Chapter 9 On Clitoral Restoration in Survivors’ Words

These emboldened candidates for reconstruction downplay the scepticism among medical professionals. After all, some clinicians ask, what about controlled trials? And how do we know that an unearthed clitoris really works? Indeed, a scarcity of evidence calls for caution. As Belluck and McGarvey (2019) wrote on the medical options available for women living with FGM, some surgeons have expressed reservations.2Belluck and McGarvey (2019). Pam Belluck and Maddie McGarvey, ‘The Medical Solutions for Women Living with Female Genital Mutilation’, The Irish Times, Ireland, 6 June. https://www.irishtimes.com/life-and-style/health-family/the-medical-solutions-for-women-living-with-female-genital-mutilation-1.3908340 [Accessed 10 July 2025]. These authors quote Dr Jasmine Abdulcadir, an obstetrician-gynaecologist at Geneva University Hospitals, Switzerland. Although Abdulcadir had been a student of Pierre Foldes, she contends that ‘unless women are in pain’, they require a three-month wait and psychosexual counselling before restoration. In fact, ample briefings prior to surgery appear to have become routine. No positive outcome is assured, but even while lacking certainty, thousands of women choose to grapple with the hurt and flashbacks to undo the theft by blade.

To illustrate the motivating factors for women seeking reconstructive surgery, in the early 1990s, at Goethe Universität, Frankfurt am Main, I taught a class featuring videos about FGM. For six weeks, Senait, twenty-one, from Ethiopia, took her seat in my living room and watched one movie after another. At that time, although international advocacy was still in its baby shoes, my video library already shelved dozens of shows from independent filmmakers as well as from the BBC and German, Austrian, French, Dutch, and Spanish television stations. ‘I’m looking for something’, Senait told me. ‘But I can’t say exactly what.’ Finally, though, insight came. ‘Now I understand’, she said. ‘What’s missing is my clitoris. Because I was only two, I don’t remember being cut, but ever since, I’ve felt like something isn’t there that should be …’3Senait and the author were speaking German. All translations from German and French are by the author unless otherwise noted.

As van der Kolk (2014) has written, ‘the body keeps the score’. He found that ‘trauma’s impact is not only mental, emotional, and neurological, but also physiological: trauma rewires the brain to put people in a constant state of stress or numbness, leading to a host of physical problems’ (book cover blurb). Senait’s sense of something amiss, and missing, aligns with van der Kolk’s description. It also dovetails with testimony collected by Marie-Noël Arras (2008:39): ‘J’ai toujours senti qu’il me manquait quelque chose … toujours!’ [‘I’ve always felt I lacked something.’]

At the University of Toronto, Gillian Einstein connects the dots. Her research links the clitoris to the body as a whole. In 2008, Einstein found remarkable similarities when comparing cerebral alterations in clitoral cancer amputees to brain configurations in ritually (i.e. deliberately, not accidentally) excised women. ‘Cutting neural innervation to the vulva’, Einstein notes, causes the brain and spinal cord to respond in a manner similar to ‘any loss of neural targets or inputs’ (Einstein 2008:84). Einstein’s work took place when the dearth of holistic studies acknowledging FGM’s effects on ‘the entire body via neural rewiring’ (ibid.:85) was startling, especially when one considers the vulva’s high innervation ‘by both sensory and motor nerves. Cutting the vulva must include cutting nerve and muscle, components of the nervous system’ (ibid.:88). The gratuitous injury becomes all the more chilling considering that ‘loss of targets may lead to further retrograde degeneration in the brain’ (ibid.:93), a known result of ablating these organs if diseased or lost in multiple sclerosis patients. When Einstein was preparing to write, she found ‘no information about how the breasts, legs, corpus cavernosum of the clitoris, and pelvic representations are related to the external genitals in female somatosensory space or how they map in relation to each other’ (quoted in Levin 2011:240).

