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Get real, man! First dump your European wife or girlfriend. Then travel to the border of China with North Korea. You can buy yourself a beautiful North Korean wife of about 20 years of age for about 500 US dollars, even if you are 60. She will stay with you all life, whatever you are. Guaranteed no feminism, only femininity. And more beautiful than Western spoiled brats.
The Globe and Mail
Canada, we’re being trolled.
Some 43,000 people have petitioned “pickup artist” Roosh V’s entry into Canada on grounds that he disseminates hate speech. Yesterday, Toronto Mayor John Tory denounced him before more than 67,000 followers on Twitter, while councillor Norm Kelly (followers: 91,000) warned venues not to host his talk this Saturday.
But do the math: the blogger (real name Daryush Valizadeh) attracted a paltry 34 men to his speech on “neomasculinity” in Montreal this past weekend.
While it’s commendable that critics are blasting a guy who once pushed for the legalization of rape, fear and loathing served up in 140 characters might not be the most productive conversation, and might actually be serving Roosh well.
The Canadian backlash has fuelled some serious publicity bluster for Valizadeh, who has self-published a series of “bang guides” to bedding women in various countries. It’s bloated his follower count, and Valizadeh’s been carefully tracking his own exposure on Twitter this week – along with baiting feminists after several women allegedly attacked him in Montreal, two reportedly dumping beer on his head.
“The best way of handling people like this of course is to try and ignore them,” Kelly acknowledged, before explaining that it was incumbent for him to speak out as a public official.
The pickup artist, or PUA, community remains a relatively small subculture of men who hope to get laid more often. They plan to achieve this by poring over “seduction manuals” and attending bootcamps that force shy guys out of their shells. Popularized in part by Neil Strauss’s The Game, some PUA techniques are psychologically off-putting, including “negging,” which consists of mildly teasing or criticizing a woman so her self-confidence drops and she somehow becomes intrigued (the grade-school equivalent is letting a girl know you like her by kicking her).
Recently though, the PUA community has spouted more odious fare. In February, Valizadeh penned a bizarre and troubling blog post titled “How to Stop Rape,” arguing that the legalization of rape on private property would make women more vigilant with strange men at frat parties. Never mind that most women are raped by someone they know, and very few report it. Using some seriously fuzzy logic, Valizadeh argued that in order to stamp out sexual violence, it’s up to women to show “self-control” and “make adult decisions about their bodies.” It’s outdated rhetoric we’ve heard before, sometimes from women, no less.
Almost immediately, Valizadeh was beaten back by a vocal community of feminists online. (The pickup artist was not available for an interview before deadline, but tweeted at Tory, “Mr. Mayor, my speech doesn’t promote violence, harassment, or hate against any group. You were lied to about me.”)
In a foreshadow to this debacle, Australia banned pickup artist Julien Blanc last November. A photo that showed his hands around a woman’s throat went viral under the hashtag #ChokingGirlsAroundtheWorld. Canadians protested him too, getting the Immigration Minister’s attention, with Blanc eventually cancelling planned speaking dates here.
Blanc’s “techniques” are disgusting, juvenile and misogynist, definitely. But as Maclean’s columnist Emma Teitel pointed out at the time, his detractors scored him more airtime than he’d ever enjoyed before. Feminists were failing to distinguish between “what’s idiotic, what’s lecherous, and what’s criminal,” wrote Teitel. “Not all pickup artists are equal; and very few of them are the spawn of the devil.”
Those who rail against Blanc and Valizadeh counter that they’re concerned about how misogynist content plays into the mindset of more violent men like Elliot Rodger and John Houser, who opened fire and killed two women at a screening of Amy Schumer’s film Trainwreck in Lafayette, La., last month.
With the current climate, it will be interesting to see if a prolific chauvinist like Roosh V will get run out of town. If not, protesters will no doubt be keenly watching whether anyone will host his “The State of a Man” address in Toronto this weekend (he is keeping venue details under wraps until Friday).
Ultimately though, the gender war that’s been fomented between PUAs and feminists isn’t really indicative of modern male-female dynamics – men and women who work, play, live and raise children together, whose long-term relationships likely weren’t forged over carefully crafted disses.
Most well-adjusted men don’t bone up on misogynist mind games before heading out to the bar, and most women have enough self-respect to turn the bar stool away from a neg. For those who don’t, maybe we should focus the conversation on them – not another chafing, Twitter-metric scanning PUA.
