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WARNING: This article contains graphic descriptions of female genital mutilation
Shamsa Shaarawi, who has gained notoriety in Somali communities around the world for her opposition to female genital mutilation (FGM), described in a video the pain she suffered on her vulva when she was six years old, cutting off rose petals with a razor blade and then sewing them together.
The TikTok post quickly went viral, with nearly 12 million views since it was shared 16 months ago.
No Somali, even in the diaspora, will speak openly about FGM, let alone the problems that come with it, such as dysmenorrhea, difficulty urinating, painful intercourse, and the dangers and trauma of childbirth when the vulva (including the labia and clitoris) is removed and the vaginal opening is reduced to a tiny hole.
This form of FGM, known as pubiswounds or “third type”, is what most girls in Somalia undergo because of the widespread belief that cutting off their external genitalia guarantees their virginity.
Many in Somali society believe that women who have not undergone FGM are immoral or sexually aggressive, which can ruin a family’s reputation.
Yet the 31-year-old TikToker, who came to live in the UK in 2001 after her family fled civil war in Somalia, is not afraid to tackle these taboos with humour, engaging and sometimes heartbreaking honesty.
Using the name Shamsa Araweelo on TikTok, she shared a horrific account of how she was forced into marriage and raped while travelling in Somalia shortly after turning 18. It took her six months to find a way to escape back to the UK.
But perhaps the biggest taboo is admitting she wants her genitals back – so she’s willing to pay for reconstructive surgery because it’s not offered to women on the NHS.
She discovered it was possible when she was contacted by Haja Bilkisu, a German citizen who had undergone female genital mutilation as a child when she returned to her country of birth, Sierra Leone.
In response to Ms Shaarawi’s rose video, Ms Birkisu explained that her clitoral reconstruction surgery was performed with the help of Dr Dan Mon Oddie at the Luisen Hospital in Aachen, Germany.
Ms Shaarawi told the BBC: “Even though I agreed to it this time, I am still scared to do it again.”
“But I have to do it for my mental health. I just want to never feel pain again.”
The surgery involves reconstruction of the clitoris and labia (Ms. Sharawe uses tissue from her buttocks) and removal of cysts and scar tissue to relieve pain and restore the woman’s sexual life. In some cases, the vaginal opening is also enlarged to normal size.
Last year, Ms. Sharawe was elected BBC 100 Women To show her determination to end FGM, she decided to share her journey to Germany and recovery so that other women like her can understand their options.
However, it took years of abuse and the trauma of a second failed marriage for her to muster the courage to challenge the authority of her Somali community.
Ms Shaarawi, now a single mother of a 10-year-old daughter, also feels let down by the NHS.
It only offers FGM survivors deinfibulation surgery – a procedure that opens the vagina but does not replace any of the removed tissue or undo any damage.
Ms. Shaarawi decided to find funds to pay for the surgery in Germany.
She successfully raised £25,000 ($32,000) through online crowdfunding and underwent a four-and-a-half-hour operation in December.
She spent three weeks in Germany, and upon her return, the anti-FGM activist and teaching assistant was unable to leave her home for months while she recovered.
As well as the cost of the operation, childcare and other expenses meant she was still in debt – owing the hospital around £3,000.
“It’s really unfair to pay for damage that you had no choice about or that you didn’t cause,” she said.
There are four different types of FGM, ranging in severity:
- Clitoridectomy: Partial or complete removal of the sensitive clitoris
- resection: Partial or complete removal of the clitoris and the folds of vaginal lining (labia minora)
- Infibulation: Cutting and repositioning the folds of skin around the vagina (labia minora and labia majora). Usually includes suturing to leave only a small gap
- All other harmful procedures such as pricking, piercing, cutting, scraping and burning of the clitoris or genital area are covered.
Over the past few decades, various medical techniques have been developed to try to repair this damage – pioneered in 2004 by French surgeon Pierre Foldès.
Public health insurance in Belgium, Finland, France, Germany, Sweden and Switzerland covers clitoral reconstruction surgery.
However, in Africa – where most girls and women who have undergone FGM live – the procedure is only available in Kenya, where patients must pay around £1,000, and Egypt, where NGOs cover the cost of the procedure.
“Not every surgeon can do this operation. It’s complicated and every patient’s situation is different,” said Dr. Adan Abdullahi, a Kenyan specialist.
But he said women who had undergone any type of FGM could benefit: “It has a positive effect on childbirth, especially for the ‘third type’ because it is associated with narrowing of the vagina.”
Other problems, such as painful intercourse, can be significantly improved or cured, he said, adding that his patients often experience improved self-esteem and a “sense of wholeness.”
Ms. Birkisu said she did feel more whole since she had the surgery, which was covered by the German health system: “Having the surgery was really a powerful move, a way to fight back.”
But the 30-year-old recruitment agent encourages others to do thorough research before deciding: “Reconstruction is more than just rebuilding the clitoris.
“A lot of women get really thick scar tissue after cutting. You have to discuss this with your doctor. Is there anything you can do to make your vulva more resilient?”
Determined to one day have “normal sexual experiences” and control over her own body, Ms Birkisu has undergone three surgeries in the past three years, each lasting about six hours.
“It’s so hard on your body. You’re under anesthesia. You have to take medication afterward. I couldn’t walk for three weeks,” she said.
Because of the toll such surgeries take on the body, some doctors, such as Dr. Reham Awwad in Egypt, are keen to promote non-surgical treatments.
The co-founder of the Restore clinic said that while reconstructive surgery can bring relief, the cuts are sometimes so severe that even the most advanced surgical techniques cannot restore sexual function.
“I definitely don’t think surgery is a panacea for everybody,” she told the BBC.
Her clinic, which opened in 2020, currently treats about half of its cases with nonsurgical methods, such as injections of platelet-rich plasma, which promotes tissue regeneration.
“Plasma can promote regeneration, stimulate increased blood flow, and reduce inflammation at the injection site,” she said.
But she warned that high costs meant the treatment was out of reach for many people.
Her clinic also offers psychotherapy to help women overcome trauma when they are old enough to recall the experience.
For those who choose to undergo plastic surgery, the results can be emotionally draining.
“When I actually saw my clitoris for the first time, I was shocked because to me it didn’t seem to belong to me,” said Ms. Birkisu, who underwent “category two” FGM when she was eight.
Ms Sharawe agreed that it took some getting used to, as well as learning how to deal with issues such as normal menstrual bleeding.
It will take her another six months to fully recover, and she is worried because she doesn’t have the money to go back to Germany for a checkup.
“But now I know what it’s like to be a complete woman… I’m a very happy woman,” she said.
“I can wear underwear without discomfort or pain. I can wear pants. I feel normal.”
Although she faced strong backlash from some Somalis on social media, she was surprised by the support from some family members.
One of her uncles even wondered if the procedure could be performed on his wife in the UK.
“He didn’t want to know that his wife’s FGM was still affecting her even after more than 50 years. He wanted to improve her quality of life… because we (all) deserve a good quality of life.”
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