Menstruation Health A Challenge For FGM Survivors
According to Dr.Samuel Kimani, a health expert and researcher at University of Nairobi and Africa Centre for Abandonment of Female Genital Mutilation/Cutting (ACCAF), survivors of FGM could encounter painful menstruation associated with scarring of external genitalia and vaginal opening.
The pain is mainly as a result of the obstruction caused as a result of the procedure, which makes blood flow difficult or completely obstructed.
“It is worse or severe with the more extensive FGM/C (infibulation or type 3) where there is a pin hole vaginal opening due to narrowing caused by the FGM procedure or scarring associated with FGM,” Dr. Kimani says.
When the blood flow is completely obstructed, there will be more blood accumulation in the vagina, uterus and into fallopian tubes leading to infertility.
“The survivor may complain of abdominal discomfort and pain,” he says.
When Halima Golicha, the founder of Waso Hope community-based organization underwent FGM at the age of five, she had difficulties passing urine and developed a swelling on her abdomen.
At 12 years, she began having menses, which were extremely painful, accompanied by severe backaches, abdominal pains, that would render her immobile.
“I suffered throughout my teen years every time I had menses. After getting married, I had infertility problems, where I lost four pregnancies. The psychological trauma that followed was even worse,” Halima narrates.
Through the shackles of painful periods and fertility struggles, Halima carried one pregnancy to term. She gave birth to a boy, and was told she can never have children again.
Other than the health challenges they encounter, FGM survivors who underwent type 3 procedure also have difficulties using menstrual hygiene products such as tampons because of scarring and pin hole vaginal opening.
Frequent reproductive tract infections have also been reported by survivors as a result of the distortion of the normal anatomy of the external genitalia.
“During menstruations these problems may be increased because of hygiene requirements but could also masks menstrual problems associated with FGM/C. This may cause a misdiagnosis of the problem,” Dr. Kimani says.
However, most survivors delay seeking medical help when they encounter challenges as some are not sure that the problem they have is medical and can be treatable.
“Mostly, especially in rural areas survivors would seek first the help of traditional healers. It is until the problem is complicated or not responding they seek health expert help,” the health expert adds.
For survivors in remote areas, seeking healthcare is a major challenge, hence they may opt to rely on painkillers as they lack means to seek expert help.
He cites stigma and discrimination as another reason FGM survivors fail to seek medical help for their menstrual challenges.
“In some culture girls and women would be very uncomfortable discussing matters reproductive with the opposite sex or professionals from a different culture especially in the presence of FGM/C. This has hindered survivors from seeking health care because the professionals from non-cutting communities expressed shock on how the genitals looked like.”
Medical interventions such as the de-infibulation procedure can help FGM survivors deal with the menstrual challenges.
The surgical procedure, which entails opening up of the infibulated tissues is recommended for women and girls with type III FGM.
Other interventions include removal of the scar to open up the vaginal opening, counselling and psychosocial support to the survivor and sharing health messages about the problem with the survivors.

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