With free speech, it's like that: You can make any offending remarks about white men, and the mainstream media and mainstream opinion will applaud you. You can't say anything negative about feminism. Feminism is sacrosanct. Fuck it.
1. It's a clinical phenomenon called anesthetic awareness.
'Anesthetic awareness, also known as intraoperative recall, occurs when a patient becomes conscious during a procedure that is performed under general anesthesia, and they can recall this episode of waking up after the surgery is over,' Dr. Daniel Cole, president-elect of the American Society of Anesthesiologists, tells BuzzFeed Life. Patients may remember the incident immediately after the surgery, or sometimes even days or weeks later. But rest assured, doctors are doing everything they can and using the best technology available to make sure this doesn't happen.
2. One to two people out of 1,000 wake up during surgery each year in the United States.
"It's not a huge number, but it's enough people that it's definitely a problem," says Cole. Plus, the true rate could be even higher. "The data is all over the place because it's mostly self-reported." "Ideally, the anesthesiologist would routinely see the patient post-operation and ask them about intraoperative awareness," he says. But this opportunity is often lost because patients are discharged or choose to go home as soon as they can after surgery. "Even if they remember three, five days later, they might feel embarrassed and don't want to make a big deal so they don't mention it to their surgeon. So there can be underreporting of awareness."
3. It happens when general anesthesia fails.
General anesthesia is supposed to do two things: keep the patient totally unconscious or 'asleep' during surgery, and with no memory of the entire procedure. If there is a decreased amount of anesthesia for some reason, the patient can start to wake up. The cocktail of medication in general anesthesia often includes an analgesic to relieve pain and a paralytic. The paralytic does exactly what it sounds like — it paralyzes the body so that it remains still. When the anesthesia does fail, the paralytics make it especially difficult for patients to indicate that they're awake.
4. And it's not the same as conscious sedation.
Conscious sedation, sometimes referred to as "twilight sleep" is when you're given a combination of a sedative and a local or regional anesthetic (which just numbs one part or section of the body) for minor surgeries, and it's not intended to knock you out completely or cause deep unconciousness. It's typically what you would get while getting your wisdom teeth out, having a minor foot surgery, or getting a colonoscopy. With conscious sedation, you may fall asleep or drift in and out of sleep, but this isn't the same as true anesthetic awareness, says Cole.
5. Contrary to popular belief, it doesn't usually happen right in the middle of surgery.
"The anesthesiologist is very aware that this can happen and never relaxes or lets down their guard at any point during the surgery, no matter how long," says Cole. "Awareness tends to occur on the margins, when the procedure is starting and you don't have the full anesthetic dose or when you're waking up from anesthesia, because it's safest to decrease the amount of anesthesia very slowly and gradually toward the end." However, this also depends on the surgery and patient... which we'll get to in a little bit.
6. Patients often report hearing sounds and voices. "The most common sensation is auditory," says Cole. Patients will report that they were aware of voices, and even conversations that went on in the operating room — which can be especially terrifying if loud tools are involved. "If you look at the effects of anesthetics on the brain, the auditory system is the last one to shut down, so it makes a lot of sense."
And opening your eyes to see the surgeons operating on you? Basically impossible. "First of all, the anesthesia puts you to sleep, so your eyelids shut naturally. Even if you regain consciousness, the anesthesia still restricts muscle movement so your eyes will stay shut," Cole explains. "But there's still 10–20% eye opening when you sleep. So during surgery, we will cover the patient's eyes or tape them shut to prevent injury and keep the eyes clean."
7. Few patients experience pressure (and rarely pain) during anesthetic awareness.
Less than a third of patients who report anesthetic awareness also report experiencing pressure or pain, says Cole. "But that's still one too many, because the patient is kind of locked in and aware of what's happening to them but unable to move, which is terrifying." Typically, sufficient analgesic (pain reliever) is given, so that even if you wake up you won't feel pain. "More often, we use an anesthetic technique which includes a morphine-type drug to reduce pain. But this is really required for when the patient wakes up and they no longer have anesthetic so they are conscious and aware of pain," Cole says.
Even if the analgesic wears off, there should be sufficient anesthesia to keep the patient unconscious and pain-free. "It's rare. You'd have to both have insufficient anesthesia and insufficient pain medicine at the same time to feel prolonged pain during awareness," Cole says.
