IPPS 2019: Sexual Health and Sexual Pain Across Cultures

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By: Nina Chou

This year’s IPPS meeting was held in Toronto, Canada, which is one of the most diverse cities in North America. In fact, the official motto of the city is “Diversity is our Strength.” Today, I want to recap a lecture on the impact of culture on sexuality by Beatrice “Bean” Robinson, PhD. Dr. Robinson is a licensed Psychologist, a licensed Marriage and Family Therapist, professor, and researcher at the University of Minnesota Medical School’s Program in Human Sexuality. In her lecture, she discusses her research methods and findings from two studies: the Somali Women’s Initiative for Sexual Health (SWISH) and the ongoing Our body, Our health NIH study. 

Due to the ongoing civil war, families have been fleeing Somalia since the 1990’s, with the majority settling in Kenya, Ethiopia, and Yemen. In the United States, the largest number of Somali refugees can be found in Minnesota. Dr. Robinson reports that 98% of Somali women undergo some form of female genital cutting, otherwise known as female genital mutilation or female circumcision. This practice is defined by the World Health Organization as “procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.” There are 4 types of female genital cutting, and type 3 appears to be most common among Somali refugees.

  • Type 1: Partial or total removal of the clitoris, prepuce, or both
  • Type 2: Partial or total removal of the clitoris and the labia minora with or without excision of the labia majora
  • Type 3: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora or labia majora, or both, with or without excision of the clitoris (infibulation)
  • Type 4: No removal of genital structures; all other procedures to female genitalia for non-medical purposes; e.g. pricking, piercing, tattooing, scraping, and burning. 

In order to better understand how this cultural practice affects female sexuality, Dr. Robinson asked Somali-American women in Minnesota about their thoughts and experiences surrounding circumcision, sexual relationships, orgasms, and deinfibulation, or the re-opening of Type 3.

Some findings from her studies did not surprise me. For example, almost all Somalis are Muslim and have sexually conservative beliefs. They do not discuss sex with friends or professionals, and reported many prohibitions surrounding sex (no oral or anal intercourse, no premarital sex, no sex during menses, etc). The researchers also found that those with a more severe form of female genital cutting were more likely to report pain with intercourse. As a pelvic floor physical therapist, I can imagine how this pain could be related to scar tissue, muscle guarding, and other pelvic floor dysfunction due to the physical and psychological trauma surrounding the circumcision.

However, there were also a lot of findings from her studies that I did not expect. I have always associated this practice with the term “female genital mutilation (FGM).” However, many of the women in this study considered FGM to be an offensive term to describe their cultural practice, and preferred to use “female genital cutting.” Many thought of their cutting as a rite of passage and actually preferred the aesthetics of genitals that looked like theirs. Many of the women also expressed having sexual desires and stated that the Qur’an actually encourages husbands to sexually pleasure their wives and provide sexual satisfaction. Additionally, almost all the women reported that they had the right to tell their partner if they did not want sexual activity. In the preliminary data from the “Our body, Our health” study, Dr. Robinson reported that the overall attitude towards de-infibulation was actually positive and women wanted their doctors to bring this option up to them. Finally, information regarding orgasms was difficult to gather, but only because researchers had a difficult time describing an orgasm in words and translating it into Somali. 

This lecture highlights the importance of understanding how someone’s religion, culture, and personal beliefs may impact their healthcare. Thank you to Dr. Robinson for sharing her research with us!

I would also love to hear your thoughts about this lecture and female genital cutting. Did anything surprise you? How would you describe an orgasm in words? Let me know below!

Additional Reading:

Click here to learn more about how pelvic PT can help with painful sex.

Read about how Martha overcame painful sex here and here





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