The Kindest Cut

One day, when Sila Folow was an 8-year-old girl living in Mali, four elderly women held her down on the dirt floor of an outhouse and, in keeping with local tradition, used a sharp blade to cut out her clitoris and most of her labia. Her grandmother and other villagers held a celebration. Sila, bleeding and in terrible pain, could not walk for weeks. Like millions of other African girls who are forced to undergo female genital mutilation—a ritual many women say is intended to ensure that they grow up to become sexually passive wives who will not stray from their husbands—Sila never recovered. She eventually moved to New York, married, and had two children. But she was reluctant to have sex with her husband. It hurt, and the scarring made it impossible for her to feel pleasure. (Article continued below...)

This May, Sila, now 38 years old, underwent a simple but profound operation to undo the past. She traveled to Trinidad, Colorado, where Dr. Marci Bowers, a gynecological and pelvic surgeon, has recently begun to perform "clitoralplasty" or "female circumcision reversals" on African women. A relatively new procedure, it reshapes the anatomy and, in 80 percent of patients, restores pleasurable sensation. "I want my womanhood back," Sila told Bowers when she first spoke to the surgeon about the operation. "I just want to know it's there. To have the feeling that I can fight against this culture."

As she awaited the anesthesiologist on the morning of the surgery, Sila—attractive, fun-loving, and talkative—was uncharacteristically quiet in her thin blue gown and hospital socks. She took a final phone call from her husband and mother, and set aside the romance novel she had brought to the hospital as a little joke. It was titled Good Girl Gone Bad.

The doctors wheeled her to the operating room, anesthetized her and got to work. Dr. Bowers cut away the thick scar tissue that had formed over Sila's wound and had obscured the remains of her clitoris. She then scraped away layers of a black, sooty material—the decades-old remnants of the ash poultice the local women had used to stop the bleeding. It had caused a low-grade infection that still hadn't healed—one reason Sila was always in pain. "They really got her good," Bowers said, shaking her head behind her surgical mask. Bowers used a cauterizing tool to quickly stop a sudden rush of blood. "That's arterial blood flowing there," she said. "You can see why so many girls have died after circumcisions." The root of the clitoris, which extends several centimeters beneath the surface of a woman's skin,is much larger than most people—and for many years scientists—ever suspected. Bowers exposed the remaining flesh of the organ and drew it out, securing it in place with delicate stitches that eventually dissolve. Finally, Bowers also did some cosmetic work to restore the appearance of Sila's labia.

A little less than an hour after it began, the surgery was complete. Two days after that, Sila was on her way home. In most cases, it takes three to six months to begin to tell if the operation was a success. However, the extent of Sila's injury was so severe—her reconstruction took twice as long as the average 30 minutes due to the level of scarring and the depth of the cut—it may take longer before she knows if the surgery worked. Still, "You should be able to feel something; there was two centimeters of scar tissue over the area," Bowers told Sila right after the operation.

"Just knowing it's out and I'm clean, I feel great," Sila said, still groggy from the anesthesia. She says she looks forward to the day when she can "have a romance with my husband."

Sila's operation was only the fourth time Dr. Bowers had done the procedure, but she has more than twenty years of experience in reconstructive surgery. Bowers learned the procedure in Europe by observing Dr. Pierre Foldes, a French urologist and surgeon who pioneered the technique after years of humanitarian work in Africa. He has received death threats from radical Islamists for his work as a surgeon and for his other efforts to reduce violence against women, he says. But he continues to train doctors and to perform the surgery. Foldes—reached by telephone outside Paris—tells NEWSWEEK that more than 3,000 women have come to him, largely because in France, genital reconstruction surgery is covered by national health insurance. (In the United States insurance companies are still mostly unfamiliar with the surgery—only one of Bowers's patients has so far gotten full medical coverage for the procedure; others are still fighting with their insurance companies or have paid out of their own pockets. Bowers performs the surgery free of charge, and the hospital caps its fees at $1,700. "As Dr. Foldes has said, you cannot charge money to reverse a crime against humanity," she says. "Sexuality is a right."

Bowers speaks from personal experience. She was born male and underwent gender-reassignment surgery to become a woman 11 years ago. She now specializes in sex-change operations; she has performed some 700 of them, and is one of the leading gender-reassignment specialists in the U.S. The small Colorado town where her clinic is located has long been known as the sex-change capital of the world thanks to work of Dr. Stanley Biber, a pioneering surgeon in the 70s whose practice she took over. Asked if she is worried about the death threats that have followed Foldes, Bowers doesn't flinch. "I've jumped through enough fires and over enough barbed-wire fences in my life by now. I do not fear for my safety."