Case Report: Eye Movement Desensitization and Reprocessing   Treatment of Female Genital Mutilation

Introduction

Eye movement desensitization and reprocessing. (EMDR) is a psychological therapy procedure used for post-traumatic stress disorder, similar anxiety or distress disorders, first reported by Shapiro (1989). It can also reduce certain physical symptoms, as described below. The flashback or distress trigger is identified and scored on a zero to ten subjective distress scale (n/10). The patient is then taken through a series of directed eye movements, resulting in distress reduction and image decrease. The canonical account can be found in the third edition of Shapiro’s manual (2018). A review of randomized controlled trials of EMDR can be found in de Jongh et al. (2019).

Female genital mutilation is the removal or partial removal of external fe+male genitalia, or other injury, for non-medical reasons, in girls and women. It is sometimes referred to as female genital cutting or female circumcision. We use the acronym “FGM” here. It is usually a non-medical procedure by traditional practitioners. In some places it can be a medical procedure. The World Health Organisation estimates that 230 million girls and women have been subjected to FGM (WHO 2025).

FGM affects women’s sexual health and functioning. A meta-analysis found 5 reports which used comparable methods of assessing female sexual function (Nzing, AM et al. 2021). There are issues with assessing female sexual function in different cultures and languages. Sexual function was impaired in FGM women. This included more pain on intercourse.

FMG is associated with increased post traumatic stress disorder and other psychosocial disorders (Keles et al. 2025). We cannot find any previous case reports or trials of EMDR for FGM. There is a report of EMDR in the context of clinic care for FGM, but no details are given (Caillet, et al. 2018).

Procedure

The EMDR treatment is summarized from the treatment notes, as follows.

Discussion

It is not known how EMDR works. The speed of the effect, in which improvement happens inside a single session implies a process that is as much physiological as psychological. An initial explanation is that it is artificial exploitation of the rapid eye movement sleep process, which must be available in waking. Physiological effects have been reported. Changes in the brain anatomy has been observed after eye movement therapy. An increase in hippocampal volume and a decrease in thalamus volume was reported by Bossini et al. (2017). An increase in the volume of the amygdala but not the hippocampus was reported by Laugharne et al. (2016). Animal models have been reported, for example Ruvalcaba-Delgadillo et al., (2024). Rats were subjected to a standard laboratory stress regime. The experimental group rats received an EMDR procedure in restraint boxes, and administered by sequential LED lights. Control group rats who received the stress procedure without EMDR showed significant damage to the structure of hippocampal neurons. Microscopic examination demonstrated that the neurons dendrites were damaged and reduced. This damage was completely mitigated in experimental rats who received stress plus EMDR.

The EMDR protocol used here differs from the standard protocol on certain respects. It is based on experience with sexual health and medical patients. It commonly requires focus on physical sensation or pain images. These “below the neck” EMDR targets can be scored and treated but may lack cognitive or emotion labels.

Notably, the safe place was not used. The safe place procedure establishes with the patient a metaphorical, imaginary or remembered safe piece to retreat to in the event of high distress in EMDR treatment. This is replaced by decomposition of stalled EMDR targets. This is based on the premise that distress and symptoms are proximally caused by overloaded or constricted working memory. Reprocessing will resume if the load on the working memory bandwidth is reduced. There are six possible methods to reduce (Hassard 2023). Two were used here. First, the target can be divided into different sensory modalities e.g. pain, sound, smell or taste. Second, physical sensation or pain images can be divided up by body location and treated in turn. We refer to this as “anatomical decomposition”. This is often symmetrical, e.g. right leg, left leg. We take the position here that EMDR treatment of FGM would not be possible without this decomposition protocol. A retreat to safe place would prevent the necessary desensitization and symptom reduction to be effected.

Conclusion

We hope this report will be of interests to clinicians interested in exploring the positionalities of EMDR treatment and those who have FGM victims in their waiting rooms. This report demonstrates a possible treatment for this common women’s health problem. Clinics with more FGM cases may be able to devlop EMDR beyond a single case. However, it is unlikely that we will ever provide enough EMDR therapists for 230 million women.