Defibulation

This is a big name for a procedure that reverses the destructive effects of female circumcision (aka Female Genital Mutilation) and I did my first one ever (haven’t ever even seen one) last week. Female circumcision is an extremely destructive practice that unfortunately is still practiced in this part of Kenya, despite the fact that it is illegal. Many people are actively campaigning against it, but it is still being done in the smaller villages. It is, in fact, so common here, that I’m surprised when I see a woman who hasn’t had it done. It is done without anesthesia and under very unsterile conditions. Some girls are as young as 7 or 8 when it is done. For those nonmedical people reading this, basically all of the external genitalia are removed and the woman’s opening is closed over until only a very small opening remains. This causes all sorts of problem for the woman, including giving birth.

About 2 weeks ago, one of the maternity nurses approached me and said she had a friend who had been circumcised as a young girl and was getting married in December. She wanted to have her circumcision reversed prior to getting married, something that is unheard of in her community. She asked if I knew how to do this. “Well,” I said, “I did do a presentation on it in residency and it explained how to do it. I’ve never seen one, but I think I could do it.” So, I met her friend. I was shocked when I examined her – it was the most severe circumcision I have seen yet. She was forced to urinate and menstruate through an opening that I could barely fit my pinkie finger in. What an awful way to live, I thought. As we talked, she described to me how careful she had to be that no one at home or that knew her family found out she was having this done. She would be ostracized if they found out. (I have yet to find out exactly why this practice is still done here, but many Kenyans also find it awful.)

So, last Friday, I did my first ever circumcision reversal (after reviewing how to do it from my presentation – thank you ACOG!). There were about 10 people in the OR watching over my shoulder, as they had never seen one before, either. Don’t worry – no pictures for the blog for this one J It went well, and I’ve seen her back once. She is very happy with the results and couldn’t stop thanking me. What a joy to do such a simple procedure but have such a huge impact on someone’s life. The theatre staff were joking that maybe this will become my new niche here – we’ll see!