Global Women P.E.A.C.E Foundation 5 K Walk Against FGM

Photo 4a_SahiyoU.S.AdvisoryBoard.JPG

Each year, the Global Women P.E.A.C.E. Foundation hosts a 5K Walk Against FGM in Washington, D.C., and activists working to end FGC around the world come to participate. This year, the event was extended to 2-days and commenced with a Global Woman Awards ceremony on Friday, Oct 26th at the Milken Institute of George Washington University.  Two of the award recipients, included Maria Akhter and Severina Sangurikuri, two women who took part in the U.S. Sahiyo Stories project. They each received a Global Woman Awards from the Global Woman Peace Foundation in the categories of Student Ambassador and Survivor Activist respectively.

Here’s what Maria has to say about receiving her award:

I am thrilled, honored and humbled to receive the Global Woman Award in the Student Ambassador category from the Global Woman Peace Foundation. With boundless support from friends, family, and the hardworking activists in Sahiyo and other organizations working to end FGM/C, I’ve been able to turn my quiet interest in activism into a bold passion and lifelong commitment to a cause I hold near and dear to my heart. Receiving this award reinforces and challenges me to continue working in new ways to break the silence around FGM/C and end the practice for future generations.

The 5K Walk, scheduled for October 27th was at the last minute cancelled due to severe winds and rains. Yet, prior to the walk, people still gathered to listen to the guest speakers such as FGC survivor, Lola Oje from Nigeria who shared that she refuses to allow her beautiful daughter to be subjected to FGC. To learn more about the event, visit ‘A Mini United Nations Convenes in Washington, D.C.

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California Thaal pe Charcha allowed me to share my experiences through storytelling

By Anonymous

I grew up in India, and when I moved to California a few years ago, I didn’t know anybody from the Bohra Jamaat (congregation). The Sahiyo ‘Thaal pe Charcha’ event came at a time in my life when I had been thinking a lot about sharing through storytelling. What a powerful tool it is to get people together and find ways to let go, heal and learn from our shared experiences. Sitting in a room full of Bohra women, sharing a meal in a thaal (a large circular steel dish), and exchanging laughs and a few cries too, I felt a strong sense of belonging. I soon learned that we all had very different upbringings outside of our Bohra lives, yet very similar experiences as women within the community.

My mother had her storytelling circle her group of women friends who met once a IMG_2198month at each other’s homes, shared a meal together and talked about their lives. She always came back from those gatherings with a glow on her face, as if a heavy burden had been lifted off her shoulders. She felt safe within that group, and the group was built on trust, love, respect, and compassion for each other.

As one of the facilitators of the California Thaal pe Charcha event, I was hoping to create a similar space for all our participants. I knew it would be a challenge since this was the first time we were all meeting, and it takes time to build trust and friendship. But it was heartwarming to see everyone feel so comfortable right from the beginning. The rest of the afternoon was full of rich and insightful discussions about what it meant to grow up Bohra in California, the multiple lives and identities that a woman has to balance, what we value about the community, the pressures, daily challenges and barriers that women faced within the community.

Interactive activities throughout the afternoon allowed participants to share something unique about their lives, and think about what community and freedom meant to them. And just when we needed a break to take in a few deep breaths, and process everything that we had discussed, we were treated to a hot cup of ‘chai’ that warmed our hearts and minds!

We ended the afternoon with many questions, dreams, and hopes in our minds. And I think that is the magic of such gatherings. It pushes us outside our comfort zones but allows us a space to share, to feel important, to know that our voices, our thoughts, and perspectives are appreciated and heard, and most importantly, a reminder, that we are never alone.

I look forward to many more gatherings where we can learn and grow together.

Read more reflections on the Bay Area TPC here!

Examining Female Genital Cutting and Intersectionality

By a Bohra

The recent dropping of charges against Dr. Jumana Nagarwala, who is accused of performing female genital cutting on underage girls in the United States, on a constitutional technicality rather than perceived criminality, solidified my thinking about the relationship between power and oppression.   

