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Asking questions about Clitoraid

April 10th, 2010

Dr Petra

Just before Easter a friend of mine forwarded a request to me. It read ‘End FGM/C [Female Genital Mutilation/Cutting]. Adopt a Clitoris’. And linked to an organisation called Clitoraid that promised to restore pleasure to women who had undergone genital cutting.

At first glance it sounded like a wonderful idea. Not only did it seem to be challenging FGM/C, but was also helping women experience pleasure. Unsurprisingly many colleagues from the academic, science and sex education/therapy communities eagerly forwarded calls to support Clitoraid via forums, email, or on Twitter.

However, our training within education and research should always remind us to question and investigate everything. No matter how good it sounds. Just to be sure we are supporting something that is genuinely beneficial.

Below are the questions I asked to find out more about this venture, which I encourage you to also ask before supporting Clitoraid.

Who organises/oversees this initiative?

Clitoraid is funded by an organisation called the Raelians. Depending on who is defining this organisation can either be described as a religion or a cult. It is notorious for a number of reasons (including its view of sexuality and believing in intelligent design), but most famously for claiming it has cloned a baby human through a venture called Clonaid.

The leader, Rael, explains Clitoraid here

Faith based/cult groups have a track record of funding health ventures in developing countries, so the involvement of the Raelians is not unique.

However the tenets of the organisation should raise questions to those involved in science, healthcare or education. Any organisation offering interventions requires careful assessment, regardless of the beliefs underpinning it. After all many faith/cult organisations do offer services in health/social care in well meaning ways. But being well intentioned is not adequate. It also needs establishing whether what is offered is effective, and whether it has been imposed on a culture or developed within a community. And whether any organisation involved is there to do good, or to promote themselves or even operate a scam.

How is it paid for?

Clitoraid is a charity based in Nevada. The initiative is based around donations (see the ‘adopt a clitoris’ scheme). It is unclear what additional funding comes from the Raelian organisation.

What is being offered? (What is Clitoraid)?

This is explained in their Information Package which outlines the surgery provided to reconstruct the clitoris. This procedure is not unique to Clitoraid or the Raelian organisation. It has been developed by Pierre Foldes. Described in more detail with surgical images here. Contemporary research suggests restorative procedures are ineffective without considering wider social and cultural factors.

Foldes opted not to get involved with Clitoraid but did train US gynaecologist Marci Bowers to perform the procedure.

What evidence is there of the effectiveness/acceptability of procedures offered? And how is this assessed?
I contacted Clitoraid’s Nadine Gary (patient care and operation manager) as well as their offices in the UK and US head office. I heard nothing back, despite repeat contacts. However a colleague Matthew Greenall has also been investigating and has documented the correspondence he has had from the organisation in his blog.

This response does not confirm whether any research has been undertaken, but somewhat naively states “No publication yet (we are working on that), just women calling us to report orgasms which is our biggest reward”.

While this may well be rewarding, it is not particularly useful as a measure of effectiveness or acceptability. It does not tell us whether all women who underwent the procedure were able to experience orgasm, nor whether this was acceptable to their partner or wider community. It does not tell us whether any adverse events were noted, or complications from surgery. It also bases the measure of ‘success’ of the repair solely on orgasms, rather than more general pleasurable genital sensations. This may be equally important to women.

If you are conducting any surgery you should have this basic information available – particularly if you are requesting public donations to maintain this service. And particularly to explain and justify the surgery you are providing to potential clients.

It is deeply troubling that such basic information could be provided. And perhaps somewhat unfortunate that email correspondence from the organisation ends with an invitation to support another Raelian cause that perhaps some might feel does not fit with the serious issue of FGM/C.

How was the community involved in the initiative consulted and involved?

