Before commencing treatment around three years ago, female genital mutilation (FGM) survivor Zara* could barely sit down.
The pain from a repeated urinary tract infection was unbearable, and antibiotics were not helping.
"We used to have just a tablet, and it didn't help much," Zara said.
"It keeps coming back [and] I wasn't able to sit properly."
'Female genital mutilation' refers to the partial or full removal of the external female genitalia, or other injuries to female genital organs for non-medical reasons.
The World Health Organisation (WHO) estimates more than 200 million women and girls across the world have experienced FGM — which varies depending on cultural groups.
It is mostly carried out on young girls between birth and 15 years of age.
Zara was offered free treatment at a charity clinic in Ashford in Adelaide's inner south-west.
She was treated with multiple rounds of platelet-rich plasma injections, using plasma from her own blood to soften scar tissue and said she has not experienced any pain since.
"With this treatment, it was really, really great," she said.
"We appreciate as women if we have another centre, or even more clinics they [could] have this.
"I was very lucky. Other friends or other sisters — they didn't know about this treatment or about this centre."
'Sitting on a chair would be painful'
The clinic was co-founded by Iranian-Australian gynaecologist Dr Fariba Behnia-Willison and provides minimally invasive, holistic treatment.
It offers services for marginalised women, with a specific focus in treating FGM-related health issues.
Dr Behnia-Willison said women and girls who have experienced female genital mutilation often experience painful health complications, which can be exacerbated by childbirth and menopause.
"Urinary tract infection is very common, or painful intercourse can be common, as well as period issues and pain," Dr Behnia-Willison said.
"Sometimes just sitting on a chair would be painful because the nerves that have been affected in that area have never recovered."
According to the WHO, the practice of FGM has been documented in 30 countries in Africa, as well as the Middle East and Asia.
Although the practice is banned in Australia, Dr Behnia-Willison said there were at least 53,000 recorded cases of women who have experienced FGM in the country and it was possible there were up to 200,000 survivors living here.
"We don't have a 100 per cent registration of FGM — we often see women in the labour ward, when they give birth," she said.
Women's health issues need more attention, doctor says
A federal government paper released last month said there was growing evidence that women suffered poorer health outcomes due to "systemic issues in healthcare delivery and medical research".
The discussion paper, published as part of the National Strategy to Achieve Gender Equality, also found that women from marginalised and socio-economically disadvantaged groups were even more at risk.
Late last year, the federal government set up the National Women's Health Advisory Council to improve health outcomes for women, and to focus on key areas of concern including pelvic pain.
It also delivers advice on implementing the National Women's Health Strategy, which was set in motion by the former federal government in 2020.
Dr Behnia-Willison said a far more common women's health issue that also required more attention was prolapse — a displacement of one or more pelvic organs, usually occurring after childbirth.
Dr Behnia-Willison, whose mother experienced prolapse-related health complications, is also working on a device which she said could revolutionise treatment options for women experiencing issues due to prolapse.
"We reverted back to doing the conventional surgery which has a failure rate of 30 to 50 per cent depending on who does them — that is not acceptable," she said.
At least 50 per cent of women experience prolapse, which can affect bladder and bowel function, ease of activities, and intimacy.
Dr Behnia-Willison has called for more training for doctors in treating women's health issues – especially those faced by marginalised groups — and for more funding for these services more broadly.
"Women have a lot of value in their reproductive age, but nobody asks what happens to that woman after she carries those babies," she said.
"You don't want to treat any woman as a condition — a woman who sits in front of you is a person.
"Some of the pain could be because of social circumstances that they go through, could be some emotional problems, it could be psychological."
Dr Behnia-Willison's clinic also offers services for women in South Australia's transgender community.
Michaela Andrea Tippins described the clinic as a "godsend" and is calling for more funding to make healthcare more inclusive.
"Some funding across the board for GPs so that we don't have to teach them about our needs — or even just places where GPs can go to ask questions," Ms Tippins said.
"It's reasonable for me to go the doctor and expect them to know what the deal is."
For Zara, the impact has been so positive that she has since referred her friends to the service.
"It did help them as well," she said.
"The change is always there, if we know how to use it."
*Name changed to protect identity.