This thought was first introduced to me by Irfan Engineer, the son of Asghar Ali Engineer, a prominent activist who engaged in a decades-long battle with the Bohra orthodoxy over community reform. Irfan, a successful activist in his own right, described to me the relationship between the Indian state and the Bohra clergy. As long as the clergy declared electoral allegiance to the government, the state would turn a blind eye to the clergy’s authoritarian rule over the Bohra community. This relationship was made visible by the government’s reversal of its support for a national law against FGC, shortly after Prime Minister Modi (dis)graced the stage at one of this year’s Bohra Ashura sermons.

Modi extolled the virtues of the economically and educationally advanced Bohras, who were allegedly setting a great example for their impoverished and persecuted Muslim countrymen. Seeing Modi on stage, Bohra Muslims could almost forget the carnage inflicted in Gujarat in 2002, and Modi’s rampant Islamophobia since. The Bohra community has probably been shielded from Islamophobic violence because of the clergy’s close relationship with the ruling right-wing BJP (Bharatiya Janata Party) and its ideological parent, the RSS (Rashtriya Swayamsevak Sangh).

Even I was willing to overlook the fact that the Indian government’s attempt at criminalising FGC was based more on criminalising Muslims rather than empowering women. Yet, I thought, maybe the ends will justify the means. I was wrong. Modi’s relationship with the Bohra clergy makes it clear that we cannot rely on the Indian government to end FGC in our community. Even if the Supreme Court rules in favour of criminalising FGC, we can be certain that the government will do nothing to enforce the ruling.

This violent relationship between the state and vulnerable women is not restricted to the Indian context. I am reminded of the first FGC case to be prosecuted in Australia, where three people were sent to jail after being proven guilty. An appeals court, however, acquitted them all after new evidence was released that showed that “the tip of the clitoris was still visible in each girl”. The reduction of the emotional, physical and ideological violence of FGC down to a visual assessment of a pinch of skin shows the weakness of even Western legal systems in protecting marginalised women. It is similar to the victim blaming that is still a routine in rape trials, and the inability of the state to protect women who report honour-based violence. Whether through negligence or structural misogyny, Western and non-Western governments have failed women.

If the government is not an ally, could I turn instead to ‘reformists’ within my own community?

I am in contact with certain Bohras who are not part of the mainstream community, and reject the leadership of the current clergy. They believe that the current leaders have deviated from the true message of the Imams,  and that we must educate ourselves by going back to the original sources of our tradition. I thought that this group of people (mostly men), espousing rationality and critical inquiry, would immediately be against FGC. I was wrong. The emphasis on going back to the original sources means that they accept, uncritically, the infamous book by Qadi Numan (Da’im Al Islam) that advocates for girls to be ‘circumcised’ once they are older than 7 years old. Any debate, often started by the few women in the WhatsApp group, about the necessity of this practice in our modern context, or even about the issue of consent, is shut down. I thought that a shared experience of living under a tyrannical religious clergy might force these men to be more critical of existing power structures and hear the voices of marginalised women. Once again, I was wrong. I learned that the patriarchy, embodied by these ‘reformist’ men, can never be leveraged to end violence against women.

I learned that it is not worth compromising my core values in order to ally with fickle powers that do not center marginalised voices and their struggles. Real change can only happen from the ground up. This is why the work done by organisations such as Sahiyo is vital. By reaching out to individuals, and creating a space to share our stories, Sahiyo creates sustainable change within the community, and rebalances the power structures that exist within.

 

Inaugural screening of Sahiyo Stories in California

On October 19 in Oakland, California, Sahiyo, in collaboration with StoryCenter, Asian Women’s Shelter, Asian Pacific Institute on Gender-Based Violence hosted a screening of Sahiyo Stories that included a behind the scenes short film documenting the women’s experiences in creating their digital stories.