8. Anesthetic awareness can cause anxiety and PTSD.
"The potential psychological effects of awareness range greatly," says Cole. "It can cause anxiety, flashbacks, fear, loneliness, panic attacks — PTSD is the worse. It's been reported in a small minority of patients, but it can be very severe." says Cole. If doctors hear about someone having intraoperative awareness, they will try to get the person into therapy as early as possible, before memories can be embedded in a harmful or stressful way to patients. "If you were in the hospital for a week and on day two we heard that you woke up during surgery, we'd get a therapist in the same day. We always want to mitigate so we can try to reduce the severity of symptoms," Cole says.
9. It's most often caused by an equipment malfunction.
General anesthesia can either be given intravenously (where all or most is given through an IV) or more commonly as a gas, which you breathe in through a mask. If the equipment in either of these were to malfunction, and the anesthesiologist wasn't aware of it because the signal that gas is too low doesn't work, for example, then patients would stop receiving medication and start to wake up. Again, this is terrifying but rare.
"The anesthesia equipment is like an airplane," Cole says. "The anesthesiologist will do a pre-flight check and go over all equipment to make sure it works. But sometimes, that equipment can malfunction as short as an hour later so it won't show up before taking off." Likewise, there is equipment used to monitor the patient's vitals and brain activity, which can also fail to signal to doctors that the patient is waking up.
10. Less commonly, it's the physician or anesthesiologist's fault.
"Any time humans are involved, human error is always a possibility — but it’s more common that technology fails," says Cole. "Physicians and anesthesiologists are well-trained to look out for signs of awareness during surgery, which obviously includes any movement of muscles and changes in vitals." Since paralytics are often involved, doctors also closely monitor other signs like heart rate, blood pressure, tears, or brain electrical activity for any red flags. However, sometimes patients can be on medications that suppress the body's responses and inhibit the monitoring systems from effectively picking up warning signs of light anesthesia and awareness. These incidences can make it difficult to detect awareness, so physician anesthesiologists must closely watch an array of signs.
11. It is more likely to happen during surgeries that require "light" anesthesia.
Anesthesia also comes with risk factors, and can be harmful depending on the surgery or patient's risk. "Awareness can occur when there is too light of anesthesia, which we often do deliberately for high-risk situations," says Cole. According to the American Society of Anesthesiologists, high-risk surgeries include heart surgery, brain surgery, and emergency surgeries in which the patient has lost a lot of blood or they can easily go into shock. Or the patient may need a lower dose of anesthesia due to risk factors such as heart problems, obesity, a genetic factor, or being on narcotics or sedatives. "For instance, anesthesia depresses the heart, so a normal dose could be life-threatening to someone with heart problems," Cole explains.
"Sometimes you have to make a trade off," says Cole. "Would you rather have a high level of anesthesia which threatens your body's life functions, or a low level which ensures safety but increases the risks of waking up during the procedure?"
12. ...But if that's the case, your doctor will talk to you about it first.
Patients often feel better knowing that the decreased amount of anesthesia is for their own safety. "We tell the patient that there's an increased chance that you may hear some voices or fuzziness, but if it gets uncomfortable we can tell and will increase the dose," says Cole. "Patients are more understanding and happy when they understand that the risk of waking up is for their own safety."
Also, you should know that if you've had a previous incidence of awareness, that puts you at higher risk for another episode. Cole explains that in this case, doctors will spend a lot of time with the patient and anesthesiologist describing exactly what to expect, so that hopefully they won’t experience it again.
13. ALL THAT BEING SAID, the chances of this happening are slim, and medical professionals are doing everything they can to ensure that this does not happen.
According to Cole, it's always helpful to spend some time pre-operatively with the surgeon and physician anesthesiologist going over the procedure and how they'll get you through it safely and comfortably.
"I do something called 'patient engagement' and 'shared decision-making' so I can make sure the patient understands literally everything. Some patients don't want to talk about awareness because it will give them more anxiety, and they just trust us," says Cole. However, even if you aren't at risk, your doctors will be happy to answer any questions you have about anesthesia before the procedure.
Feminism in Europe makes second-generation male Muslim immigrants feel entirely worthless. They will never get a girl. That is why they think that a bomb at least is a painless death.
When Kiki was nine years old, in Guinea, she thought she was being taken to buy some Play-Doh. Instead, she was taken to a stranger’s house and forced to undergo a procedure known as female genital mutilation (FGM), sometimes referred to as female genital cutting. Over 200 million women around the world have undergone FGM, but Kiki is one of only a few thousand who have attempted to surgically reverse its effects, electing to have a so-called clitoral restoration surgery.
