Lucy was only a month into her marriage when she decided to quit, citing unbearable pain during sex as the reason.
"I cannot bear it!" she exclaimed when she sought care in the sexology clinic, "and if I must have sex as part of marriage, I would rather be single." She looked into the distance, tears welling up at the corners of her eyes and eventually rolling down.
She had walked alone into the consultation room. Despite complaining about the pain to her husband, he seemed hardly concerned.
"Could it be that he feels more masculine when I writhe in pain?" She asked rhetorically. “I have learnt to cry quietly because the more I complain, the harder and rougher he gets, injuring me even more!”
I examined Lucy to try to work out what was causing her sexual pain, and I was amazed at the sight of her genitalia. She had undergone the popular but painful practice of female genital cutting as a child. This had completely altered the anatomy of her vagina. Her clitoris and surrounding tissues had been mutilated and were literally absent.
Instead, there was a large scar around the vaginal opening, extending into the vaginal canal. She must have suffered a severe infection after the procedure, which led to the tissues matting together as they healed. The vaginal opening itself was reduced by more than half.
This caused Lucy severe sexual pain. Under normal circumstances, vaginal tissues are elastic, allowing for expansion during sex. In addition, lubrication reduces friction, making sex painless and pleasurable. In cases like Lucy’s, however, elasticity and lubrication are lost, making sex a painful grinding of two dry, inelastic tissues. The vaginal cavity can become bruised or even lacerated in such circumstances.
Unfortunately, not many women in Lucy’s situation seek treatment. According to the latest statistics from the Ministry of Health, one in every five women in Kenya is living with scarred genitals as a result of female genital mutilation (FGM). In some communities, up to 98 per cent of women have undergone the procedure.
In communities that practise genital cutting, there is a strong belief that it prevents women from becoming ‘sexually wild’ and seeking sex with multiple partners. Furthermore, women who do not enjoy sex are considered good.
Genital cutting is traditionally carried out by women in the community. Most men do not even know the difference between a cut and an uncut genital area. One study found that, when asked if they had ever seen or recognised a cut genital, over half of men in communities that practise genital cutting reported that they did not know the difference. Indeed, many had never seen their wives' genitals, as sex was performed in the dark, under the blanket and with their eyes closed.
This raises the question: whose benefit is genital cutting for? It causes pain for women and makes sex painful; men lack knowledge of what it is and how to handle it, and it leads to severe childbirth complications that affect the wellbeing of the whole family.
For Lucy, the safety of her genitals was now a moot point. The issue was not whether to cut or not to cut. She was already suffering the consequences of the practice. She would never be able to enjoy sex like other women. When the time comes, childbirth will be another nightmare; she will have to undergo a caesarean section to avoid tearing the scarred vagina. She was fortunate to have access to hospital care; most women in rural areas suffer in silence.
In an attempt to save the marriage, I arranged for Lucy to undergo surgery to enlarge the scarred vaginal opening and open up parts of the vagina that had become contracted due to scarring.
After counselling, Lucy’s husband reluctantly agreed to the procedure. He was reassured that it would not recreate the genitals in an uncircumcised state. This was an important point for Lucy’s mother-in-law and other close relatives to accept her back after the surgery.
Six weeks after the surgery, Lucy had healed well, but was still experiencing pain during sex. Natural lubrication was inadequate as the glands that produce it were destroyed by the genital cutting. She was prescribed artificial lubricants to reduce friction during sex. She would have to use lubricant throughout her sexually active life.
Sex coaching was an important aspect of care. The couple were made to understand that sex is supposed to be pleasurable for both partners, and that it is not a contest in which one person enjoys pleasure while the other suffers pain. They were taught to communicate their feelings during sex, so they could be in sync and enjoy mutual pleasure.