I asked this question of Clitoraid and received no reply. Matthew Greenall also asked this question (see link above) and was told “the project is led by Banemanie Traore, a BF citizen who was herself a victim of FGM and who deals with all the local authorities in the building of Clitoraid’s hospital”. This does not explain community consultation or involvement – key issues required for any health initiative to be effective and ethical. Projects have failed on countless occasions because of top down approaches where outsiders have decided what should be done to/for a community. In this case there is no evidence of how local communities have been consulted about the programme, nor included in deciding what happens. Indeed the idea of a leader working with the authorities does not suggest collaborative or partnership working with communities. Which are vital in any health or educational programme but particularly important when a highly sensitive and complex issue such as FGM/C is being addressed.

What research was undertaken before any initiative took place to ensure it was appropriate, timely and useful?

This was an additional question I asked and have received no reply to. In order for any intervention or programme to work effectively it should be based on sound evidence. While Clitoraid did inform Matthew Greenall they were basing the surgery on Pierre Foldes work (see above) this is not really adequate for cross cultural working. Surgical rehabilitation is only one aspect of FGM/C. There are also issues of identifying what social and cultural barriers may be in place that might compromise such surgery – or put women who seek it at risk. Given the women involved are undergoing reparative surgery in a culture that sees clitorises so negatively that they excise them, there needs to be more research underpinning any potential ventures than simply knowing a surgical procedure.

Are there any partners involved?

Clitoraid has recently gained a commercial partner in the form of Good Vibrations, a sex store established in 1977. On March 24 2010 Good Vibrations press released their support of Clitoraid and their donation of vibrators to women who had undergone reconstructive surgery. They were joined by veteran sex educator Betty Dodson.

Good Vibrations and core staff supporting Clitoraid such as Carol Queen, and Betty Dodson do have an established reputation within sex positive work. So it is somewhat surprising these key figures have seemingly backed a venture without doing the due diligence checks I’ve outlined above. I would hope such checks had been carried out, but it is worrying to consider either the partnership was agreed without such checks, or after making such checks it was felt the venture was worth supporting.

Furthermore, donating vibrators and teaching sex positive masturbation techniques, while well intentioned, remain problematic if these are not part of an evidenced, reflective and community-centred approach. Sadly all too often well meaning Western practitioners decide their approaches to empowering women’s sexuality are so profound they should be available to women all over the world. Without considering first what different social and cultural factors exist internationally that may make such approaches ineffective or perhaps counterproductive if applied without careful consideration and adaptation through collaborative working.

It’s worth noting that in the last couple of weeks, a small number of individuals asking questions and working together has confirmed there are issues about Clitoraid that need addressing. It may have been better if Good Vibrations had engaged in a more in depth activity like this (on a formal basis) particularly talking to NGOs and healthcare staff working in Burkina Faso and other countries to find out more about Clitoraid. Networking on health can be essential in helping us make decisions about what organisations and initiatives we support – and find out who is truly benefiting.

Has anyone else asked similar questions about the initiative/organisation?
As the calls to support Clitoraid grew I began asking questions of colleagues about the Raelians, the procedure offered, wider social/cultural issues, and the involvement of sex store partners. Reactions varied. Some colleagues began investigating themselves. Others, including Leonore Tiefer from the New View Campaign, helpfully provided information which I’ve incorporated into this post. Some thought it was a joke or a scam. Some became hostile arguing that FGM/C was so abhorrent that any intervention to undo excision should not be questioned; or that even if the work was funded by the Raelians and hadn’t been fully evaluated it didn’t matter as giving women back an orgasm was more important. A few argued I was racist for questioning Clitoraid, or accused me of endorsing FGM/C. And some withdrew from discussions due to feeling conflicted in having to question established sex positive colleagues.

One person who did ask questions was Wanjiru whose first post on this issue ‘No, you can’t have my clitoris’ documented her questioning of Good Vibrations about their involvement with Clitoraid. Their response worryingly included the “request for more scientific evidence that support of Clitoraid was a bad idea”. This is a concerning response. As you can see from the questions listed above one should fully research and investigate an area before getting involved, not get involved without apparently carrying out assessments but then demanding of anyone who questions you to prove ‘scientifically’ you are wrong.