Sahiyo Stories involved bringing together nine women from across the United States to create personalized digital stories that narrate experiences of female genital cutting (FGC). These nine women, who differ in race/ethnicity, age, and citizenship/residency status, each shared a story addressing a different challenge with FGM/C. Some women who had only recently discovered they had undergone FGM/C were grappling with its emotional and physical impacts, while others were invested in advocacy to prevent it from happening to more girls. The collection is woven together with a united sentiment and a joint hope that the videos will build a critical mass of voices from within FGM/C-practicing communities, calling for the harmful practice’s abandonment.

A panel discussion on female genital cutting followed the screening, and the greater connection FGC has to gender-based violence.

Female Genital Cutting charges dismissed but our work continues: Global reactions to Michigan case news

By Sahiyo

On November 20, U.S. District Judge Bernard Friedman dismissed the female genital cutting charges in the historic Michigan case involving girls from the Dawoodi Bohra sect, emphasizing that FGC should be regulated by states as a “local criminal activity.” Congress enacted the 22-year-old federal law banning FGC in 1996 — the law Judge Friedman has declared unconstitutional.

Charges were dropped against two Michigan doctors, Dr. Jumana Nagarwala and Dr. Fakhuruddin Attar, and six others accused of subjecting at least nine minor girls to FGC. However, Dr. Nagarwala, Dr. Attar and his wife, Farida, and a mother remain charged with conspiracy to obstruct an official proceeding. Dr. Nagarwala is also charged with conspiracy to travel with intent to engage in illicit sexual conduct.

In light of these developments, we would like to share the responses of many Bohras and other activists working to end FGC.

“What is so disappointing to me is that justice will be delayed in this case. There is a growing, global movement against khafz/FGC and we need positive judgments to send a strong message to our community that this practice is harmful and illegal. We must protect future generations of Bohra girls.”
~ Farzana Doctor, Canada  

“By declaring the federal ban on FGM/C unconstitutional, Judge Friedman opens the door for parents to do exactly what was done in this case — take their daughters from states that ban FGM/C to states that don’t so they can be cut.”
~ Umme Kulsoom Arif, USA

“The ruling on the jurisdiction of this case is giving some folks a perceived green light to proudly say that khatna/khafz/FGM/C is not illegal in the US after being afraid to say it out loud after Nagarwala was arrested. But people should understand that there are many state laws still in place (including in Michigan now) and the judge said that FGM/C is a ‘criminal activity’ so parents beware. This does not give you permission to cut your daughters. It will be a regrettable time in history if there is an uptick in the practice of FGM/C in the US because of this technicality in the jurisdiction of this case.”
~ Zehra Patwa, United States

“Shameful really! While 30 other countries have made FGM illegal, US, the supposed defender of human rights, has just shown the world what American justice is…women’s rights are not just not important for the federal court.”
~ Saleha, Canada

“Shocking judgment. But at the same time judgment gave us more spirit to work hard and achieve the desired goal to end FGC. To bring social change takes time but nothing is impossible. I’m sure through our collective efforts we will achieve our goal one day.”
~ Chandni Shiyal, India

“While on our climb towards the summit, we are going to face slips and stumbles but the climb must go on…..this judgement though disappointing is a mere stumble or slip….”
~ Fakhera, India

“This judgment is clearly based on a technicality of the federal versus the state jurisdiction. Irrespective, FGC still continues to be a violent act against 7-year old girls. Are we disappointed to hear this decision? Most certainly. However, it’s only a matter of time until people open their eyes and see the truth. Tradition without any logic can only hold its ground so long. Sati used to be tradition too, in this very land. Look where we are now.”
~ Alifya Thingna, India

“One of the most disheartening outcomes of this case is the lack of outrage among our elected officials. Two, recently elected, Muslim women representatives from Michigan and Minnesota (the two states involved) have failed to use their platforms to proactively address this issue. FGM is an issue that affects the safety of women and girls, and constituents in their communities. This decision (and the lack of public outrage) sends a signal to communities who practice FGM that there will be no accountability.”
~ Maryum Saifee, United States