Dr Pierre Foldes, pioneer of clitoral reconstruction surgery, encountered a similar disinterested ignorance. Even the Royal Academy of Medicine in London, sponsoring a colloquium on 4 July 2007 on ‘circumcision’ and excision, devoted five of six lectures to the penis and only one, by Efua Dorkenoo,4In 1983, Efua Dorkenoo (1947–2014), a nurse from Ghana residing in London, founded FORWARD (Foundation for Women’s Health Research and Development). It was among the first organisations to oppose FGM, and is now the largest such charity in the UK. to the clitoris. Despite countless articles detailing reconstruction of the male organ, for the clitoris Foldes found next to nothing. It was as though ‘surgeons had never operated on it and anatomists had barely noticed it. … Certain sexologists’ wild imaginings notwithstanding, it appears that physiology considers the circuitry of pleasure simply too blurry to capture’, Hubert Prolongeau remarks in Undoing FGM (2011:93). It was as if the world conspired in disdain: the clitoris is a sexual organ, no more, and ‘that simple function was insufficient to make it as interesting as other organs’ (ibid.).

Yet Pierre had discovered a means to reverse the damage, offering his patients renewed genital health and pleasure. How? Let’s keep in mind that the trauma proceeded not only from atrocious pain but also from the perceived betrayal of a normally protective mother, hence wounding from both physical and emotional assaults.

To say the physician has generated enthusiasm among FGM survivors would be an understatement. Arriving late to a meeting of the European Network against FGM in Paris in 2002, I walked in at the end of Dr Foldes’ speech.6Hosted by GAMS (Group Femmes pour l’Abolition des Mutilations Sexuelles) Europe Seminar, Espace Conférence des Diaconesses, Paris, France, 29 March 2002. He received not only a standing ovation but also playful requests from a number of activists who implored: ‘Don’t go yet. You’ve got work to do right here.’

Foldes began carrying out restoration in the Clinique St Germain, but to achieve a more holistic vision, he co-founded the Institut en santé Génésique in the same location. He named it in English Women Safe and Children, inaugurated in March 2014.7www.women-safe.org [Accessed 2 September 2025]. Women Safe is presently an interdisciplinary holistic centre, which welcomes distressed women of all backgrounds. Paid and volunteer staff include physicians, surgeons, lawyers, politicians, psychiatrists, psychologists, and social workers, thereby offering clients a single address at which to start what could be a nightmarish journey seeking aid through unfamiliar bureaucratic channels. Let’s remember that, though Women Safe welcomes all victims of violence – FGM as well as domestic violence, forced and early marriage, serial marital rape, spousal refusal of contraception and more – many clients are immigrants of African descent who must first learn to navigate the intricacies of French social benefits.

This broad approach to Violence against Women (VAW) notwithstanding, a special focus on clitoral restoration continues, and Dr Foldes offers it to young and old who celebrate not only renewed erotic options but, even more, enhanced self-esteem. As a man, he takes pride in opposing other men’s crime against women. For who really wants to truncate women’s genital organs? Men fearful of the vulva’s power. This interpretation is Pierre’s. ‘FGM is the most violent expression of male domination’, he has often told me.

Although this chapter gathers verbal testimony from women who have had their clitoris and often labia restored, significance also derives from their feelings toward the loss, and a few outspoken survivors who relentlessly campaign to spare girls from the blade understand FGM as a feminist issue in a manner similar to Dr Foldes. For instance, Vavenger8The Vavengers is a UK charity dedicated to ending FGM/C using theatre, storytelling, puppets, and multi-media presentations. See https://thevavengers.co.uk [Accessed 2 September 2025]. co-founder Hoda Ali, speaking on 12 March 2015 at the University of Oxford, in a colloquium I organised called ‘Contestations around FGM’, narrated her heartbreaking story of infibulation and its agonising aftermath. When she was in her early thirties, innumerable operations left her sterile, and the inability to bear children often drove her to despair. She has called what she went through ‘torture’, a term her colleague Dr Leyla Sirad Hussein Gikandi implied when, speaking in October 2024, she insisted during an End FGM US movement meeting: ‘Please don’t call it a “practice”, even less so a “ritual” or “tradition”, for those terms ennoble what should be denounced without ambivalence or hesitation. FGM is a crime.’9Gikandi, L. S. H. (2024). Speech. George Washington University Milken Institute for Global Health, Washington DC, USA, 29 October.