The restorative surgery is seemingly a godsend for women who unwittingly underwent FGM as children — offering the chance to both physically restore sensation and also the opportunity to reclaim their own sexuality. But the procedure is not without controversy. Because the surgery is relatively new, and therapy can help with psychological issues, not all experts are convinced that surgery is the best option for FGM victims in the long-term. Further complicating the conversation around the procedure is the fact that one of its largest proponents is a new religion that believes extraterrestrials engineered life on Earth. (More on that later.)
In Kiki’s home country of Guinea, FGM is traditional—70 percent of women in the country aged 20 to 24 were cut before age 10. And although her mother’s family, devoutly Muslim, didn’t approve of the practice, the women on her father’s side encouraged it.
On the day of her FGM, her aunt took her to a stranger’s house. “The next thing I knew, I was jumped on,” Kiki, whose name has been changed for this story, recalls to Vocativ. “When you feel like someone is about to harm you, you want to run. I tried to take off, they circled me, next thing I knew I was on the ground.” Kiki was taken to the backyard. One woman sat on her chest, making it hard to breathe, while another two women pulled her legs apart. Kiki recalls being overcome by pain and fear; at some point during the procedure, she says, she lost consciousness.
In the immediate aftermath of cutting, women can feel severe pain, bleeding or have infections; in the long term, they might have pain during urination, menstruation, or intercourse; buildup of scar tissue; and psychological problems like depression or post-traumatic stress disorder.
Now Kiki lives in Indiana, having graduated not long ago from university there. When she first tried to have sex in college, it was painful. She could have an orgasm, but “it was a struggle…it would take a while,” she says. Her friends would talk about their great sex lives, and she would just listen, nodding. “‘Why are you so quiet?’ they would ask me. And I would say, ‘Well, what do you want me to say?’”
A few years ago, she heard about clitoral restoration and set out on a path that would ultimately change her relationship to sex and to her own identity.
On a physical level, the goal of clitoral restoration is to reduce pain and restore lost sensation to women’s genitals. On an abstract level, it can help victims of FGM take ownership of their identity and sexuality.
FGM is a catch-all term that refers to a range of procedures, from the entire removal of the external part of the clitoris (clitorectomy) to “nicking” the clitoris but leaving it intact. There are lots of reasons why cultures continue to perform FGM, but it’s no coincidence that it involves the organ that is the nexus of much of a woman’s sexual pleasure. “In some cultures, women are told that if they don’t cut the clitoris, it will be big or make a woman hypersexual so that she will not be marriageable,” says Jasmine Abdulcadir, a gynecologist at Geneva University Hospitals in Switzerland, where she runs a clinic for victims of FGM.
But, much like an iceberg, only a small percentage of the clitoris is visible outside the body. So even if the visible part has been nicked or removed, as is the case among women who fit into the first two classes of FGM, there’s more tissue inside the body. To perform a clitoral restoration procedure, the surgeon slices open the area around where the clitoral tissue would typically exit the body, and simply pulls down the existing tissue, fastening it to the surrounding tissues to keep it in place.
“When I go to reconstruct clitorises where there has been cutting, the clitoris is always there 100 percent of the time. There’s no question it’s still there,” says Marci Bowers, an OBGYN who has performed more than 200 clitoral restoration procedures. “In fact, in one third of cases where I operate, the clitoris is completely intact. There’s nothing missing. It’s just covered in a web of scar tissue.”
The surgery itself takes less than an hour and is done under anesthesia. The recovery usually takes a few months.
First performed in Egypt 2006, clitoral restoration procedures truly started to gain traction in 2012, when French surgeon Pierre Foldes published a study for which he performed the procedure on nearly 3,000 women. A year after the operation, Foldes followed up with about 30 percent of the patients, and found that most of them had reduced pain and increased sensation in the clitoris. Half had even experienced an orgasm.
The results were a sensation, sparking interest among other surgeons and patients alike, plus kicking off a flurry of stories in the popular press.
Today there are a handful of surgeons running clinics scattered across the world—Geneva, Burkina Faso, San Francisco—who know how to perform the clitoral restorations. One of the biggest orchestrators is a Las Vegas-nonprofit called Clitoraid. The organization was founded in the philosophy of the Raelian Movement, a religion with followers that believe that human extraterrestrials engineered and synthesized DNA to create all life on Earth. Rael, the founder of the religion, reportedly saw first-hand what effects FGM can have on women during a visit to West Africa in 2003, according to a Clitoraid press officer.