“It’s a sad day for silent seven-year-old girls when there is no clear US law to protect what is truly theirs!”
~ Rashida Rangwala, United States

“I am so disheartened by this decision! It’s actually shocking. I thought at least USA law would give justice to innocent girls.”
~ Alifya Sulemanji, United States

“No little girl in this world should have to go through the trauma of female genital cutting. Cultures should not be empowered to take away the human rights of their members.”
~ Renee Bergstrom, United States

“I feel angry and deeply disappointed. This isn’t over but it’s incredibly discouraging to see our legal system disrespect and let down girls and women being violated in this country.”
~ Lara Kingstone, United States

“यह केस 23 US राज्यो में FGM कानून के अभाव में जीता गया है। यह एक ही टेक्निकल ग्राउंड है। अब यह केस अमेरिकन सुप्रीम कोर्ट में जाएगा। UN कानून के तहत अमेरिका बाध्य है। अब वहां सुप्रीम के आदेश पर फेडरल कानून बन सकता है। कोई भी संघर्स लंबा समय मांगता है कभी जीत कभी हार होती है। हरेक निष्फलता अगली सफलता का बेज़ (फाउंडेशन) बनता है। भारत के कोई राज्य में ऐसा FGM कानून नही है। मगर हम भी UN के सदश्य है। भारत मे भी ऐसा कानून आज नही तो कल बनेगा।”
~ Ibrahim Patel, India

“There are many practices which have been blindly followed from decades. Some of them have been changed, modified or amended in the course of time, with the advancement of research and scientific development. We are just trying to tell the world the actual fact that women undergo suffering with no fault of their own because of FGC.”
~ Insiya Ganjifrockwala, India

“Regardless of the impending appeal, this decision may inevitably embolden many to continue cutting girls. We should take this opportunity to continue to pressure our leaders to stand against FGC as a human rights violation, to bring awareness to the issue, and to protect our girls.”
~ Jenny Cordle, United States

“I would call this verdict as a legislative failure as no justice has been given to the child, and this gives a loophole to people in that country to keep practicing FGC.”
~ Insiya Lokhandwala, India

“It’s sad to note that technicalities can overshadow fundamental human rights. Hoping to strive for a mature treatment of this issue.”
~ Shabana Mashraki, India

“This is horrible! As a victim of FGC myself, I really wanted to see this doctor punished and her punishment to set a strong example for others in the community who practice FGC/ khatna thinking it’s the right thing to do. I feel like we women are never going to get justice for the wrongs done to us. What’s more, these wrongs will continue to go on and little girls will continue to be traumatized. It’s so frustrating and just makes me want to scream.”
~ Shabana Feroze, Bahrain

“I am shocked and deeply disappointed that a Federal judge in the USA has lifted the ban on FGM. It is so, so important that the USA as a world leader takes an unequivocal stand on this human rights issue afflicting women and the girl child.”
~ Zarina Patel, Kenya

“As I was reading, ‘Judge dismisses female genital mutilation charges in historic case.’ My blood was boiling. Where’s the justice for these women? What message is our federal government sending out to all doctors, mothers, and members who carry out this act? That it’s okay for them to violate girls without any real consequences. And what message are they sending out to our young girls? That their bodies are up for grabs? Or that what they’re going through doesn’t matter to us. Sad day to say the least!
~ Aisha Yusuf, United States

“I wasn’t sure what to expect from the  Michigan trial but I never dreamed it would get dismissed on a technicality about federal vs state jurisdiction! I don’t know enough about the law to know if the judge’s ruling was correct but I know I’m not going to let this setback keep me from fighting. Let’s all work together to get legislation passed in the 23 states that don’t yet have a law against FGM so this never has to happen again!”
~ Maryah Haidery, United States

Read more at U.S. Court’s dismissal of FGM/C charge in Michigan case is disappointing but does not condone genital cutting.

Read the Amicus Brief for Dr. Nargawala hearing on November 6, 2018, submitted by Equality Now, WeSpeakOut, Sahiyo, And Safe Hands For Girls in support of the United States.