Thus, ideologically aligned with the IAC, Dr Foldes is, as he has said, ‘reversing the effects of a crime’, and while doing so, he too has been a victim. When interviewing him in St Germain-en-Laye in 2005, I asked what blow-back from traditionalists he had seen. Without hesitation he opened his shirt to reveal a six-inch scar. ‘An Islamist’, he explained, having engaged the fellow in calm conversation after the self-invited guest had deployed sharpened cutlery to dissuade him from his mission. Fortunately, the attack misfired, for Pierre has gone on to assist more than 6,000 patients and growing. Mainly residing in France, they have roots in francophone nations such as Mali, Burkina Faso, Senegal, Benin, Guinea Bissau, Guinea-Conakry, and Côte d’Ivoire.

A harbinger of opposition had, however, already emerged in 1987 in Ouagadougou. A male nurse got wind of an Ouagadougou patient’s refurbished jouissance (delight or ecstasy), expressed in her effusive gratitude to Foldes when she returned to the clinic to thank him. The manly gatekeeper confronted the surgeon and issued a warning: ‘Relieving pain you can do’, he said, ‘but no tampering with that ….’

Pierre was taken aback, but he decided not to pass moral judgment. His patients, however, would disabuse him, strongly disapproving of approval expressed by medical professionals in misguided efforts to be courteous.10Note the Inter-African Committee’s insistence on terminology, i.e. avoiding euphemism, calling it FGM, and refraining from coddling African listeners. Please be attentive to the Bamako Declaration, which I edited for economy. It is in Hilary Burrage’s blog: https://hilaryburrage.com/2020/04/06/the-bamako-declaration-revisited-female-genital-mutilation-terminology-mali-2005/ [Accessed 2 September 2025]. This becomes clear in ‘testimony from excised women about their run-ins with Western health professionals’ (Prolongeau 2011:97) which revealed that Foldes was not the only one who refrained, at first, from condemning the condemnable. ‘No one opposed what had been done nor proposed to repair damage or even lessen inconvenience’, one of the excised complained to Prolongeau. ‘When my gynaecologist examined me for the first time’, Félicité Bangre recalls, ‘she [the gynaecologist] said with ice in her voice, “Well, well. So, you’ve been excised.” I hadn’t ever talked to anyone about it but had hoped to find a more encouraging ear’ (ibid.:98).

As for Sorna Boubakar, her gynaecologist’s words were hurtful: ‘Well, this is bizarre.’ Equally upsetting, other patients of Pierre’s have heard ‘your excision was well done, thank goodness. What a great job’ (ibid.)11Félicité and Sorna typify Foldes’ clients, aged mainly between twenty and thirty with familial roots in West African francophone nations. In reports that sometimes follow unrehearsed testimony, witnesses do not want to be more closely identified at speak-outs (monthly public meetings at the Women Safe Centre in Paris to discuss, celebrate, or complain about reconstruction), given that parents and families are not told about reversals. Secrecy shrouds the proceedings. ‘What is that supposed to mean, well done?’, Pierre scolds, acknowledging the trauma on hearing a professional approve of clitoral ablation despite clinicians’ Hippocratic Oaths. Given most patients’12Note that I (the author) am speaking of most patients (perhaps redundant since they would not have sought medical help had they approved of the cut), not most of the excised. rejection of the blades, the turn from ‘neutrality’ to disapprobation came swiftly.

As satisfied patients announce with pride, ‘I’m no longer excised’, becoming uncut is a therapeutic side-effect of treating their initial complaint. Thus, encouraged to do more, he’s surprised at specific requests. ‘In aesthetic terms, even though a clitoris can be almost invisible, they want it imposing. So, adjusting to their perspective, I “produce” something “big”’ (Prolongeau 2011:99).

