AHA Foundation: What is the main purpose of your organization, forma? What inspired you to establish your nonprofit?
Joanna Vergoth: forma is a non-profit organization dedicated to providing culturally sensitive clinical services to FGM-affected women. Also, we offer psychoeducational outreach, advocacy, and awareness training to hospitals, social service agencies, universities and the community at large. Although there are many organizations that exist to help stop the practice of FGM and I support each and every one of them—my primary interest has always been offering survivors the care they may need.
AHA Foundation: What are some of the psychological consequences of FGM?
Joanna Vergoth: FGM is a violent, life-threatening genital assault that can imprint survivors with debilitating consequences—both psychological and psychosexual. Those that can remember say they will never forget the day they were cut. And, for some, undergoing FGM may be compounded by rape, forced marriage, wars and separation from family. Such traumatic events can profoundly rupture an individual’s sense of self, safety; the ability to trust and feel connected to others.
Although each woman and her story is unique, women who have undergone FGM may be affected by chronic pain which can increase their risk of depression and reduce social functioning. Some women may develop persistent negative emotional states such as fear, anger, guilt, or shame, or engage in distorted thinking and suffer from low self-esteem and concerns about body image and their missing parts.
Generally speaking, re-experiencing is the most typical symptom and occurs when a woman involuntarily and vividly re-lives the traumatic event in the form of a flashback—when the memories are of then but the feelings are of now. Jarring and disruptive, they can leave one feeling fearful, confused and distressed—affecting the way one thinks, feels and behaves.
AHA Foundation: Does the degree of cutting correlate with the severity of psychological consequences?
Joanna Vergoth: For those women experiencing psychosexual difficulties the primary problem is generally painful intercourse which can normally be attributed to the removal of the clitoris and labia leading to damaged nerve endings clitoral neuromas or epidermal cysts, or chronic urinary tract infections. Painful intercourse can also be caused by the development of inelastic scar tissue and adhesions surrounding the excised areas thereby causing the narrowing of the vaginal canal. Even with the least severe form of FGM, scar tissue can develop and affect the ability to experience pleasure.
Because of repeated pain, women may develop anxiety responses to sex and this can lead to avoidance and reduced capacity for sexual arousal.
AHA Foundation: In your experience, is it difficult for survivors to reconnect with their parents? Have you seen parents and families of survivors change their mind about the practice?
Joanna Vergoth: FGM is an intergenerational trauma but it can also constitute an experience of betrayal and this can be a challenging situation for some survivors who may develop problematic relationships with their mothers or female authority figures in their family or communities—especially with those who promoted their surgeries. I have witnessed mothers, FGM survivors themselves, express their feelings of grief and regret to their daughters for having been instrumental in the FGM surgeries their daughters were forced to undergo. I have also helped survivors process difficult and complex feelings towards parents who continue to believe that this surgery is and was necessary and consequently place the importance of this cultural tradition above the safety and bodily integrity of their daughters.
AHA Foundation: Based on your experience in hospitals, would you say that doctors are sufficiently educated on FGM? Do they understand how to handle these situations with sensitivity?
Joanna Vergoth: When presenting on FGM (referred to as grand rounds) in Chicago hospitals OB/GYN’s have come up to me and say “I have had women like this in my practice, but I didn’t know what to say to them. They did not discuss it [FGM] nor did I”. I do believe that the increased attention to, knowledge about, and awareness of this issue has helped medical personnel (especially in cities with large concentration of FGM affected women) work more effectively with this population but psycho-educational outreach must continue.
AHA Foundation: What message would you give to survivors or girls at risk of FGM who are suffering from trauma in isolation, trying to deal with it alone, and not seeking help from trained psychologists?
Joanna Vergoth: It’s very difficult to deal with this level of trauma alone. And isolation often makes a person isolate even more. Sometimes a cycle can develop where the more time they spend alone, the less they feel like people understand them. Counseling is an effective process for helping painful experiences become tolerable and for learning healthy ways to cope. Just as we have broken through the taboo of coming out against FGM, we must also work to overcome the stigma surrounding mental health and seeking help to stabilize emotional well-being. We have to fight the stigma that therapy looks scary, is foolish, or self-indulgent. Seeking therapy is not an act of weakness — it’s often the most courageous and compassionate act of self-care—it could be the best gift you give yourself.