Shortly after Good Vibrations did respond. Confirming they would continue their support of Clitoraid and stating they felt they had acted in an appropriate and culturally aware fashion.

Then Wanjiru also uncovered evidence that the local community are not happy about Clitoraid’s plans to name the hospital where surgery will take place ‘the pleasure hospital’ – yet the organisation plans to ignore their objections.

Meanwhile a Facebook group and petition against Clitoraid have been established.

Other bloggers such as Afrogeekchick and Blacklooks raised similar concerns.

The involvement of bloggers writing about this issue in terms of gender, politics and race adds an important dimension to the discussions around community, culture and health. Drawing these topics together is important to help us reflect on whether any activity is appropriate.

It does involve asking questions that are difficult and uncomfortable at times and sadly this case is an example of how ‘sex positivity’ is not always fully understood or engaged with. While pleasure is important, unless we ask crucial questions about what initiatives are planned; what the local community feels about them; what the core needs of the community are; and how our actions may represent the community globally; we may find ourselves doing more harm than good.

I am sure that the partners of Clitoraid are well intentioned, and it is very sad to see well known sex educator professionals caught up in a case that potentially could harm their reputations.

What should we conclude?

While there is good evidence for the effectiveness of reparative surgery, this alone is not effective without wider social/community support programmes and psychological therapy. We cannot draw any conclusions on the effectiveness of the Clitoraid programme, nor any evidence of their community partnerships because they have not provided this information when requested.

Because of a lack of evidence around the programme, questions about how it has been implemented, and concerns over wider issues addressed above (including the issue of Raelian backing), this is not a scheme to support.

We can, and should, question Clitoraid, while continuing our efforts to prevent FGM/C.

Update 11/04/10

In another excellent post Wanjiru identifies reportage stating restorative surgery is offered free by the government of Burkina Faso (where Clitoraid is based). Colleagues in Burkina are confirming whether this remains the case. Part of Clitoraid and Good Vibrations justification for the work in Burkina Faso was based on reconstructive surgery being prohibitively expensive. [My Burkina colleagues reminded me to mention Burkina Faso was one of the first African countries to formally outlaw FGM and while it still struggles to overcome the practice, certainly has taken a strong stance on this issue].

Darklady contacted me to explain how Clitoraid has been a concern of hers for several years. She explained the organisation has been active at many Adult Industry events and Trade Fairs, collecting donations from delegates to help restore women’s orgasms. In this 2007 piece she questions the approach taken by the organisation, but notes how keen people were to support the cause. In 2007 Clitoraid were asking for money to build the ‘pleasure hospital’. The current drive is also to achieve this goal. While I appreciate building hospitals does take a lot of time and money it would be helpful for Clitoraid to confirm how far they are along with this building scheme, how much money they have so far collected for it, and if the programme of building is ongoing how likely it is to continue for. It may also be worth them explaining if the ‘pleasure hospital’ will only do reconstructive surgery, or will it offer the much needed wider healthcare communities are so often in need of.

Darklady also raises the important point that given many women who have not had reconstructive surgery struggle to experience orgasm, what does this mean for women who have undergone the trauma of FGM/C – does everyone who has reconstructive surgery experience orgasm, and if so how long does this recovery/relearning process take?

I have had several emails from colleagues anxious they have publicly supported Clitoraid, but who are now worrying if they withdraw this support they will be viewed as hypocritical or losing face. My advice to them is to consider one of the joys of working in health/education. We review information all the time. And if evidence is telling us to question or avoid an organisation or intervention, then it is appropriate we change our standpoint. This is not a case of losing face, but one of showing you have reflected and can make appropriate shifts to ensure those you want to support are empowered. This may be something Good Vibrations could also consider. I’m sure if they were to engage in critical reflection at this time it would gain them more respect and undo the damage against their reputation.