Returning now to the women in the taxi, Neneh also wants it ‘big’. Once restored, she intends to revisit The Gambia and exhume her clitoris, trashed ignominiously somewhere in the compound. When she had asked to see it after severance, the exciser and witnesses had remonstrated: ‘What do you want to see it for? It’s gone where it belongs, under the earth.’14A range of fates may await the severed organ. FGM specialist midwife and activist Comfort Momoh, for example, found pulverised clitorises for sale as libido enhancers in a Nigerian market. She referred to this at a colloquium at the University of Oxford, ‘Contestations around FGM. Activists and the Academy’, in March 2015. Neneh feels otherwise, the scorn it drew like molten lava dumped on her dignity. Instead, having made the remarkable journey from Farafenni to Paris,15The title of her forthcoming memoir on excision and restoration (Bojang and Kortum). she plans to rebury the organ with pomp and decorum, for were it not thought to possess extraordinary strength, it would not meet the millions of blades ceaselessly employed in amputating it. Neneh wants to orchestrate a solemn ceremony, a requiem in honour of women’s robust joy. And how has her new appendage changed her? One day after surgery, although not wholly free of pain, Neneh is also ecstatic. As she told Jeanie Kortum (2014): ‘What’s different in my life now is the freedom from a hardened scar walling in my sexuality, and, liberated, I look forward to jubilant sex with fewer inhibitions.’ She said this while she was blowing out the candle on a birthday cake to celebrate a clitoris soon to meet a vibrator ‘for maximum potential’. Looking up with an impish grin, ‘It’s a big one’, she confides. ‘Now when washing, my hand finds a hill instead of a clearing. A massive clit. It sends twinkles up my spine.’

So, has Neneh won the lottery? Exuberant with orgasmic jouissance restored? Is the furtive orgasm the Holy Grail? Yes, for some; not really, for others; yet not ‘in the first place’ for most. Indeed, emotions surrounding the loss and return of an overdetermined body part can be boisterous and even contradictory. But above all, these are stories longing to be told.

Let’s take Félicité’s tale, for instance, as narrated by Prolongeau (2011). The preface is easily sketched: abandoned by her mother in Mali, Félicité, then age nine, found refuge with her grandmother in Paris who, however, used her as a servant. Uneducated and unskilled but longing to escape grandma’s beatings, the teen met a man – Monsieur Bernard – and moved in with him. But sex was her Achilles heel. Indeed, she had thought, ‘If I can’t change what’s down there, at least I can change what’s up here’, her attitude (ibid.:193). That is, she tried altering her mindset, but instead made an unsuccessful suicide attempt.

Félicité’s tale grows rosier, however. She left Monsieur Bernard, and on 7 September 2004, she was ‘fixed’; that is, she had reconstructive genital surgery. ‘For a month or two, healing was uncomfortable. But I was so proud of myself. And I’m sure my delight was visible even in my strut. I was whole, and often gazed at myself in the mirror or stripped to enjoy my nakedness. And in the shower, I felt sensation gradually return’ (ibid.:193–4).

Over the next six months there was a striking metamorphosis:

So, let’s celebrate with Félicité (nomen est omen), but with a touch of sobriety, for ‘not all those Foldes has restored have known the same pleasure’ (ibid.:194). We, too, can admit that ‘sexual recovery … is initially mental or spiritual’ (ibid.), that it takes time, and that beyond healing of the physical wound, behavioural scars remain. As sexologist Catherine Solano notes, ‘Many patients, even six months later, cannot let anyone touch them down there’ (ibid.:195), a barrier that others have confirmed.

Operated on in September 2004, Awa Koita, a Senegalese woman in her twenties, noted how excision prevented her from feeling relaxed around men, so she lied to her partners, at first, as numbness persisted. But gradually, sensation returned. ‘A vast expanse down there that had been unresponsive isn’t any more. And I’m so much more confident’ (ibid.), she says.

