(This article is Part one of a seven-part series on trauma related to FGC. This article should not be used in lieu of seeking professional mental health and counseling services when needed)
By Joanna Vergoth, LCSW, NCPsyA
Many women who have undergone FGC may not have any lasting disturbances. But based on the Sahiyo study alone (see pie-chart below), there are those who may benefit from a deeper understanding of the effects of trauma. Often, we minimize, dismiss or normalize our symptoms and resign ourselves to feeling/living compromised. Learning more about trauma can provoke conversation; help one to feel less isolated and can prompt one to seek professional help.
What is trauma?
A traumatic event is defined as direct or indirect exposure to actual or threatened death, serious injury or sexual violence. The incident may be something that threatens the person’s life or safety, or the life of someone close to the victim. Traumatic incidents can include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, or violent attacks such as rape, sexual or physical abuse, or FGC. As defined—although culturally sanctioned— FGC is a traumatic event (see chart from Sahiyo’s study to the right).
Although for some the consequences can be minimal, most of the evidence suggests that FGC is extremely traumatic and the physical or medical complications associated with FGC may remain acute or chronic. Early, life-threatening risks include hemorrhage, shock secondary to blood loss or pain, local infection and failure to heal, septicemia, tetanus, trauma to adjacent structures, and urinary retention. One of the more frequent longer-term medical consequences includes adhesions or scarring, which can contribute to lingering pain and impede sexual functioning.
The focus of FGC has long been regarded from a physical and medical perspective but it is equally important to consider the psychological and emotional implications of this practice. It has been reported that the psychological trauma that women experience through FGM ‘often stays with them for the rest of their lives’ (Equality Now and City University London, 2014, p.8). Sahiyo’s study found that of the 309 participants in the study who had undergone FGC in the Dawoodi Bohra community, almost half (48%) reported that the practice left a negative emotional impact on their adult life.
Usually, the girl, unprepared for what is about to happen, is taken by surprise and cannot prevent what is about to occur. Those that can remember the ‘day they were cut’ often report having initially felt intense fear, confusion, helplessness, pain, horror, terror, humiliation, and betrayal. Many have suffered a multi-phase trauma; the first being forced down and cut and then second is seeing or hearing another family member endure the procedure. Even anticipating the procedure, oneself can be terrifying. Also of significance is the community and family reaction to the painful reactions experienced by these young women. Often girls can be chided for crying and not being brave while undergoing the cutting. This dismissive, non-nurturing reaction can potentially lead to another facet of the multi-phase trauma.
Some proponents of FGC actually consider that the shock and trauma of the surgery may contribute to the behavior described as calmer and docile—considered to be positive feminine traits.
FGC is a traumatic event that can profoundly rupture an individual’s sense of self, safety, ability to trust and feel connected to others—aspects of life considered fundamental to well-being. Such genital violence can interrupt the process of developing positive self-esteem. And, when children are violated their boundaries are ruptured leading to feelings of powerlessness and loss of control. Children who have experienced trauma often have difficulty identifying, expressing and managing emotions, and may have limited language for describing their feelings and as a result, they may experience significant depression, anxiety or anger.
Over time, if the distress can be communicated to people who care about the traumatized individual and these caretakers respond adequately, most people can recover from the traumatic event. But, some FGC affected girls and women experience severe distress for months or even years later.
The symptoms of trauma:
Outlined below are some of the consequences that may occur following a traumatic event. Sometimes these responses can be delayed, for months or even years after the event. Often, people do not even initially associate their symptoms with the precipitating trauma.
- Eating disturbances (more or less than usual)
- Sleep disturbances (more or less than usual)
- Sexual dysfunction
- Low energy
- Chronic, unexplained pain
- Depression, spontaneous crying, despair, and hopelessness
- Anxiety; feeling out of control
- Panic attacks
- Feelings of ineffectiveness, shame, despair, hopelessness
- Irritability, anger, and resentment
- Emotional numbness
- Withdrawal from normal routine and relationships
- Feeling frequently threatened
- Feeling damaged
- Self-destructive and impulsive behaviors
- Sexual problems
- Memory lapses, especially about the trauma
- Difficulty making decisions
- Loss of previously sustained beliefs
- Decreased ability to concentrate
- Feeling distracted
Over time, even without professional treatment, traumatic symptoms generally subside, and normal daily functioning gradually returns. However, even after time has passed, sometimes the symptoms don’t go away. Or they may appear to be gone, but surface again in another stressful situation. When a person’s daily life functioning or life choices continue to be affected, a post-traumatic stress disorder (PTSD) may be the problem, requiring professional assistance.
To learn more about PTSD, see our Part II – Post Traumatic Stress Disorder
About the Author:
Joanna Vergoth is a psychotherapist in private practice specializing in trauma. Throughout the past 15 years she has become a committed activist in the cause of FGC, first as Coordinator of the Midwest Network on Female Genital Cutting, and most recently with the creation of forma, a charity organization dedicated to providing comprehensive, culturally-sensitive clinical services to women affected by FGC, and also offering psychoeducational outreach, advocacy and awareness training to hospitals, social service agencies, universities and the community at large.