A research in The Netherlands into the psychological, social & relational effects of FGM. Presented on Zero Tolerance Day 2010, Rotterdam

1. Veiled Pain A research in NL into the psychological, social and relational consequences of FGM 06 February 2010 Erick Vloeberghs

8. Predictors After multiple regressionanalysis: Predictors of PTSS-complaints : The variables memory (good), country of origine (except when from Somalia), coping (misuse of drugs) and type of mutilation (infibulation) Predicors of anxiety & depression : The variables coping (avoidance and misuse of drugs), country of origine (except when from Somalia), type of mutilation (infibulation) and not having a job. Country of origine. In order from more to less complaints: a. Ptss: Soedan, Ethiopia, Sierra, Somalia, Eritrea b. Depression/anxiety: Soedan, Ethiopia, Eritrea, Sierra, Somalia

10. Som 1: A consequence of FGM is that we have many health problems. Like me for example. During menstruation, childbirth and when we have sex. That is emotionally hard. In those periods, I feel temporarily disabled and I can not take care properly for my family. I must leave the care to others. And of course that is not what I want. On top of that you do not know what it is to enjoy [Ms looks sad.] Citation

11. Soe 8: He seemed to push against a wall. That place had been sewn closed my whole life. He never fits in, I thought. I thought I died at first sex, I was so tense and nervous until he was ready ... My husband insisted on having sex with me, while because of my circumcision no matchstick would go in easily. I begged him to go to the doctor to open it up. I went to the doctor - I had made an appointment with him for the operation. My husband finally came along and heard the explanations of the doctor. Once we were out of the room he said that nothing of that was going to happen, no surgery. Citation

13. Sie 12: If you're genitally mutilated you have less sex because you do not really enjoy it as much as a woman that did not undergo the ritual. In my case I know that my misery is caused by circumcision. And it really has a major impact on my life. The stress ... and I also get angry quickly. Because the m utilation I have no pleasure at all while an uncircumcised woman does not need to bother about that… Sometimes I respond strongly to my partner. I get angry and quick for nothing. If someone has pain, or if something is bothering you, then that person can sometimes become aggressive. I have that occasionally. My relationship suffers from the fact I’m mutilated. I would be happy if it stops. Citation

14. Citation When asked to this respondent whether FGM has influence on the relation with her husband, she answers: Eri 8: Yes. I hear many complaints from men about their wives. They say that women do not have sexual feelings or simply don’t want to have sex. And that makes the relationship difficult. There is dissatisfaction; men have sex with other women and ultimately divorce may result.

16. Sie 6: I just try not to think about what the mutilation and other painfull things because I have many problems, including relationship problems. But when I think about these things, I find the way to God. I listen to even more gospel songs and read the Bible. My faith helps me a lot ... Citation

18. Theme Riskfactor Question Answer 1) Circumcision Type Type 1, 2, 3 of 4? Type 2 but especially type 3 Memory of that moment Can you remember your circumcision good? I remenber my circumcisiom very well 2) Social economic situation and acculturation Level of education What is your highest attained level of education? Low education Age at migration How old were you when you migrated to The Netherlands? When I was already somewhat older Information Did you receive information about FGM (awareness raising) Yes Job Do you have a job or follow a course / study No, I’m not working neither paid nor voluntary Language capacity Can you express yourself well in Dutch? No, my knowledge of Dutch is rather bad 3) Coping Seeking support Do you talk with others about your problems, and does it help you? Sometimes I talk about it with others but it does not help me much. Avoidance Do you often feel excluded (receptive) or keep distance to others (actively)? Yes, both; active as well as receptive Misuse of drugs Do you often use drugs to feel better? Yes, that happens quite often. 4) Relational Partner In what way your partner deal with the sexual constraints and pain? He has little patience and act egocentric Stepmother and daughter Does your partner choose for his mothers’ wish when it comes down to performing the ritual on his own daughter? The wish of his mother is more important for him.

19. Som 8: I am a religious woman and I do not want the doctor to look at my genitals look. And I also don’t want to explain. I have no need in doing that... I try to go on with my life despite the infections. Simply by working hard. Interviewer: Did you ever had contact with Dutch healthcare? Som 8: No, never. I never go to the doctor if I have an infection. I dont want to show my genitals and tell him what is wrong. Interviewer: Would a female doctor do better? Will she be able to help you? Som: Maybe so. With a female doctor I may dare to speak about my complaints. After all it is a woman and she understands me better, I think. Citation