Read the U.S. End FGM/C Network Statement on Judge’s Decision in Michigan Case.

 

Thaal Pe Charcha Launches in California

On Oct 21st in Berkeley, CA, a team of Sahiyo activists organized the first California Bay Area Thaal Pe Charcha (TPC). This Sahiyo flagship program allows Bohra women to come together in a private, informal setting so that they can bond over food and discuss issues that affect their lives, like Female Genital Cutting or Khatna. The program started in Mumbai, India in 2017 and is being piloted in the United States in 2018 in New York and California. For the organizers of the California Bay Area TPC, the weeks leading up to the event were full of excitement and anticipation for what they hoped would the start of new friendships in the Bay Area.

This is what one organizer, Sabiha Basrai, has to say about the program:IMG_2198

“Sharing space with an inter-generational group of Bohra women was healing and inspiring. I was able to embrace my Bohra identity in a new way and celebrate the special bonds that we build in our community, take pride in our cultural and religious history, and of course, enjoy a shared meal around a thaal. It is difficult to talk about the patriarchy that exists within our jamaats and I am grateful that TPC created a safe and confidential space to hear each other’s stories and to remind one another that we are not alone in these struggles.  We are all figuring out how to practice our faith with feminist values. This means challenging certain social norms that are oppressive to women, such as khatna or female genital cutting, while recognizing that empowering women is a very Muslim thing to do.

I am grateful for the patient and supportive work of Sahiyo and look forward to the continued work bringing about gender justice in our communities.” 

Read more reflections on the Bay Area TPC here!

My Reflections on the first-ever California Bay Area Thaal Pe Charcha

By Maria Akhterimg_2212.jpg

On Oct 21st in a cozy home in Berkeley, CA, a team of Sahiyo activists organized
our first Bay Area Thaal Pe Charcha.

Thaal Pe Charcha (TPC) is a Sahiyo flagship program that allows Bohra women to come together in a private, informal setting so that they can bond over food and discuss issues that affect their lives, like Female Genital Cutting or Khatna. The program started in Mumbai, India in 2017 and is being piloted in the United States.

The weeks leading up to the Bay Area event were full of
excitement and anticipation for what we hoped would be the pilot of a new program
and the start of new friendships in the Bay Area.

The team and I spent a few weeks carefully crafting our invitations and considering
whom to include in this informal discussion about the norms and challenges of
being a Bohra woman.

With delicious food displayed on our thaals and a crisp Autumn breeze flowing in
the room, 13 women gathered around a living room and engaged in a unique
conversation.

We went around the circle and introduced ourselves, sharing a memory or item in a
show-and-tell icebreaker. We discussed challenges and conflicts we’d faced in the
Bohra community in the Bay Area and globally as well as various strengths and joys
we’d experienced in the Bohra community.

Familiar faces and new ones surrounded me. My mother, childhood friend, and
fellow Sahiyo activists surrounded me with a comfort in knowing that I had their
support and that I had encouraged them to join me at this event.

The Bay Area is a tough area to operate in. Bohra women are more hesitant to speak
out and form connections with Sahiyo, so I considered this TPC a huge milestone in
breaking the silence around FGM/C in the Bay Area specifically. I could tell from
conversations that rose up that many of the women wanted a space to share their
voices and to connect with other like-minded women.

My hope is that these events continue to occur and that they grow and expand in
ways that benefit the community. There was substantial tentative interest from the
attendees in continuing to meet and my goal is to turn the Bay Area TPC group into
a consistent resource for any and all Bay Area Bohra women with an interest in
open communication and positive change.

Read more reflections on the Bay Area TPC here!

Introducing Sahiyo’s inaugural U.S. Advisory Board

Sahiyo is pleased to introduce our inaugural U.S. Advisory Board. As our U.S. operations and programs have grown, the advisory board will provide strategic advice to the management of our organization, and ensure that we continue fulfilling our mission to empower communities to end Female Genital Cutting and create positive social change through dialogue, education, and collaboration based on community involvement. Advisory board members will be supporting a human rights driven organization dedicated to creating a world without Female Genital Cutting through dialogue, education and direct community involvement.

