SEXUAL HEALTH: You can reverse FGM

Jane and her husband travelled seven hours to Nairobi by bus. By the time they arrived at the sexology clinic, it was well past working hours and the watchman was hesitant to allow them in. I was driving out of the clinic when I saw them pleading with the watchman.

“If we cannot be seen today we are requesting to sit in the clinic until morning,” Jane said.

CANNOT HAVE SEX

I asked the watchman to allow the couple in. I reversed, parked and went back to the consultation room to see the couple.

“Sorry we are late doctor, we are unable to have sex and we were told that you can do something about it,” John, Jane’s husband, said as soon as they settled down. “We are not ready to go back to our home until a solution is found to this problem.”

Jane was a 27-year-old teacher in a rural primary school while John was a 30-year-old pastor. It had been seven months since their wedding… and they were yet to have sex. “Aren’t you at least kissing, cuddling…?” I asked in wonderment

“No, what we mean is that we have not done the main thing,” Jane interrupted. “We are doing all that you are saying and it is fine and enjoyable, but when it comes to the main thing, we are unable.”

Like many African couples, this couple considered penetrative sex the ‘main’ thing.

This is a problem we face all the time at the clinic: Couples believe that as long as penetration has not happened, sex is yet to happen.

This belief is especially problematic when a couple has a disease or an injury that prevents them from having penetration.

“They cut and stitched me when I was young so the hole I have cannot allow sex,” Jane explained. She suddenly became emotional and started weeping. John nodded reassuringly, patting her back.

FGM

Jane had undergone female genital mutilation (FGM). She was suffering one of the long-term effects of the procedure: apareunia, or inability to have penetrative sex.

She was also psychologically traumatised by her status.

A number of women who have undergone FGM will, at one point or another, suffer a sexual problem. It may be lack of sex desire, failure to get lubrication, pain during sex or lack of orgasm.

Sometimes the issue is psychological since the experience of FGM can lead to emotional and psychological distress, loss of self-esteem and abhorrence of sex. Other times the problem is anatomical, meaning that the damage to the sexual organ interferes with sexual intercourse. In many cases the problem is both.

“So you mean so many of the women who have undergone FGM have these difficulties? Do they normally come for treatment?” John interrupted me.

The problem we are facing with couples who have undergone FGM is that they do not seek help. If they did, they would be fully assessed and appropriate treatment given.

Some just need reassurance that all is well; some need counselling while others need sex therapy. A few need surgery to open up the sex organs.

I examined Jane and as it turned out, the entry into the vagina was very small.

SURGERY

I booked her for a de-infibulation procedure to open up the matted scars. I also booked her for counselling, and her and her husband for sex coaching.

The de-infibulation procedure is a minor operation but with great results and minimal complications. Jane came for the procedure a week later.

It took another two weeks for the wound to heal fully. We then embarked on post-traumatic counselling, which went for another month before we embarked on sex coaching for another month.

Sex coaching helps a couple be intimate, discover what is pleasurable sexually and learn how to pleasure a partner.

“Thank you for what you have done for us but I have one question,” John said on their last visit to the clinic. “Why are you and your colleagues not advising communities to come for treatment? How do you expect them to know that such help exists?”

I reclined in my seat, not having an answer to John’s question. It was a challenge to me and my colleagues.

“Well, I will write a story about this in the newspaper. Let me hope the story reaches women undergoing similar problems,” I said remorsefully.

With this story, I have kept my promise to John and passed the ball to the women’s court. If you are a woman who has undergone FGM and are facing these complications, it is time to seek help.