Apr 15 / Dr Priyesh Patel

FGM & Sex: Pain & Pleasure - Is It Even Possible?

Can people with  Female Genital Mutilation (FGM) have sex? Can women with altered clitoris still be sexually stimulated, feel pleasure and have orgasms? Is it too painful? Is it even physically possible? Many wander: what are the sexual implications of FGM? Female sexuality is often shrouded in cultural shame, especially in communities where FGM persists. This article fearlessly addresses the taboos and reality. Read on to explore this crucial intersection and uncover the impact of FGM on sexual function.

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The Right To Have Good Sex

Human sexuality involves a complex interaction of multiple anatomical, emotional, neurological, physiological and biochemical mechanisms which are influenced by sociocultural factors as well as relationship dynamics.

Every woman has the fundamental right to engage in sexual intercourse, experience pleasure, and enjoy satisfying sexual experiences. These rights are crucial for overall well-being, yet survivors of FGM may encounter significant obstacles in this regard.

Sexual dysfunction can cause significant personal distress, but does this happen to women with FGM?
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What is FGM?

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Painful & Impossible Sex

For survivors of FGM, engaging in sexual activity can be uncomfortable, difficult, and even traumatic for several reasons:
  • Anatomical Distortion: FGM, especially infibulation, can create physical distortions that act as obstacles during vaginal intercourse.
  • Scar Tissue and Nerve Damage: FGM can result in scar tissue and nerve damage, leading to persistent genital pain (dyspareunia) during or after intercourse.
  • Reduced Vaginal Elasticity and Dryness: Scarring and narrowing of the vaginal opening can reduce flexibility and cause dryness, making sexual activity uncomfortable.
  • Increased Risk of Injury: Attempting vaginal intercourse after FGM can cause further damage to the genitals, resulting in cuts and abrasions that worsen pain.

In severe cases, sexual intercourse may become impossible due to pain and anatomical changes, leading to a condition known as apareunia. Additionally, men attempting intercourse with infibulated women may also experience pain and abrasions due to the challenging anatomy.

Impaired Sexual Function

Research indicates that survivors of FGM often face impaired sexual function, manifesting as pain and difficulties during penetrative sexual intercourse, such as penile penetration.

This can contribute to feelings of profound isolation and disconnection from one's own body, impacting not only physical sensations but also emotional and psychological well-being, ultimately leaving some individuals to perceive themselves as 'sexually handicapped.

Psychosexual Problems

Psychosexual problems refer to sexual difficulties with psychological roots, impacting the mental, emotional, and behavioural aspects of sexual development. These issues can manifest uniquely in each individual, resulting in a complex and varied impact on sexual experiences and symptoms.

When considering the effects of FGM on sexual experiences, it's essential to recognise the combined influence of physiological and psychological factors. FGM procedures can lead to severe psychosexual complications, significantly affecting a woman's sexual well-being and overall quality of life.

Sexual Stimulation

FGM procedures often involve the removal of erogenous (sensitive to sexual stimulation) and sexually responsive vascular tissue from genital zones. This can reduce natural sexual responsiveness, making it more challenging for survivors to become sexually stimulated compared to women who have not undergone FGM.

The removal of these sensitive tissues can affect sexual experiences, making it harder for survivors to feel sexually stimulated and aroused. This impact on sexual responsiveness can significantly influence overall sexual well-being.

Satisfaction

FGM/C can negatively impact sexual function, leading to decreased natural lubrication during intercourse. The removal or alteration of sensitive genital tissue can reduce sexual desires, sensitivity, and arousal. These changes can contribute to lower sexual satisfaction and increase the risk of difficulty achieving orgasm (anorgasmia), which is when a person has trouble reaching orgasm.

Orgasms

Even after undergoing clitoridectomy (a type of FGM that involves partial or total removal of the clitoris), some women can still experience orgasms, although the frequency may be affected by how much of the clitoris was removed. Generally, more extensive removal of the clitoris can lead to less frequent orgasms. However, every woman's experience is unique, and some may still be able to achieve orgasm despite having undergone FGM.

