When we think of FGM, we think of the physical changes to the structure of the clitoris and vulva.
It is easy to overlook that FGM is also a condition associated with pain, and it may be the pain following FGM that is one of the most distressing and life changing aspects of FGM.
FGM survivors are more likely than other women to report dyspareunia (pain with intercourse), urinary infections, or dysmenorrhea (pain with periods). It may be that they are more likely to develop endometriosis than other women.
So, why do those affected by FGM have so much pain? This varies according to the type of FGM, and the way the tissues have healed.
The effects of FGM around the clitoris and vulva
FGM to the clitoris can result in scar tissue that buries the deeper clitoral tissues. When the affected woman is sexually aroused, this scar tissue prevents the clitoris from enlarging and causes pain.
FGM to the vulva around the opening of the vagina, reduces the elasticity of the vaginal tissue and narrows the vaginal opening, making penetrative intercourse painful at the opening of the vagina, and sometimes impossible.
The effects of FGM around the urethra
The urethra is the tube that allows urine to pass from the bladder. FGM can distort the urethra making voiding difficult and preventing some urine to pass. This results in voiding dysfunction and an increase in urinary tract infections.
The effects of FGM around the vagina
Painful intercourse related to the scarring and narrowing of the opening of the vagina is more common in FGM survivors. Period pain is more prevalent, and there is a suspected but not yet proven increase in the frequency of endometriosis. There is significant narrowing of the vaginal opening at times which does not allow the inner layer of the womb to be shed away naturally through the vagina, and instead it may flow back to the pelvis via the fallopian tubes and get implanted in the pelvic organs causing pain, painful intercourse at the time of deep penetration, and fertility issues.
The effects of pain on muscles within the pelvis
Whenever there is ongoing pain in the pelvis, a muscle reaction to this pain is common.
This is true whether the original pain involves the uterus, bladder, vulva, clitoris, bowel, or endometriosis lesions. As the muscles become firstly tight, then tender, then aching and ultimately cramp, it is muscle pain that causes a sudden stabbing feeling and often becomes the worst pain experienced.
The effect of pain on the central nervous system
Anyone with a pain that is present on most day for more than 3-6 months has changes to their central nervous system. This pain can’t be seen on scans, or blood tests or during an operation; however, it is very real. There may be symptoms such as burning, tingling, numbness – or a worsening of other pains over time. Symptoms like fatigue, poor sleep, anxiety, low mood, nausea or sweating are common. It is often worse in people who have had stressful experiences, or painful experiences when they were young. FGM is certainly a procedure that results in pain and stress in girls, and thus predisposes them to chronic pain.
You can read more about the different types of pelvic pain, and how to manage them at www.pelvicpain.org.au