Let’s be real for a second. Most people don’t even like saying the words. It’s heavy. It’s uncomfortable. But when we talk about female circumcision—more accurately known in medical circles as Female Genital Mutilation (FGM)—we are talking about a physical and psychological shift that millions of women navigate every single year. It isn't just one thing. It varies from a small nick to the total removal of external tissue.
Honestly, the "before" and "after" isn't just a medical timeline. It's a total rewrite of a person's relationship with their own body.
The Physical Reality: What Happens During the Procedure
Before the procedure happens, the anatomy is intact. We’re talking about the clitoris, the labia minora, and the labia majora. These aren't just "parts." They are densely packed with nerve endings designed for pleasure and protection. In a healthy, "before" state, the vaginal opening is unobstructed, allowing for the natural flow of menstrual blood and a relatively straightforward childbirth process later in life.
Then things change.
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The World Health Organization (WHO) breaks this down into four types. It’s not a "one size fits all" situation. Type 1 might involve the partial or total removal of the clitoral glans. Type 2 goes further, removing the labia minora. Type 3, often called infibulation, is the most extreme. This is where the labia are cut and sewn together, leaving only a tiny hole for urine and blood. Type 4 includes everything else—piercing, pricking, or scraping.
The immediate "after" is often a state of medical emergency. Because these procedures are frequently done without anesthesia or sterile tools—think razor blades, glass, or sharpened stones—the body reacts violently. We see hemorrhage. We see infections like tetanus or sepsis. In some cases, the shock alone is fatal.
Long-term Health: The "After" That Never Really Ends
You might think once it heals, it's over. It’s not.
The long-term "after" of female circumcision is a chronic medical journey. When you remove or scar tissue that is meant to be flexible and sensitive, you create a host of issues. For starters, many women deal with recurrent urinary tract infections (UTIs). Why? Because if the opening is narrowed (Type 3), urine can pool behind the scar tissue, becoming a breeding ground for bacteria.
Then there’s the period.
Imagine your menstrual flow trying to exit through a hole the size of a matchstick. It’s slow. It’s incredibly painful. It can lead to pelvic infections and even infertility because the backup of fluid causes internal damage.
Dr. Jasmine Abdulcadir, a leading specialist at Geneva University Hospitals, has documented how these physical changes lead to "de-medicalized" trauma. Women often don't realize their chronic back pain or pelvic heaviness is a direct result of the scarring from years prior.
Childbirth and the Risk Factor
The "after" becomes particularly dangerous during pregnancy. The scarred tissue isn't elastic. It doesn't stretch. When a woman who has undergone Type 3 FGM goes into labor, the tissue often has to be cut open (defibulation) just to let the baby through. If this isn't done in a hospital, both mother and child are at high risk of death or obstetric fistula—a condition where a hole develops between the birth canal and the bladder or rectum. It’s devastating.
The Psychological "After": Beyond the Scars
We can't just talk about the flesh. The mind keeps a tally too.
Before the procedure, a young girl usually feels a sense of belonging in her community. In many cultures, the "before" is a time of anticipation where she is told this ceremony makes her a "real woman" or "pure." The betrayal that often follows—being held down by loved ones—creates a fracture in trust that is hard to mend.
Psychologically, the "after" often mirrors Post-Traumatic Stress Disorder (PTSD). Research published in The Lancet suggests that women who have undergone female circumcision show significantly higher rates of anxiety and depression. There’s a specific kind of "sexual dysfunction" here too. It’s not just about the loss of physical sensation, though that’s huge. It’s the fear of pain. When sex is associated with the memory of trauma and the physical reality of tearing scar tissue, the "after" becomes a cycle of avoidance and marital strain.
The Global Shift: Why the "Before" is Shrinking
The good news? The "before" is staying "before" for more girls than ever.
Data from UNICEF shows that the practice is declining globally. In countries like Egypt, Ethiopia, and Kenya, the rates among adolescent girls have dropped significantly over the last three decades. This isn't just because of laws. Laws help, sure, but the real change comes from community-led education.
When "cutters" (the women who perform the procedures) are given alternative livelihoods and when imams or priests publicly state that religion does not require FGM, the culture shifts. We are seeing a move toward "symbolic" ceremonies in some regions where no cutting actually occurs, though activists argue that even these can perpetuate the idea that a woman’s body needs "fixing."
Medical Reconstruction: Reclaiming the "After"
For women living with the "after" of female circumcision, there is a path toward physical reclamation. Clitoral reconstruction surgery, pioneered by surgeons like Dr. Pierre Foldes, aims to restore some anatomy and reduce chronic pain.
It’s not a magic fix. It’s a complex surgery that involves uncovering the internal part of the clitoris (which is usually still intact deep under the scar tissue) and bringing it to the surface.
For many, the goal isn't just about sexual pleasure. It's about feeling "whole" again. It's about looking in the mirror and seeing a body that hasn't been dictated by a razor blade. However, access to this surgery is limited and often expensive, leaving millions of women without the option to physically "undo" the damage.
Actionable Steps for Support and Prevention
If you or someone you know is dealing with the physical or emotional aftermath of this procedure, or if you're looking to help end the practice, here is how to move forward:
- Seek Specialized Care: Don't just see a general GP. Look for "FGM Specialist Clinics" or pelvic floor therapists who understand the specific mechanics of infibulation scars. Organizations like the Desert Flower Foundation provide resources for medical help.
- Mental Health Support: Trauma-informed therapy is vital. The "after" is a mental burden that shouldn't be carried alone. Look for therapists who specialize in cultural trauma and sexual health.
- Support Local Activism: Change doesn't happen from the outside. Support groups like Tostan in Senegal or SAFE (Strategic Advocacy for Empowerment) that work within communities to facilitate "community-led abandonment" of the practice.
- Educate Without Stigma: If you are talking to someone from a practicing community, avoid "othering" language. Understand that for many, this was done out of a misguided sense of love and protection. Approach the conversation with health-focused facts rather than judgment.
- Report Risk: In many western countries, if a child is at risk of being taken abroad for the procedure (often called "vacation cutting"), there are mandatory reporting laws. Contact local child protection services or specialized hotlines immediately.
The journey from "before" to "after" is a profound one. While we can't change the past for the 200 million women living with the effects of female circumcision today, we can absolutely change the "before" for the next generation. It starts with speaking the truth about what happens, without the euphemisms.