Self-Image & Sexual Confidence

Feeling negatively about oneself can significantly impact sexual experiences. This negative self-image may lead individuals to avoid engaging in certain sexual activities that are associated with pleasure, ultimately resulting in reluctance or complete avoidance of sex and intimacy altogether. This can deeply impact sexual confidence, which is believing in one's ability to enjoy and have satisfying sexual experiences.




Frigidity

They may experience frigidity, which involves:
  • Difficulty responding to sexual stimulation;
  • Trouble achieving orgasm (anorgasmia) during intercourse;
  • Strong aversion to sexual activity.
These challenges can lead to feelings of disconnection and impact overall sexual well-being.






Vaginismus

Fear can lead to pain, and for women who have undergone FGM, it can cause a condition called vaginismus many years later. Vaginismus is when the body reacts to fear of vaginal penetrative sex with involuntary muscle spasms, making penetration difficult or impossible. This condition is not only physically uncomfortable but also emotionally distressing for survivors.




Intimacy & Relationships

The challenges discussed can deeply strain both the sexual and emotional aspects of relationships for women who have experienced FGM/C. These individuals often face significant obstacles in maintaining close relationships, which can lead to serious problems in marriages.

Healthy relationships are crucial for emotional well-being, and when intimacy and marriage suffer, it can deeply affect mental health. Dealing with these challenges is important for healing and overall emotional well-being.





Key Factors Affecting Sexual Function

There is a clear link between how severe the FGM procedure is and the level of sexual difficulties experienced. The more extensive the procedure, the greater the impact on sexual function.

Sexual functioning in FGM survivors is complex and influenced by three main factors:
  1. Anatomical changes and trauma: This can lead to pain and difficulties during penetration.
  2. Psychological factors: Conditions like PTSD, anxiety, and depression can affect sexual functioning.
  3. Relational factors: Behavioural patterns, dissatisfaction in relationships, and feelings of shame can also impact sexual experiences

    - Check out this Webinar by Sahiyo on Sexual  Pleasure & Emotional Healing after FGM...





Valid Responce

The impact of FGM/C varies among women because each person undergoes different types and extents of the procedure. They also experience varying levels of physical harm and face diverse traumatic situations and cultural influences. This can affect their sexual pleasure, ability to have orgasms, and relationships differently. While some women may not have difficulties with sex or relationships, others face significant challenges that can be very difficult to overcome.

FGM is complex but easier than you think to understand. To learn more about FGM and its effects, consider reading our other educational resources. Sign up for one of our comprehensive insightful training courses on FGM to deepen your understanding and support efforts to address this critical issue. 

Relevant Sources
Dahlia Project. Female Genital Trauma: Guidelines for Working Therapeutically with Survivors of Female Genital Mutilation [Internet]. 2019 [cited 2023 Sep 15]. Available from: https://www.dahliaproject.org/

Buggio L, Facchin F, Chiappa L, Barbara G, Brambilla M, Vercellini P. Psychosexual Consequences of Female Genital Mutilation and the Impact of Reconstructive Surgery: A Narrative Review. Health Equity. 2019;3(1):36–46. 

O’Neill S, Pallitto C. The Consequences of Female Genital Mutilation on Psycho-Social Well-Being: A Systematic Review of Qualitative Research. Qual Health Res. 2021 Jul;31(9):1738–50.

Abdel-Azim S. Psychosocial and sexual aspects of female circumcision. African Journal of Urology. 2013 Sep 1;19(3):141–2. 

Bazzoun Y, Aerts L, Abdulcadir J. Chronic Vulvar Pain After Female Genital Mutilation/Cutting: A Retrospective Study. Sex Med. 2021 Oct;9(5):100425. 

NHS, Vaginismus information, Available at https://www.nhs.uk/conditions/vaginismus/

Shafaati Laleh S, Soltani F, Roshanaei G. Female Genital Mutilation, Sexual Quality of Life and Marital Relationship: A Case-Control Study From Iran. J Family Reprod Health. 2022 Dec;16(4):264-271. doi: 10.18502/jfrh.v16i4.11357. PMID: 37465431; PMCID: PMC10350551.

Sahiyo, Sexual pleasure after female genital cutting, 
By Derrick. Available at Simiyuhttps://sahiyo.org/sahiyo-blog/sexual-pleasure-after-female-genital-cutting.html

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