Join us in welcoming the team: Maria Akhter, Renee Bergstrom, Alisha Bhagat, Insia Dariwala, Dr. Melody Eckardt, Joanne Golden, Priya Goswami, Aarefa Johari, Zehra Patwa, Maryum Saifee, and Joanna Vergoth.

Moving Beyond Cultural Relativism to a Call for Action to End Female Genital Cutting

By Brionna Wiggins

Earlier this year I had no idea about female genital cutting (FGC). None whatsoever. I mean, events happen all the time around the world and I’m not aware of the dozens of happenings that occur day-to-day. But for FGC to go on without so much as a whisper of this harmful practice, I thought was rather strange.

I learned about FGC when I was given an assignment during my junior year in high school. It was a Pre-Senior Project, which was essentially a practice before our year-long project we had to do for our final year of high school. Ideally, we were to choose a topic that pertained to our passions or a problem related to us on some level. I was at a loss for what to choose. Everyone around me jotted down several potential ideas, but my ideas were comparatively vague. By day two or so, I sat with my teacher to make a final decision. My teacher wrenched out my distaste for injustice and helped me narrow the target of people who undergo it. She typed online in the search bar something along the lines of “issues involving women and children” and there it popped up–female genital cutting.

I was appalled when I first learned about it. To reiterate, I had no idea this tradition existed and I wondered how it continued to go on. Why did women and men subject their daughters to this? What was the appeal? I dug deeper, finding out the reasons behind FGC. In some communities, while the intention was to keep daughters clean or marriageable, it was done at the cost of carrying out a potentially traumatic procedure that could leave the woman or girl with a handful of health issues afterward.

However, the concept of cultural relativism impeded criticism and questioning, while justifying the tradition. The idea that because one has not lived in a certain community or society, they can’t truly pass judgment on the cultural practices of others. Two people living in two different places across the world from each other naturally grow up with different experiences. Who is to say that another’s culture and traditional practices are objectively wrong? What is considered wrong when it comes to culture? Outsiders may feel as if they do not have a voice in regard to scrutinizing FGC because it’s an issue beyond their homes. Therefore, proponents of FGC claim that the divide or differences between two groups is too great to judge each other. Admittedly, I initially agreed with the notion of cultural relativism. Who was I to criticize people who carry out FGC in their communities when I knew nothing of their lives? Even so, remaining in place and staying quiet, doesn’t sit well with me, especially if I could be a person who brings awareness to FGC being a human rights violation. The excuse of cultural relativism shouldn’t be used when people are being harmed.

I continued researching FGC for my project the next school year, my senior year in high school. This time, the project had to be more extensive, including a longer research paper, another presentation, and some sort of final product. This ranges from documentaries to creating design plans. With all this work I was doing, I thought maybe I could make some sort of difference. I needed a mentor for guidance, one who is an expert on the topic. I sent out an email or two before finding Mariya, a co-founder of Sahiyo. The organization specializes in advocacy regarding FGC, even working with affected communities to diminish the practice. By sharing the stories of women involved with FGC, a wider audience becomes aware of the issue with a deeper understanding. With the combined efforts of multiple organizations and people from different walks of life, the perception of practicing communities will change. Then, I believe, FGC will become part of the past.

Over the course of my project, I hope to improve my advocacy skills and fully understand the issue that I’ve been invested in for the past couple of months. So far, researching FGC and looking into multiple perspectives has encouraged me to consider my own views on the topic. By the end, I will have figured out my ethical priorities. For the rest of my blog posts, I want to look into a handful of countries where FGC is practiced and talk about the circumstances around them. Until next time!

More on Brionna:

Brionnabiopic

 

Brionna is currently a high school senior in the District of Columbia. She likes drawing, helping others, and being able to contribute to great causes.

