Transcriber: Sheri Friedman Reviewer: Rhonda Jacobs
My mother Lucrezia
comes from Calabria, right at the tip of Italy,
and she’s the first of seven children.
Since she was a child,
she encountered myths and taboos around female sexuality.
Such myths were rife in Italy
at that time,
and many still persist.
She remembers when her and her sisters had their period.
They were told not to touch or prepare the bottles of tomato sauce
because the bottles would explode.
And when my grandmother went into labor at home,
my mother was told
that her baby brother and baby sister arrived in doctor’s suitcase.
My mother was looking for real answers,
and she became a gynecologist and sexologist.
My father, Abdulcadir, comes from Somalia,
and he’s the first of 17 children.
He comes from a country
where there are also many myths and taboos around female sexuality,
a country where the practice of female genital mutilation or cutting
was and still is the standard norm for many girls and women.
I’m going to talk about myths around female genital mutilation or cutting,
and about taboos around female sexuality,
particularly about female sexual anatomy and physiology.
Worldwide,
there are 200 million of girls and women
that are at risk or have undergone female genital mutilation or cutting
in 30 countries of the world and among different religions.
In Somalia, where my father grew up,
98% of women and girls have been cut.
My father remembers his sisters recovering from the procedure at home,
and as a child, he wanted to stop this happening to them.
Later in life, he too, became a gynecologist,
and together with my mother, they set up one of the first referral centers
for women and girls with female genital mutilation
in Florence, Italy.
Believe me, I didn’t think I was going to become an obstetrician and gynecologist
trained in sexual medicine
who specialized in female genital mutilation or cutting,
but it must have had something to do with my upbringing.
My parents gave me a sense of curiosity and respect for differences.
In 2010,
I opened the first outpatient clinic
for women and girls with female genital mutilation or cutting
at Geneva University Hospitals.
Women come to our clinic for different reasons,
mainly for health problems
and complications related to their cutting:
recurrent infections,
chronic pain,
reproductive and sexual problems,
psychological problems.
They also come to ask for information
or for surgery.
There are different types of female genital mutilation or cutting.
There is pricking or piercing of the clitoral hood.
There is cutting of the clitoral hood, or the external part of the clitoris.
There is excision of the labia
with or without excision of the external part of the clitoris,
and then there is infibulation,
which is the narrowing of the vaginal orifice by stitching the labia
with or without excision of the labia
and with or without excision of the external part of the clitoris,
and then there are many other procedures on the female genital organs
for non-medical reasons.
When I listen to my patients, both cut and uncut patients,
I’ve realized that there are many myths
around female genital mutilation
or cutting,
and many taboos around female sexual anatomy and physiology,
so female sexuality.
And I realized
that there are the same myths and taboos among health professionals,
and why is this?
This is because these are all taboo subjects,
and when you don’t have awareness or scientific knowledge,
then myths spread.
And they pervade societies as a whole,
and health professionals believe them, too.
There are very few health professionals
that are trained in the care of women with female genital mutilation or cutting,
and very few health professionals
that know the sexual anatomy and physiology of women.
This is why I believe that countering myths
around female genital mutilation
or cutting
and breaking taboos around female sexuality matters.
These myths drive or maintain harmful practices.
They stigmatize girls and women.
So let me tell you now about four myths.
Myth one:
Women that have been cut share all the same experience.
Not so.
Not only there are different types of cutting and different consequences,
but the setting,
the age when the practice is performed,
the memories,
the experience,
and the self-body perception of women, differ greatly.
Many women suffer from very severe complications.
Many women feel sad,
angry,
traumatized, betrayed -
because they have been cut.
But surprisingly,
there are women that feel normal,
and others that say even that they feel sexy
and beautiful.
This is because different standards of beauty and normality
exist in different cultures and societies.
Where infibulation is practiced, for example,
a closed vulva is considered polite,
clean,
feminine,
pure,
beautiful.
Urinating slowly without making noise is considered polite and feminine.
A vulva that is not closed is imagined as a huge hole
where the wind can come in together with bacteria and diseases
or from where a baby can fall out during pregnancy.
Myth two:
The clitoris is a small organ that is removed during the cutting.
Not so.
The clitoris is a big deep organ that measures 12 centimeters.
As you can see in this diagram,
the clitoris and the penis are very similar
because they share the same embryology -
the same origin.