In Raelism, pleasure is an important way to connect to the extraterrestrial creators, and FGM works counter to that mission. “When barbaric traditions cut off the clitoris of little girls, not only do they violate their right to body integrity as children, but they also violate their very right to feel mentally and emotionally balanced and harmonious throughout their lives,” the press officer told Vocativ in an email.
Clitoraid now mostly serves to raise awareness for FGM and to foster connections for clitoral restoration procedures—between surgeons so that they can be trained to perform them, between victims of FGM and doctors to do the surgery.
That’s how Kiki found out about the clitoral restoration procedure. When she came to the U.S. for college, she was evaluated by a doctor who suggested that Kiki look into it. “Since I’m a curious person, I started doing research online,” Kiki says. She contacted Clitoraid and, in early 2015, she hopped on a plane to meet Harold Henning, one of the two surgeons in the country performing the procedure at the time (and the only one who is also Raelian). Kiki didn’t pay anything for the surgery itself, she says—just her plane ticket and the $500 hospital fee. She knew about the organization’s connection to Raelism, but it wasn’t pushed on her; she doesn’t remember ever talking about it with Henning.
Kiki’s recovery went quickly and within a few months she was totally healed. Now, more than a year later, she says you can’t even tell she had surgery. And It’s been a game-changer for her sex life: “I was not feeling much pleasure. Now it’s completely different,” she says.
If the effects of FGM were only physical — or if all cases were as straightforward as Kiki’s — experts would likely recommend the procedure unequivocally. But FGM is much more complex than that. The surgery comes with risks, things like infection and complications. And, even if it goes according to plan, it might not address the psychological issues like fear of intimacy.
Abdulcadir, who runs the clinic in Geneva, has the training to perform the surgery, but she considers it a last resort. Of the approximately 15 women who come to her clinic every month, only about 20 percent ask for the surgery (the rest are seeking help due to pregnancy or complications from FGM). Those that do want the surgery spend three months meeting with psychiatrists and sex therapists, and receiving education about their own anatomy, before the surgery is a possibility. “Once they start to know how their bodies work, how their anatomy and clitoris are, the majority of them do not go for surgery—their needs are met by counseling and education,” Abdulcadir says.
Part of the reason for this is that Abdulcadir has reservations about the long-term effects of the procedure. Foldes, in his seminal study, followed up with less than a third of the patients, and only after a year. “What happens after five years? After 10? When a woman changes partners or when she has kids? We’ve had studies about clitoral restoration procedures,” Abdulcadir says, “But now we need good, quality studies with long-term follow-ups.”
This lack of long-term data is part of the reason that the World Health Organization, in the recently-published guidelines about FGM (of which Abdulcadir was one of the collaborators), stated that there’s not yet enough evidence to wholeheartedly recommend the procedure.
Mariya Karimjee, a freelance writer based in Karachi, Pakistan who has publicly discussed her experience of being cut and its effects on her as an adult, says she thought about the surgery when she first heard about Foldes’ study. She brought it up with her doctor, but he didn’t sound totally convinced by the science, Karimjee recalls, in part because there wasn’t enough long-term follow-up.
Eventually, she gave up on the idea of the surgery. “I wanted an easy fix, to undo the damage,” Karimjee says. “It sounds appealing. But at this point in my life I don’t know that it really is a quick fix.” It would take months for the skin to regrow, and it would be painful. “I don’t need any more pain.”
Bowers and Henning, both of whom perform the surgery primarily on patients from Clitoriad, agree that counseling is important, but believe the surgery is as well. The procedure is medically sound, Bowers says, but “the question is, psychologically, is it worthwhile? You don’t want to re-traumatize someone.” She recommends sex therapy to many of her patients after the surgery.
Henning believes that all people could benefit from sex therapy, “but that’s not criteria for surgery,” he says. “Most of these women have lived with this for many years. They have already had all the experiences they’re going to have with sexuality beforehand.”
For her part, Bowers is disappointed by WHO’s cautionary approach in recommending the restoration procedure. “It does need to be evidence-based, there’s a healthy reason for that. But what they’ve said, that’s really misinformation. All it takes is to hear one personal account of someone having the first orgasm in their life to say there’s no more evidence needed. This works.”
