The invisible scars of FGM

Leyla Hussein is just one of 140 million girls and women worldwide who are living with the effects of female genital mutilation. But as she explains through her personal story and experience as a psychotherapist working with survivors of FGM, the psychological impact is just as haunting as a physical scar – and it should no longer be ignored.

I only realised how deeply FGM had affected me when I became pregnant. My pregnancy was extremely traumatic and I was severely depressed. Every time I had a medical appointment I would feel ill to the point of passing out. I felt anxious whenever anyone touched me and had panic attacks whenever I was checked by medical staff.

Not one doctor or midwife questioned this or understood why. In my medical records it was documented that I have a scar on my hand, but not that I have a scar on my genitals. What I began to realise is that I also have an invisible scar.

We often associate female genital mutilation with the horrific physical trauma suffered by the 140 million women worldwide currently living with it. But there is less awareness about the psychological trauma that can haunt a woman throughout her lifetime. Sometimes the emotional scars are even harder to heal than the physical, as I was finding out.

While awareness is growing among the medical community, and we’re now slowly seeing prosecutions for doctors who perform the procedure, there is still only one therapy support group for FGM survivors in the entire European Union. It’s called the Dahlia Project, based in London, and I started it last year to provide a safe space for women to unpack the effects of FGM.

One of the most difficult aspects of FGM is accepting it as part of your life and learning how to live with it every day. I had to start figuring that out when I was seven years old.

I was living in Somalia, living the life of a princess, and I was nearing school age. In order to go to school, girls were cut. If not, we would have been socially excluded and ostracised. The day it happened was quite bizarre because it was a big celebration. I woke up and wondered why there were caterers and people everywhere. My next-door neighbour asked me if I was excited, and it was then I heard my sister scream from the other side of the house. She had just been cut. I tried to avoid it by running around, but I was young and got tired.

I fought the cutter, but I was pinned to a table, and I was exposed. It’s sexual abuse. It’s someone touching my genitals – to me, the cutting comes after. Afterwards, I was showered with gifts, lots of gifts, like it was a wedding. I got a pearl necklace. At that moment I was no longer thought of as a child: that’s the real message.

It wasn’t until after I gave birth to my precious daughter that I met an amazing practice nurse and trained counsellor who would change my life. She dared to ask me what no one had before: “Were you cut as a child?” She was the one who linked my experience as a child to my panic and anxiety in pregnancy.

It really, really upsets me that the other medical staff didn’t pick up on it. That’s why I became a therapist to help women who have gone through FGM by talking about the psychological effects. The nurse who did help me invited me to a presentation she was giving on FGM. Just before it, she took me aside and warned me that I might feel distressed.

“Don’t worry about me,” I told her. “I’m OK.”

By the second slide, I began to feel sick and faint. I ran out of the room in tears, not even sure of why I was feeling this way. I couldn’t escape the feeling of shame that came down like a cloud over me. It was only then that I learned I had experienced flashbacks during my pregnancy.

It was that day I decided my daughter would never go through this. Many people fail to understand that from the moment a child is grabbed and pinned down to a table, she has been violated and traumatised by someone she trusts, and she will carry the emotional scars for the rest of her life.

Here in the UK, primary health services focus on the physical effects of FGM, such as chronic urinary tract infections, painful periods, and acute and chronic pelvic infections that can lead to infertility. The emotional and psychological effects are ignored.

Many FGM survivors also suffer from sexual dysfunction, and they’re not able to enjoy sex. This, too, needs to be tackled, especially by those who work in the mental health sector.

Therapy is a chance to heal and start a journey of self-acceptance. Becoming a psychotherapist and founding the Dahlia Project was my way of repaying what was given to me by that incredible nurse. We receive 50 or 60 women a week for one-to-one counselling and group therapy. We get a big number of Nigerian women and a lot of women who were cut as babies. Many don’t even realise they’ve been cut so it’s a double trauma – we have to break the news to them. At the moment, it’s a London-based service, but I’m working on expanding it, maybe nationally. I’d like to see this offered in maternity wards.

Without the support of one health professional and her refusal to give up, I might not be where I am today – working on The Girl Generation, the most ambitious project yet to end FGM in a generation. The Girl Generation is an Africa-led campaign that will bring stories of change to a global audience, stimulate media campaigns and mobilise resources to support social and behavioural change.

No one can start this journey without specialist support. Survivors will lead the movement to end FGM, but more support and safe spaces for the affected girls are needed.

It’s a matter of urgency: every minute, five girls will be cut. Over the next 10 years, 30 million more girls will be at risk. We need to work together to ensure that my generation is the last to suffer from the consequences of FGM.