These are 3D - real - MRI reconstructions that we did
of an uncut and a cut clitoris,
and we have printed them.
This is an uncut clitoris,
and this is a cut clitoris.
As you can see,
the part that is cut is the tip of the organ, the glans -
more or less the body of the clitoris -
but all these other structures
that are around the vagina are still there,
and they can respond to sexual stimuli.
And this leads to myth three -
that women that are cut have a mild or inexistent sexual response.
Not so.
Women that are cut can suffer from psychosexual complications or pain,
but they can be treated,
and the clitoris is still there.
You know that women are much more than their genitals,
and their sexual response depends on many factors.
And finally, there is myth four -
that women that are not cut are hypersexual.
Not true.
Among many communities that practice female genital mutilation or cutting,
the clitoris is imagined like an organ that can grow like a penis
and make a girl hypersexual and promiscuous.
I always remember the story that a woman told me once:
She just had a daughter,
and she didn’t want her daughter to undergo the practice.
She knew that genital cutting was harmful, illegal,
a violation of her daughter’s rights,
but every time she washed the genitals of her daughter,
she worried.
When she looked at that uncut clitoris,
she worried that her daughter grew up and could become sexually aroused
just walking - literally chasing after men.
But don’t think that myths and taboos
and knowledge gaps around the female genitals
exist only in countries where female genital mutilation
or cutting are practiced -
such myths abound worldwide.
An accurate drawing of the clitoris
is missing in many student and medical textbooks.
It will be only in 2019
when we will update the drawings used in the biology lessons
of the Swiss French-speaking schools,
introducing the accurate drawing of the clitoris.
And it was only in 2017 that we introduced,
at the faculty of medicine of Geneva University,
the first course on the history, biology, and anatomy of the female genitals.
In this course,
we show how knowledge has changed over time,
and harmful practices and beliefs have existed and still exist
worldwide.
In the UK, for example,
in the 19th century, cutting the clitoris was proposed and performed
to treat some "female diseases"
like hysteria.
So myths, taboos, and knowledge gaps are rife everywhere.
At our clinic, we counter myths,
and we break taboos around female sexuality.
We spend a lot of time really listening to women,
informing them,
counseling,
talking.
We make sure that women are aware and that they can make informed decisions.
We do perform surgery.
We can do defibulation, which is the opening of infibulation,
reconstructing the labia.
This surgery really treats obstetric, sexual, and pain complications,
infections, and so on.
And then we do clitoral reconstruction,
which is a surgery that reexposes the clitoris under the scar.
But before we do surgery, we have to counter myths.
Before we do defibulation,
we have to counter myths around the opened vulva or closed vulva.
If we don’t do this, women will refuse treatment,
even when they suffer from very severe complications.
Some women can be afraid,
confused.
Some others can even ask to be reclosed after a delivery.
And similarly, when we do clitoral reconstruction,
we have to be sure that women know that they still have a functional clitoris
and that their sexual function
does not depend only on the tip of the organ.
Many girls grow up thinking that they do not have a clitoris anymore
because they have been cut,
and they start to feel incomplete,
not normal,
and this is very sad and unfortunate.
Among women that ask for clitoral reconstruction
and do not suffer from pain or other complications,
once that they received this information and psychosexual therapy,
in 70% of the cases, they decide against the surgery
because they feel complete again and can discover their sexual function.
Many patients of refugees, migrants
that have experienced other traumatic events
that need to be addressed during their care.
Many women speak another language,
do not know their rights to treatments,
and many never looked at or touched their genitals
because this is also taboo.
So deciding to come to the clinic,
book an appointment,
and start to talk about subjects that are so fundamentally taboo,
not just in their culture, but in every culture,
and on top of this, through a certified interpreter,
it is a very big step -
to start to understand what has happened to them.
And girls, women, their partners,
they come to the clinic to discuss about female genital mutilation or cutting,
but we discuss about so much more.
We discuss about sexual and reproductive health,
well-being,
and sexual pleasure.
We discuss about empowerment.
So I believe that countering myths about female genital mutilation or cutting
and breaking taboos around female sexuality is very important.
We must have honest, factually-based conversations
with boys, men, girls, and women.
It is essential because it makes that we do informed decisions -
we can make informed decisions about our sexual and reproductive lives,
and in the future about those of our sons and our daughters.
Thank you.
(Applause) (Cheers)