Trauma and Female Genital Cutting, Part 6: Effects of FGM/C on the Lower Urinary Tract System

(This article is Part 6 of a seven-part series on trauma related to Female Genital Cutting. To read the complete series, click here. These articles should NOT be used in lieu of seeking professional mental health and counseling services when needed.)

By Julia Geynisman-Tan, MD

Background

FGM/C has no known health benefits, but does have many immediate and long-term health risks, such as hemorrhage, local infection, tetanus, sepsis, hematometra, dysmenorrhea, dyspareunia, obstructed labor, severe obstetric lacerations, fistulas, and even death. While the psychological, sexual, and obstetric consequences of FGM/C are well-documented (refer to prior posts in this series), there are few studies on the urogynecologic complications of FGM/C. Urogynecology is the field of women’s pelvic floor disorders including urinary and fecal incontinence, dysfunctional urination, genital prolapse, pelvic pain, vaginal scarring, pain with intercourse, constipation and pain with defecation and many other conditions that affect the vagina, the bladder and the rectum. Urogynecologists are surgeons who can both medically manage and surgically correct many of these issues.

FGM/C and Urinary Tract Symptoms

One recent study from Egypt suggested that FGM/C is associated with long-term urinary retention (sensation that your bladder is not emptying all the way), urinary urgency (the need to rush to the bathroom and feeling that you cannot wait when the urge comes on), urinary hesitancy (the feeling that it takes time for the urine stream to start once you are sitting on the toilet) and incontinence (leakage of urine). However, the women enrolled in this study were all presenting for care to a urogynecology clinic and therefore all of them had some urinary complaints so it is difficult to tell from this study what the true prevalence of lower urinary tract symptoms are in the overall FGM/C population.

Therefore, given the significant number of women with FGM/C in the United States and the paucity of data on the effects of FGM/C on the urinary system, my research team studied this topic ourselves in order to describe the prevalence of lower urinary tract symptoms in women living with FGM/C in the United States. Publication will be available online in December 2018.

We enrolled 30 women with an average age of 29 to complete two questionnaires on Overactive bladder 1their bladder symptoms. Women in the study reported being circumcised between age 1 week and 16 years (median = 6 years).

  • 40% reported type I
  • 23% type II
  • 23% type III
  • 13% were unsure

Additionally, 50% had had a vaginal delivery; and 33% of these women reported that they tore into their urethra at delivery.

Findings:

A history of urinary tract infections (UTIs) was common in the cohort:

  • 46% reported having at least one infection since being cut
  • 26% in the last year
  • 10% reported more than 3 UTIs in last year
  • 27% voided ≥ 9 times per day (normal is up to 8 times per day)  
  • 60% had to wake up at least twice at night to urinate (once, at most, is normal)

Most of the women (73%) reported at least one bothersome urinary symptom, although many were positive for multiple symptoms:

  • urinary hesitancy (40%)
  • strained urine flow (30%)
  • intermittent urine stream (a stream that starts and stops and starts again) (47%) were often reported
  • 53% reported urgency urinary incontinence (leakage of urine when they have a strong urge to go to the bathroom)
  • 43% reported stress urinary incontinence (leakage of urine with coughing, sneezing, laughing or jumping)
  • 63%reported that their urinary symptoms have “moderate” or “quite a bit” of impact on their activities, relationships or feelings

What’s the Connection Between FGM/C and Urinary Symptoms?

Urinary symptoms like the ones described above can be the result of a number of factors. pee-night-400x322Risk factors for urinary urgency and frequency, incontinence, and strained urine flow include pregnancy and childbirth, severe perineal tears in labor, obesity, diabetes, smoking, genital prolapse and menopause.

