By Andrea Meade, Reg. PT

It goes without saying that the world of pelvic health is never boring. For patients and therapists alike, there is always something new to learn, a new area to explore and a new direction in which to grow. Physical therapy is an evidence-based practice, and any scientific discoveries will eventually trickle down to enrich and advance our knowledge base, theories and practices. The more you know, the more you want to know!

A few weeks ago we listened with interest to Ms. Omima Mohidin, who brought us information about an initiative spearheaded by Africans in Partnership Against Aids and Toronto Public Health. Their work centers around the topic of ‘Female Genital Cutting’. Oh yes, we thought to ourselves as she began to speak. We’ve heard about that. We know about that. We know that it happens to women from certain cultures, in certain parts of the world.

In fact, the practice of Female Genital Cutting or FGC (also known as ‘Female Genital Multilation’), has received increased attention from the international media. It includes any ‘procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons’. FGC directly affects over 200 million girls and women today, and is classified as a human rights violation (1). It is mainly practiced in 30 countries in Africa, the Middle East and Asia (1). While there have been local public health efforts in some of these countries to discourage FGC, the practice continues.

This workshop brought our team of practitioners to a realization of just how difficult it is for women suffering from complications related to FGC to request and access healthcare. Often those who practice FGC see the procedure as beneficial to women and girls, even helping to enhance cleanliness, marriageability, femininity, and modesty. So what could possibly go wrong? Aside from the obvious – acute and/or chronic pain, bleeding, infection and death – there are long-term effects of urinary retention, menstrual difficulties, sexual pain, birthing injuries, and complications and psychological trauma.

We were surprised to learn that FGC is practiced illegally in many parts of the diaspora (including the Greater Toronto Area), among new immigrants who continue to hold beliefs in support of FGC. Whereas 10 or 20 years ago, the idea of FGC may have seemed rather foreign, modern migration routes increase the likelihood that we may encounter and interact with individuals affected by FGC in our daily life, work or travels.

It also brought to light that as pelvic health physiotherapists, we may be in a key position to help inform – and empower – all women about what is normal and healthy for female pelvic health. Public education initiatives focused on the basic facts of human anatomy, bladder function and sexual function can be a powerful tool for demystifying and debunking the myths that perpetuate harmful practices such as FGC.

We in the Western world have many of our own myth-based practices to dismantle. Were you taught by a female elder that douching to cleanse the vagina is not only necessary but better than plain water? How about the urban legend that leads many young women to believe that using the toilet at any and every opportunity is the best way to prevent bladder infection? We use synthetic menstrual products, we worry about how our labia might look to others, and we tear out our pubic hair with an alarming resolve. Based on what? Fact? Or fallacy…

We encourage you to start a thoughtful discussion about FGC with people you know. For more information on FGC, please visit https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation, or search any of the references listed below.

References:

1. World Health Organization. 2018, January 31. Female genital mutilation. Retrieved from https://www.who.int

2. Sexuality Education Resource Centre. Female genital cutting. Retrieved from https://serc.mb.ca

3. Africans in Partnership Against AIDS & Toronto Public Health (2019). Female Genital Cutting: Clinical tips and cultural awareness [Powerpoint Slides].