Excerpt from the third chapter in Undoing FGM, "The first patient."

After conveying that her body hurt, Madame Issatou fell silent, and it was this that led Pierre Foldes to delve into FGM, not the desire to combat a curse or lead a crusade. A physician, he was there to provide relief; pain ignited his desire to confront a medical condition at the heart of the curative relationship. You go to the doctor because you don’t feel well, and he helps you as a wounded individual, not because he rejects your culture or traditions. “What really got me was the pain. In that part of the world, excision is normal, and what my patients came looking for wasn’t identity or the joys of sex, but simply an end to their physical suffering. I don’t think this has ever really been communicated.” The call to which he responded wherever he went -- “Please make the hurting stop” -- he hears in the Ouagadougou hospital as well.

“Lie back, please,” he tells Madame Issatou and then examines her. “The source of her problem looked like something I was familiar with.” Excision has two consequences: amputating the clitoris causes bleeding and an infection that will displace the stump, pushing it into an abnormal position, two or three centimeters above where it would have been before being buried under the scar. This scar and the new position will prevent sexual pleasure, as the visible part of the organ has disappeared. But excision rarely slices very deep: girls have a cushion of fat at the site and fight back. The idea that occurs to him while examining Madame Issatou’s mutilated vulva is quite simple: remove the scar to reveal healthy tissue beneath it. At that point, nothing about reconstruction: he would simply incise around the injured zone, keeping his distance, to find a retracted organ stuck to the bone and pry it loose. A really modest operation, it lasted half an hour under local anesthesia. Only later would he perfect a procedure that pierces the skin to liberate a clitoris.

All goes well. He manages to remove the distressing scar, finds behind it a clitoral stump and brings the structure back to its former position. Not difficult at all. Fistula surgery that he had practiced often in the days before meeting Madame Issatou is much more challenging. But at the time, he hadn’t yet realized the connection between obstetrical problems and FGM.

Laying aside his bistoury, the long, narrow-bladed knife used to repair fistula, he feels surprise at how easy it was. Several hours later, the nurse reports the disappearance of the patient’s pain. At her bedside, he finds her smiling, clearly relieved. “Thank you, doctor. I feel hardly anything now.” An everyday event but with a coda: re-examination reveals a clitoris. “Seeing it restored set me to thinking.”