However, given the average age of women in our sample and the fact that only half of them had ever had a vaginal birth, the rate of bothersome urinary symptoms are significantly higher than has been previously reported. FGM/C may be a separate risk factor for these symptoms. Interestingly, the prevalence of urinary tract symptoms in our patients closely resembled that of a cohort of healthy young Nigerian women aged 18-30, in which the researchers reported a prevalence of lower urinary tract symptoms of 55% with 15% reporting urinary incontinence and 14% reporting voiding symptoms. The authors do not mention the presence of FGM/C in their study population but the published prevalence of FGM/C in Nigeria is 41%, with some communities reporting rates of 76%. Therefore, it is likely that many of the survey respondents had experienced FGM/C, thereby increasing the prevalence of lower urinary tract symptoms in their cohort. In the study of women in Egypt referenced above, those with FGM/C were two to four times more likely to report urinary symptoms compared to women without FGM/C.

The connection between FGM/C and urinary symptoms can be understood from the literature on childhood sexual assault and urinary symptoms. Most women who experience FGM/C recall fear, pain, and helplessness. Like sexual assault, FGM/C is known to cause post-traumatic stress disorder, somatization, depression, and anxiety. These psychological effects manifest as somatic symptoms. In studies of children not exposed to sexual abuse, the rates of urinary symptoms range from 2-9%. In comparison, children who have experienced sexual assault have a 13-18% prevalence of enuresis (bedwetting) and 38% prevalence of dysuria (pain with urination). The traumatic imprinting acquired in childhood persists into adult years. In a study of adult women with overactive bladder, 30% had experienced childhood trauma, compared to 6% of controls without an overactive bladder. There is a neurobiological basis for this imprinting. Studies in animal models show that stress and anxiety at a young age has a direct chemical effect on the voiding reflex and can cause an increase in pain receptors in the bladder. Additionally, the impact of sexual trauma on pelvic floor musculature has been well described. Women who experience genital trauma often respond with an involuntary contraction of the pelvic floor, which can develop into non-relaxing pelvic floor dysfunction and subsequent urinary hesitancy, strained flow, retention, bladder pain and overflow incontinence.

These Conditions are Treatable

There are treatments for all of the conditions. Urinary hesitancy, strained flow, bladder pain, and urgency are often treated with pelvic floor muscle therapy. That is because many of these symptoms come from an unconscious, constant clenching of the pelvic floor muscles, which then prevents them from using their full range of motion and pinches off the nerves running through the muscles. Pelvic floor therapy focused on lengthening and stretching these muscles can completely change the way that you urinate and the sensation of pain in the pelvis. This kind of physical therapy is done by all female providers in a private room. The therapy consists of a combination of external and internal work on all of the muscles of your core and pelvic floor to release trigger points of tension and teach you how to relax and lengthen these muscles. Sometimes the therapists use biofeedback devices in the vagina to help you to recognize certain muscles groups. The sessions are usually one hour long and last for 6-12 visits. You can obtain a referral to a pelvic floor physical therapist from your local urogynecologist.

If you have urinary leakage throughout the day or nighttime, this can also be treated. Your urogynecologist can help differentiate whether you have stress urinary incontinence (leakage with coughing, laughing, exercise, lifting) or urgency urinary incontinence (leakage that follows the urge to go to the bathroom or sometimes sporadic leakage without any urge). These types of incontinence are treated differently but both can be treated with a combination of medicine, office procedures or surgical treatments. To find a urogynecologist in the Unit, you can go to the website of the American Urogynecologic Society and click on patient services.

 

About Julia Geynisman-Tan

Julia is a Female Pelvic Medicine and Reconstructive Surgeon in the Department of Obstetrics and Gynecology at Northwestern. During her residency at New York Presbyterian – Weill Cornell, she founded the Survivor Clinic of New York City, a dedicated clinic for women who had experienced sexual violence, including trafficking, female genital mutilation, and torture in war. Now in Chicago, Dr. Geynisman-Tan has founded the Northwestern ERASE Clinic for survivors of human trafficking and is an asylum evaluator for Physicians for Human Rights. She is currently a co-chair of the American Women’s Medical Association Physicians Against Trafficking of Humans Committee, on the board of the America Hospital Association’s Human Trafficking Consortium and serves on the Cook County Human Trafficking Task Force.