Are you in pain if you say you are not? Accounts of pain in Somali–Canadian women with female genital cutting

Abstract

As a rite of passage to womanhood, 2 million girls undergo female genital circumcision (FGC)—the tradition of cutting, and often removing parts of the vulva—every year. The current study is the first to focus on the connection between peripheral nerve damage and chronic neuropathic pain in women with FGC. We used mixed methods—quantitative, qualitative, and physiological—to study chronic pain in Somali–Canadian women (N = 14). These women have the most extensive form of FGC, which includes removal of the glans clitoris, labia minora, medial portion of the labia majora, and stitching together the remaining parts of the labia majora. Our results indicate a multifaceted pain experience in women with FGC. Although they report good overall health and very low pain levels on the short form of the McGill Pain Questionnaire, pressure-pain quantitative sensory testing of the vulvar region applied through vulvalgesiometers shows pain thresholds consistent with those reported by women with chronic vulvar pain. Furthermore, qualitative interviews reveal a considerable amount of often debilitating pain in daily life. These results challenge the use of assessment tools offering elicited verbal pain language and highlight the importance of culturally sensitive ways of conceptualizing, measuring, and managing pain.

Chronic Vulvar Pain After Female Genital Mutilation/Cutting: A Retrospective Study

“… 35 A recent study showed that a small sample of Somali-Canadian infibulated women reported low pain levels on validated pain questionnaires and reported good general health while having pain thresholds as low as other women with chronic vulvar pain during quantitative sensory pain testing in the vulvar area. 25 Only when the participants were handed open-ended questionnaires, leaving space for self-expression of pain, did they report chronic disabling daily pain. 25 In our pouplation, vulvar pain was linked to infibulation and vulvar scar complications, such as cysts, neuromas, scar tissue and bridles.…”

“… 25 Only when the participants were handed open-ended questionnaires, leaving space for self-expression of pain, did they report chronic disabling daily pain. 25 In our pouplation, vulvar pain was linked to infibulation and vulvar scar complications, such as cysts, neuromas, scar tissue and bridles. As we present in another manuscript currently under review, surgical excision of such complications can reduce and treat such pain symptoms.…”

“… 25 The authors of this study insist on how assessing chronic vulvar pain can be challenging due to cultural differences influencing the way pain is experienced, described and verbalized. 25 …”

Dünya Çocuk Cerrahlarının Sünnette EMLA® Krem ile Oluşturulan Lokal Anestezi Hakkındaki Görüşleri Nedir?

“…These studies have stated that patients may feel pain despite local anesthetic interventions. During the preparation of this publication, there were 9 studies on circumcision in Pubmed in 2021, 5 of which focused on pain (6)(7)(8)(9)(10)(11)(12) .…”

Reflections on Neurofeminism and Intersectionality Using Insights From Psychology

“…In their critical analysis of neuroscience, neurofeminists have emphasized that critical race analysis must be considered in any investigation aiming to understand and ultimately dismantle inequitable sexed/gendered conditions ( Roy, 2012 ; Kuria, 2014 ; Rippon et al, 2014 ), and as our discussion highlights, research in neuroscience that is informed by intersectionality must expand its focus beyond sex/gender and race to include a wider spectrum of intersecting and marginalized identities. With the exception of a recent pain study conducted with Somali-Canadian women with female genital cutting (further detailed below, Perovic et al, 2021 ), to date, there are no neurofeminist parallels to this type of research ( Fitsch et al, 2020 ).…”