Meetings with the Belgium CeMAViE team  21/02/25

We had a fantastic meeting with the Belgium clinic psychosexual therapist, Cendrine Vanderhoeven. The meeting was attended by Natasha Anderson-Foster (psychosexual therapist, Birmingham), Njomeza Kartollozi (trauma psychotherapist, Manor Gardens, Dahlia Centre, London) , Lizana Latif (trauma and psychosexual therapist, Croydon FGM clinic), Christie Coho (trauma psychotherapist, formerly at Croydon clinic, London) and Alex Rogers (trauma psychotherapist, Sunflower Clinic, London).

Cendrine talked about how they run their service, in particular looking at psychosexual and trauma therapy. The woman have a joint first appointment with the trauma therapist and psychosexual therapist that lasts about an hour and a half. This is particularly so that the woman doesn’t have to keep repeating her story. Obviously, it’s really important that the psychosexual therapist knows the woman’s trauma and likewise, the trauma therapist knows about the underlying psychosexual issues. She highlighted how attuned she was to her client group. It’s not simply cultural competence, its the level of respect and warmth that she has for the ladies that she works with. It was wonderful. It was really insightful. The team strives to making sure that each woman’s experience is holistic and empowering. It was really wonderful to hear. She was amazing very professional, knowledgeable and humane.

Cendrine shared that the women often say they don’t feel complete. Or they don’t feel ‘normal’. They take care of the whole person, the whole woman. So they don’t reduce her just down to her excision. They stand in a circle when they have their discussion with the woman. So the trauma therapist and the psychosexual therapist and the woman stand in in a circle and talk about her, her past life and her present life. They provide social support as well because – if the woman has housing concerns or financial concerns or relationships difficulties, then how can she really, positively engage in in the therapy?

She talked about the women’s resilience, understanding their social circumstances, their capacity and empowering them. They find that a lot of their women have suffered other forms of violence. This is similar to UK FGM survivors. In the Belgium clinic the psychosexual therapy focuses upon the re-appropriation of the woman’s body and the impact of the culture and their community. So it’s not just reducing the woman down to the genital parts, but it’s their whole body. And also involving the partner or partners. She spoke about a general lack of knowledge about the female sexual response. They do sensitisation exercises. Mindfulness. Partner work. They talk about false beliefs, particularly about Western women’s sexuality. This idea that Western women orgasm all the time and have fantastic sex lives, which obviously we all know isn’t true.

She said they sometimes have a physiotherapist and a perineal specialist as well.
She kindly shared with us the female sexual function index tool that they use – because we need outcome measures for our project.  She talked about the fact that sometimes there’s evidence that women have surgery and the external glans is restored but then the women still aren’t happy.

Some women say they don’t want trauma therapy.  Each woman has between 4 and 6 psychosexual sessions. That’s usually enough.

At the first appointment, the midwife diagnoses the FGM type and discusses whether the clitoral glans is intact or not and gives the woman a lot of information. Actually it’soften  too much information for the women to take in, and sometimes they get very stressed. So they usually have a second appointment so that they can give them information at the first and then have a 2nd meeting when they reinforce what was said previously and the woman can ask any questions.

They do an anatomy drawing for the woman and the woman draws what she thinks she has as well. It’s a lot about providing real emotional support for the women. Cendrine and the trauma therapist Francois, reflect together on their own without the woman and they also do a reflection with the woman to try and decide on the best pathway for her. So, it’s very, very collaborative. It’s very transparent and the woman obviously makes the final decision herself. They ask the woman at the beginning – Is it OK if, as therapists, we share information between us along the course, along the pathway of care?.

They talk a lot about intimacy and hygiene with the women. They have a team meeting every month to discuss individual cases.