Update 12/04/10

Coincidentally while this ‘adopt a clitoris’ case started I was approached via email by Good Vibrations to be an affiliate of their store. I replied explaining this would not be possible, and pointed out the problems with their approach to ‘adopt a clitoris’ and support of Clitoraid, along with what seems to be a lack of clear community involvement and reflection on a cross cultural initiative. I urged the store to reconsider its position and ended my reply
Numerous individuals and organisations working in sex education, therapy, research and International Development are now discussing your store and its involvement with Clitoraid on twitter, on blogs, forums and listserves. There are plenty of people who would be willing to offer advice about why the link between Good Vibrations and Clitoraid is problematic and enable you to make more informed decisions about your link. I hope you will consider making use of that goodwill

Today I received this reply:
Dear Dr. Petra,
Thank you so much for your honest reply and I hope that our sites can work together in the future.
Good Vibrations is proud to have donated 16 vibrators and other personal care products to women whose ability to feel pleasure has been compromised by having undergone clitoridectomy. We hope their Clitoraid-sponsored surgeries, to remove scar tissue and allow greater clitoral sensation, will be very successful.
Anti-Clitoraid activists have recently misrepresented our involvement with that organization and linked their strategies and philosophy with our own more than the facts warrant, so we are taking this opportunity to clarify our role.
We are not donating funds to nor soliciting them for Clitoraid, but we are very glad to support our longtime friend and colleague Dr. Betty Dodson as her physical therapy work assists these women in discovering the pleasure that is their birthright.

This reply worries me, and I have replied saying so. Firstly the donation of 16 Vibrators is not really all that much as part of a much heralded ‘GiVe’ programme. Presumably there are not that many women undergoing surgery so that would explain the low number, but in terms of corporate giving the cost of 16 Vibrators is pretty low ($256.00 by my calculations). From the press release it explains women have been given a Pleasure Me Purse, the content of which may or may not be appropriate to women who’ve just had reconstructive surgery. I’m assuming the 16 vibrators were included in the purses (although this was not clear from the correspondence from Good Vibrations). It is unclear why this product was chosen and whether it was selected to be particularly appropriate to this client group. Were any tests undertaken to identify what kind of vibrator might be most suitable for post surgical clients?

The statement ‘we are not donating funds to nor soliciting them for Clitoraid’ is at odds with the press release sent out by Good Vibrations on 24 March which states “This Summer, Good Vibrations’ customers can give the gift of pleasure to women around the world who suffered female genital mutilation (FGM) during childhood. They can do this by making a financial gift to Clitoraid at the time of their Good Vibrations purchase”. Later in the press release it states “How GiVe Works: Each quarter, Good Vibrations will partner with a different nonprofit organization and encourage their customers to contribute directly to them at check-out. That sounds to me like soliciting funds.

Seemingly Wanjiru has had a similar communication from Good Vibrations.

It’s worth noting that there are people complaining about Clitoraid – and rightly so if you look at many of the issues I’ve outlined above. But people are asking reasonable questions about cross cultural working, appropriate interventions and understanding sex positivity. To dismiss critics as ‘Anti Clitoraid activists’ but to fail to fully engage with any of the criticisms raised is worrying. While people have raised criticisms, some more vocally and angrily than others, generally the discussions of Clitoraid and Good Vibrations involvement has been about the wellbeing of women who have undergone FGM and communities in Burkina Faso.

This continues to be a very sad situation. As previously mentioned I think those supporting Clitoraid are acting with the best of intentions, and some of the response to criticism has also been misplaced also. I would really like to see Good Vibrations and Betty Dodson engage with the wider health, international development and sex education/therapy communities to try and resolve this case, without simply dismissing anyone who questions this venture as being against them. The focus should not just be about Good Vibrations, we should continue to question the work of Clitoraid generally, and to reflect on how best to work with women and girls affected by and at risk from FGM/C.

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