will be taught to most OB/GYNs and plastic surgeons and should be a part of all medical education programs, at least in Africa. There is still no education regarding FGM anywhere that I am aware in formal medical education, even in Africa. I gave Grand Rounds at Nairobi Medical School in Kenyatta National Hospital while there and was very well received. This is just the beginning but the anti-FGM movement is moving faster now and has the potential to end FGM in my lifetime. FGM benefits no one and the truth is emerging. More education is the key. Women’s bodies need a bigger voice. During my speech there, I was able to compare the clitoris to the penis in its similarity and this seemed shocking to the audience, many of whom were major department heads but, by the end of the talk, many were nodding their heads in affirmation.

GWPF:  What is your next country to train?

   Dr. Bowers:  Since our visit to Kenya alone, we have been contacted to teach in Tanzania,     Ethiopia, Somalia, Niger and Nigeria. There is much work to be done! We also hope to bring our collaborative efforts back to Burkina Faso where we have a pre-existing hospital that we built but were unable to open.


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