This return of self-assurance is often mentioned by Foldes’ patients. Falila Ezembe, for instance, shares how she and her lover now rock the rafters, adding that ‘I’m certain … the intensity is due to my transformation. Before, I was ashamed of what I lacked and feared being rejected as inadequate. Now I’m entirely me. If the man for whom I had myself repaired were still around, I wouldn’t lose him now’ (ibid.:196). And she concludes, ‘that operation has been my salvation’ (ibid.).

Although at Dr Foldes’ speak-outs in the Women Safe Centre you will often hear about renewed, robust self-confidence, sexuality remains important, too. That was evident in a diary blog by a woman called Papillon (2007) who, having been Foldes’ patient, details the reawakening of feeling after surgery. Papillon shares her attitude toward the cutting, its impact, and her wish to shed both trauma and pain. On 12 July 2007, she titles her entry ‘Baby steps’:

Granted, the voyage was not entirely smooth sailing. At first, the perceived enormity of the reset appendage troubled her. ‘I was afraid it would stay like that, planted in my privacy like an iceberg in a lake.’ Fortunately, it didn’t. In fact, it shrank, but to acceptable dimensions, its current size she calls ‘ideal’. Yet, another transformation would ensue. It altered its hue. ‘I don’t know if it’s the cream I apply every morning or the Marseille soap, but … from bright pink, it went to a very chic salmon. I imagine in only a few weeks it will turn brown. Plus, … I can finally see my small lips. Reassured, frankly I’m delighted.’ With ‘the surgeon’s blessing’, Papillon writes, she and her husband returned to the bedroom and rekindled their sex life.

Yet, alas, the positive proved tentative. On 27 November 2007, in an entry titled ‘Going solo in seventh heaven’, Papillon notes her psychologist’s return ‘to one of Doctor Foldes’ recommendations’ which, however, she finds challenging. He’s advised applying a clitoral cream, but never having masturbated, Papillon is inhibited. She also chides herself for having expressed to her therapist ‘a slight hint of disappointment with my operation’. She goes on:

That these expectations crash in contact with reality is unsurprising. Naturally, as Foldes’ team-mate, sexologist Dr Frédérique Hédon, tells Arras in a reflection called ‘Vers la connaissance de soi’ (toward self-awareness), restoration doesn’t end on the operating table. Sexuality counselling is an integral part of treatment. After all,

This is of course intended. ‘The aim (not always hidden) of excision itself is to limit or block, from a young age, a woman’s interest in sex by hindering her experience of jouissance. It’s not a question of protecting the child but of ensuring submission by imposing pain’ (ibid.). What is intended is control of female sexuality.

But this intention meets resistance. Take Madame W., for instance. A 64-year-old West African immigrant living in the USA, Arras found her defiant:

In O’Dey’s words: ‘The individual layers of tissue, prepared with great care using magnifying lenses, are then sewn together, which takes a lot of time.’ O’Dey has now operated on several hundred women.

One of them is my close friend from Thiès, Senegal. A sociologist with a PhD in education, Dr Mariame Racine Sow and I have worked together since 1998 when we co-founded FORWARD-Germany, at Efua Dorkenoo’s behest, a charitable association now called FORWARD for Women.21FORWARD for Women: www.forwardforwomen.org [Accessed 2 September 2025]. The author of this chapter is president, Mariame executive director. Born in Senegal, a member of the Peul ethnic community, Mariame taught sex education to high-school students in her homeland with the Evangelische Entwicklungsdienst (Protestant Overseas AID) and, in Germany, has been honoured for her dedication to immigrant women and men whom she assists to navigate the complexities of integration with the double aim of opening conversations about FGM. Hoping to alter consciousness by persuading her clients that excision should cease, she acts with courtesy and tact. Convinced that ‘no one has the right to reveal the trauma’ – that is, to ‘out’ what another has suffered – she has nonetheless come out herself as a fierce opponent of FGM and a beneficiary of plastic surgery. Featured in the popular German film Vulva und Vagina,22Sat (2022). Vulva and Vagina: New Insights into Female Pleasure. Science documentary. 25 August. Mariame is interviewed by Dr O’Dey, with whose handiwork Mariame is wholly satisfied. Speaking of her own experience, she told journalist Birgit Schenk (2019): ‘The operation provided a new life of pride in myself.’