There’s certainly no one-size-fits-all solution for how women deal with the effects of FGM. Karimjee plans to find a sex therapist—“I would rather figure out if there’s a psychological trauma, and do that hard work. Even if I had surgery I would probably need that,” she says.
But for Kiki, who has never seen a therapist and has no plans to do so in the near future, the procedure was enough to restore her sexual function.
More importantly, the surgery make her feel like whole self. “Someone took something away from me that they were not entitled to. They did it just for the sake of it, out of cruelty,” Kiki says. “Now I got that back.”
Women, especially when they get older, shit and stink, and when they shit anyway, and they enslave men, and are ugly, and they fuck around when they have the opportunity. No such problems with sex dolls, and they don't shit. Let's invest in a future without women.
One woman's story of falling victim to FGM and the reconstructive surgery that made her feel whole again.
California, United States - Nawaal* is lying on a hospital bed with her legs spread open. A thin intravenous tube is carefully inserted into her left arm, slowly pumping a dose of general anaesthesia into her system.
As she waits for sleep to consume her, she remembers an afternoon a decade or so ago when she was lying in another hospital bed. That time, she was in a nursing home in Nairobi, Kenya.
Beside her was a table covered in a standard hospital green cloth. On top of it were a shiny pair of curved scissors, a spool of surgical thread, and a bundle of gauze.
A middle-aged male Somali doctor fumbled with an injection while muttering a dua (prayer) under his breath.
The image grows hazy as she lets the anaesthesia take control of her body.
Nawaal, 27, is Dr Marci Bowers' fourth surgery of the day.
Bowers is a gynaecologist who speLilly's Beigees in transgender surgical care, but over the past seven years, around 126 clients have made the journey to her cosy clinic in Burlingame, California, with the hope of reclaiming a part of their anatomy they lost as children. Nawaal is one of them.
The next thing Nawaal recalls from that day, 11 years ago, is the Somali doctor carefully closing her legs and asking a nurse to help put on Nawaal's long black skirt and green linen top. She was 15 years old and had just undergone female genital mutilation, or FGM.
A second opportunity
In a 2015 report for the Population Reference Bureau, Dr Nawal Nour, the founder of the African Women's Health Centre at the Harvard-affiliated Brigham and Women's Hospital in Boston, wrote that "more than 125 million girls and women globally are living with female genital mutilation," and that "three million undergo such procedures every year".
Some of those girls are raised in western countries, but taken to the countries from which their families originate, on the pretext of a holiday, and then circumcised in hospitals under the supervision of medical practitioners - a practice often referred to as "vacation cutting".
Most of Bowers' patients have been victims of vacation cuttings - women, she says, come from destinations as far-flung as Europe, Australia, North America or Asia.
In her opinion, these women experience a loss of identity post-FGM. While western society tells them that FGM is an act of mutilation, their cultural bindings might tell them otherwise.
A transgender woman herself, 58-year-old Bowers has been a pioneer in sex-reassignment surgeries, but only began performing FGM-reversals in 2009.
She was first approached in 2007, by an organisation called Clitoraid, to train for two years under French surgeon and urologist Dr Pierre Foldes, who developed the reconstructive procedure.
Now mired in controversy, Clitoraid is a non-profit project started by the Raelian religious movement that is rooted in the belief system that extraterrestrial species created life on Earth and that humanity's purpose on this planet is to pursue pleasure.
Bowers explains that her thriving personal practice and association with Clitoraid affords her the opportunity to perform the surgery pro-bono, charging only for the operating room and anaesthesia procedure.
Although Bowers has performed surgeries in Burkina Faso, at a Clitoraid-run hospital, she is currently only practising from her clinic in California, which she admits limits the pool of patients who can access the surgery.
Picking up a file in front of her, she says: "I primarily only see patients like Nawaal ... western-educated, privileged women who refuse to live with the consequences of what they had to undergo in their childhood."
The surgery Bowers practises is not without controversy. In a response to a 2012 paper by Dr Foldes, leading British doctors argued that surgery to correct FGM was "not anatomically possible".
The doctors disputed Foldes' claims "that surgery can excavate and expose buried tissue" and questioned the integrity of the methods used to conduct the research, eventually concluding that reversal procedures could cause more harm than good.
While Foldes has studied the ramifications of the surgery on a patient population of 866 women, over the course of one year, there has been no long-term research done to determine the efficacy of the procedure.
