OUAGADOUGOU, Aug 21 (Reuters) - Abi Sanon was seven days old when she went under the knife.
Growing up in Burkina Faso, she thought all women had part of their clitoris cut out in an age-old custom practised in various forms in much of Africa and parts of the Middle East.
"But when I got older, I had friends who had not been excised, from Burkina Faso, but especially my Ivorian, Beninoise, and Cameroonian friends," said Sanon, 35.
"I learned that for them sexuality was pleasurable, whereas for me it was mostly painful."
Now help is at hand for Sanon and women like her in the poor West African country, in the form of a surgical operation to reconstruct the clitoris and restore some sexual sensation.
Sanon first heard of the procedure being performed far away in Paris, but could not get a visa.
Then she heard the surgery was available in Burkina Faso, a country cited by experts as one of the most progressive in trying to end the tradition, and the first in Africa to make the reconstructive surgery available.
"I went to the doctor the next day," she told Reuters.
The surgery costs around $150 at public hospitals here, although Sanon's husband helped pay the extra to have the operation at a private clinic, which can cost as much as $400.
As many as three-quarters of women in this landlocked former French colony have undergone a ritual variously referred to as female circumcision, genital cutting or genital mutilation.
Variations range from superficial incisions to removal of the exposed section of the clitoris and labia of the vagina, which is sometimes sewn up with only a small opening left.
The procedure often takes place in unsanitary conditions with no anaesthetic. Many girls die from infections before the wound heals; others suffer long-term health problems including sometimes fatal complications during childbirth.
The phenomenon is widespread despite being outlawed in many African countries, affecting more than 90 percent of women in some parts of East and West Africa.
"Sexuality, sexual desire of women remains a taboo," said Alice Behrendt, who studies the custom in West Africa for children's advocacy organization Plan International.
"Men are still very afraid of women being unfaithful, and most parents refuse to abstain from excision because they fear their daughters will express sexual desire and it will bring problems for the family such as early pregnancy," she said.
Surgery to reopen the vagina to ease medical problems has existed for many years, and is offered for free in Burkina Faso.
But the new reconstructive surgery being performed here now is the first to attempt to reverse circumcision and allow women to regain some sexual sensation.
The surgery is possible because most of a woman's clitoris is embedded within the body, and often only the few external centimetres are cut off in circumcision, meaning doctors can reattach some of the embedded part.
"They open the skin around the remaining clitoris, dissect it, and pull it toward the exterior end to fix it at the skin with stitches," said Michel Akotionga, head gynaecologist at the main public hospital in the capital Ouagadougou.
But the procedure can not completely reverse excision.
"The remaining part of the clitoris is ... enervated, which is to say it has nerves, but it doesn't play exactly the same role as in a woman who was never excised," Akotionga said.
Around 100 women have had the procedure in Burkina since it was introduced here a year ago, including a Burkinabe emigree who returned from Canada to have the operation, Akothionga said.
Pierre Foldes, the French surgeon who pioneered clitoris reconstruction in France a few years ago, says the operation can cause complications if not well performed, and few surgeons have adequate experience of the procedure.
"I support science that permits such medical advances, but for me it is essential to stop the practice altogether so there is no need to repair anything later," said Benjamine Doamba, an outspoken anti-female circumcision campaigner in Burkina Faso.
Plan's Behrendt worries some families may try to re-excise women who have the reconstructive surgery.
"Already there are cases where the parents or grandparents think the excision was not done fully enough, that the girl is not yet pure, and they insist on her doing it again," she said.
Doamba says her own experience shows how hard it is to wipe out the practice.
After excising her two oldest sisters, her parents decided not to excise their younger daughters. But when her high-school-age, unexcised sister got married, her husband's family insisted she get excised.
Doamba says her sister nearly died from medical complications, which her family believes arose because she was excised so late -- so her parents decided to have Doamba excised to save her from similar medical problems later in life.
"If everyone is saying girls have to be excised, well maybe a parent will say to himself or herself 'I'll fulfill my role as a father, as a mother, and excise her, and when she grows up, if she wants, she can go to the hospital to put back her clitoris'," Doamba said.
SOURCE: Reuters AlertNet
AUTHROR: Naomi Schwarz
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