Let’s meet at least one more beneficiary of Foldes’ largesse (he doesn’t charge although the clinic does). Novelist Jeanie Kortum, author of Stones, about ethical dilemmas surrounding FGM, was the third woman in the taxi with which this chapter opens. As mentioned, Jeanie was to report on Neneh’s operation, but she also took advantage of a speak-out on FGM held soon afterwards in St Germain-en-Laye. At that event, Aminata23A pseudonym. from Mali appeared keen to talk. ‘Women who have been cut are forever altered’, she said. Now she is forty-six; the blade had struck when she was only three months old but, not unlike my student Senait, she felt an existential void. ‘Like they took away who I was. Sure, I was present but not myself. I was someone here, in the world, by mistake.’ In 2007, Dr Foldes restored her clitoris and, she says, gave her back her life. ‘What had gone missing was returned.’ But it was too late to null and void the unhappiness triggered by her injury, including her beloved husband’s rejection. He was French and, for fear of losing him, she had never mentioned that she had been excised. When he discovered it – attending the birth of their daughter – he accused her of betrayal. Given that she had refused ‘to do certain things he would want in sex’, she thought he might have guessed but instead, unable to have sex with her knowing what she had endured – a male response not uncommon yet hard to judge, being both cruel and kind – they divorced, and she felt awful, ‘aberrant, like an exile from womanhood’. But with her clitoris restored, her agency returned, and empowerment emerged. ‘Today I’m in control. I have another life’ (Kortum in Bojang and Kortum 2014, interview).

Foldes’ patients credit him with renewal of their smiles. And they praise Dr Marci Bowers, too. Presently in Burlingame, California, a student of Dr Foldes, she is credited with pioneering Gender Affirmation Surgery. ‘The first woman worldwide to hold a personal transgender history while performing transgender surgery’, she and I met in Washington DC, at an FGM Summit (1–2 December 2016). There I learned that she is also the first US surgeon to have mastered the technique of clitoral restoration after FGM. In Vienna and Berlin, you will also find clinics specialising in clitoral restoration, as well as the Desert Flower Center and hospital in Waldfriede, Berlin, where Dr Foldes holds in-house training. And today there are many more.

‘The notion of optimising the human body for some desired benefit – brighter moods, genius brainpower, a healthier gut biome – has fuelled trends like cryotherapy, UV light boxes, and keto diets’, Quinlan notes. ‘Now, led by a phalanx of online enthusiasts, the biohacking boom has come for the clitoris. In public forums like the subreddit “Grow Your Clit” which some 29,000 people have joined since its founding in 2019, members share anecdotal advice’ (ibid.). Social media sites offer ideal fora for narrating stories about hormones to encourage clitoral growth. Doctors whom Quinlan interviewed for this article mentioned growing attention to the subject from readers.

Seemingly far from accepting blades against vulvas as a patriarchal social norm, such a clitoris-positive movement nonetheless throws down the gauntlet to male dominance. Not unlike courageous FGM survivors who risk flashbacks to undergo repair, seekers of fat and ‘twinkling’ clits are their own Pygmalion, captains of their ship, sculptors of their fate. This is the agency feminists desire, utopian as it may seem.

Thus, in their 2015 review of the evidence for clitoral surgery, Abdulcadir, Rodriguez and Say wrote: ‘Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify long-term outcomes and which women might benefit.’ Their critique, however, appeared more than a decade ago. Since then, considerable progress has ensued, judging by reports from satisfied patients. Naturally, the story has another side; not every woman restored is spared discomfort. But Dr Foldes embraces the value of their telling. After all, he contends that ‘reconstructive surgery is born of sympathetic listening. And the aftermath? It belongs to women and their words. They are the ones who must now speak out about what they have always silenced, their hopes of recovery – and recovery of hope’ (quoted in Prolongeau 2011:231).

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