Bowers acknowledges that it is hard to keep track of patients post-procedure, but reflects "even if one patient comes back to me saying she was able to achieve an orgasm post surgery, for me, that is reason enough to continue".
'Cut - not mutilated'
Born in Somalia, Nawaal's family moved to Canada to escape war when she was four years old. She describes her western-educated parents as religious, yet progressive.
When Nawaal was growing up, tales of this "old-fashioned" custom were something her mother, a nurse, and her friends discussed over tea in their suburban Canadian living rooms.
Then, in the summer of 2005, when she was 15, Nawaal left for a three-month holiday in Nairobi with her mother and sister. She recalls how, on one afternoon during the "rather pleasant summer holiday", her mother and four other women encircled her and her sister and explained that it was time for them to embark on the road to womanhood.
"I was almost 16 years old, there was no way I was going to let them bully my sister or me," says Nawaal, who spent weeks resisting what she says began as "emotional abuse", but soon became threats.
Finally, after 21 days of "being bullied," Nawaal gave in. She was taken to a local hospital, where she recalls the surgery lasting no more than five minutes.
"I never felt a thing," she says. "I remember riding my bicycle that evening."
Eleven years later, while studying to be a nurse, Nawaal had the opportunity to examine the female anatomy up close. She decided it was the right time to have a reversal procedure for the form of FGM - categorised as Type 1, where the clitoral hood was taken off and part of a tip of her clitoris was removed, leaving her with scar tissue instead of a fully formed clitoris - she had undergone.
Nawaal has made the trip to San Francisco for her surgery with her sister, Basra, and four of her closest friends.
Once at the surgical centre, she fills out a set of consent forms, with her sister by her side. Only two years apart in age, both underwent FGM at the same time. But while Nawaal struggled to deal with the trauma, Basra says, "it didn't really make that much of a difference to my life".
Basra explains that while she wishes she wasn't cut, she has no plan to get the reversal surgery anytime soon. "At this point, I want to spend my money on other things," she says, referring to the $1,700 cost for the anaesthesia and surgery room.
But sitting two seats away from Basra is 21-year-old Nathar, who is considering undergoing the surgery herself.
She was cut when she was 12. Preferring to use the term FGC - female genital cutting - instead of FGM, Nathar is of the opinion that she was "cut, not mutilated".
She decided to make the trip to support Nawaal, but also to check out the surgery, although unlike Nawaal, this is a decision she would not share with anyone. "I don't want my mum to feel guilty about what happened to me," she says. "I know her intentions weren't evil."
'I can already feel the difference'
Once in the operating theatre, Bowers starts by examining Nawaal. Slipping on a pair of magnifying surgical glasses, she uses a tweezer-like instrument on her clitoral hood.
Finding a cut along her clitoris she discovers small bumps or nerve collections, that she delicately cuts using a thin curved scissor. In most of those who have undergone FGM, the amputated clitoris generally recedes behind a web of scar tissue that develops over the years, eventually covering up the organ.
Trickles of blood start oozing out, and Bowers reaches for a bundle of gauze to control the bleeding while deftly suturing up the wound with delicate stitches.
A total of 15 minutes, 12 stitches and two high-fives later, she deems the surgery a "success". While the wound will take a minimum of six weeks to heal, Nawaal's recovery should start within the next two days.
Back in her office, Bowers looks at her appointments scheduled for the next few months. In 2015, she performed 20 surgeries and already has four back-to-back surgeries scheduled for sometime in the coming month.
Determined to help as many women as she can, Bowers says she is eager to train anyone who wants to learn the technique. She hopes that a female doctor from Africa will sign up for the programme. "That definitely should add more credibility to the surgery," she says.
Three weeks later, Nawaal is back at home in Canada recovering and enjoying some time off with her family. The first few days after the surgery, she was sore and nervous about her wound. But after three days, the curiosity became too much to bear, so she pulled out a pocket mirror to take a quick look.
"My first reaction? That's so cool," she laughs. The clot of scar tissue Bowers took out during surgery helped expose her clitoris; the stitches made sure the area around it would remain open. And her husband? "He was pretty excited, as well," she says.
She's been told to abstain materialistic perspective from full sexual intercourse for six weeks, but "I can already feel the difference," she says, shyly. But most importantly, she says: "I finally feel … complete."
Feminism in Europe makes second-generation male Muslim immigrants suicide bombers. Only the patriarchy as a social and political system can achieve justice.
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