Femal Genital Mutiliation

Question 1

Who made the term FGM and describe the parameters?

Answer 1

The term FGM was used by WHO to clarify that it is a violation of human rights, distinguishing it from male circumcision and emphasizing its harmfulness

Question 2

What is the term female genital cutting (FGC)/excision/genital cutting used for?

Answer 2

These terms are used by some who feel that the word ‘mutilation’ stigmatises FGM-affected communities and/or survivors, reflecting the importance of using non-judgemental language.

Question 3

What is the term female circumcision (FC) used for?

Answer 3

This term is often used in FGM-affected countries, but WHO advises against it as it is misleading, suggesting a similarity to male circumcision.

Question 4

What is FGM (female genital mutilation)?

Answer 4

FGM is the partial or complete removal of, or injury to, the external female genitalia for non-medical reasons.

Question 5

What are the four main types of FGM?

Answer 5

There are four main types (types 1-4) with a further seven sub-types. The amount of genital tissue cut increases from type 1 to type 3, with infibulation being the most extensive.

Question 6

What is type 1 FGM?

Answer 6

Type 1 FGM, or clitoridectomy, involves the partial or total removal of the clitoral hood and/or clitoral glans.

Question 7

What is type 2 FGM?

Answer 7

Type 2 FGM, or excision, involves the partial or total removal of the clitoral glans and inner labia and/or outer labia.

Question 8

What is type 3 FGM?

Answer 8

Type 3 FGM, or infibulation, usually includes the partial or total removal of the clitoral glans and inner labia, with the remaining labia sewn together.

Question 9

What is type 4 FGM?

Answer 9

Type 4 FGM includes other harmful procedures such as piercing, scraping, burning, stretching, and/or pricking.

Question 10

Is FGM a global issue?

Answer 10

Yes, FGM is predominantly a global issue in Africa.

Question 11

What are the FGM stats in England and why have they increased?

Answer 11

The increase in FGM cases in England is due to migrants who have already undergone FGM.

Question 12

Are there health benefits from FGM?

Answer 12

There are no health benefits of FGM.

Question 13

What are the immediate impacts of FGM?

Answer 13

Immediate impacts include haemorrhage, pain and shock, urinary retention, infections, trauma to adjacent tissues, transmission of HIV and Hep B, bone fractures, and death.

Question 14

What are the short-term impacts of FGM?

Answer 14

Short-term impacts include delayed wound healing, scarring/keloid, pelvic infection, epidermoid cysts/abscess, and neuroma.

Question 15

What are the long-term impacts of FGM?

Answer 15

Long-term impacts include recurrent UTI, haematocolpos, dysuria, dyspareunia, morbidity and mortality during pregnancy and childbirth, PID/infertility, psycho-sexual and social trauma, PTSD, and death.

Question 16

How is FGM performed?

Answer 16

FGM is performed by ‘circumcisers’ using various instruments in unsanitary conditions, often with no anaesthetic.

Question 17

Why is FGM performed in certain cultures?

Answer 17

FGM is often considered necessary for raising a girl, preparing her for adulthood and marriage, and is linked to sociological, psychosexual, socioeconomic, hygiene, and religious reasons.

Question 18

What are examples of how patients with FGM may present?

Answer 18

Patients may present with various symptoms and complications related to FGM.

Question 19

What is the safeguarding assessment for when a child/woman may be at risk of FGM?

Answer 19

Indicators include the girl’s mother or female family members having undergone FGM, the father/partner coming from an FGM-affected community, and the belief that FGM is important to cultural/religious identity.

Question 20

What is the safeguarding assessment for when a child/woman may have undergone FGM?

Answer 20

Indicators include the girl/woman asking for help, difficulty walking or sitting, frequent urinary or menstrual issues, and reluctance to undergo medical examinations.

Question 21

What is the HCP response to FGM?

Answer 21

Health professionals must provide sensitive services, document FGM in medical notes, and refer cases to social services as required.

Question 22

Is there legislation around FGM and has it been illegal?

Answer 22

FGM legislation is in place in at least 68 countries, including the UK, where it is illegal in 23 of the 28 most FGM prevalent countries in Africa.

Question 23

When was FGM made illegal in the UK?

Answer 23

FGM has been illegal in the UK since 1985.

Question 24

What are the regulations in the UK against FGM?

Answer 24

FGM has been illegal in the UK since 1985, with the Females Genital Mutilation Act 2003 making it punishable by up to 14 years imprisonment.

Question 25

What act made Female Genital Mutilation (FGM) punishable in the UK?

Answer 25

The Females Genital Mutilation Act 2003 made FGM punishable for up to 14 years imprisonment. ## Footnote All countries in the UK have slightly different laws.

Question 26

What was added by the Serious Crime Act 2015 regarding FGM?

Answer 26

The Serious Crime Act 2015 clarified the challenges of dealing with FGM for registered healthcare professionals.

Question 27

What are some offences against the 2003 and 2015 FGM regulations?

Answer 27

Offences include FGM, assisting a girl to mutilate her own genitalia, assisting a non-UK person to mutilate a girl's genitalia overseas, and failing to protect a girl from risk of genital mutilation. ## Footnote Penalties include 14 years in prison and/or a fine.

Question 28

What are the additions from the 2015 and 2020 FGM regulations?

Answer 28

Additions include extra-territorial jurisdiction for FGM, lifelong anonymity for victims, a new offence of failure to protect a girl from FGM, FGM protection orders, and mandatory reporting duties for regulated professionals. ## Footnote The duty requires reporting known cases of FGM in under 18s to the police.

Question 29

What is mandatory recording and reporting in the UK?

Answer 29

Mandatory recording applies to adult women and is a matter for health professionals. Mandatory reporting, required under Section 5B of the FGM Act 2003, concerns children under 18 and is applicable to all regulated professions.

Question 30

What is involved in mandatory reporting?

Answer 30

All regulated health, social, and education professionals must report directly to the police any child under 18 where FGM has been visually identified or disclosed. ## Footnote The duty is personal and cannot be transferred.

Question 31

When does mandatory reporting not apply?

Answer 31

Mandatory reporting does not apply if an adult woman discloses FGM, if there are no signs/symptoms of FGM in a girl, or if it has already been reported by a regulated professional in your organization. ## Footnote In these cases, follow local safeguarding procedures.

Question 32

What should a medical student do regarding FGM?

Answer 32

As a medical student, you are not mandated to report but should discuss concerns about FGM with the responsible person for your clinical placement and seek advice from the local safeguarding team.

Question 33

What is the legal position on FGM postpartum in the UK?

Answer 33

No suturing that will re-infibulate should be performed. Discuss legislation and treat women with dignity. Document normal genitalia in the newborn record and refer to a multi-agency team.

Question 34

What is the significance of FGM as a public health issue?

Answer 34

FGM is a significant global public health issue and an important issue in the UK, with immediate and lifelong consequences.

Question 35

What is the focus of conversations regarding FGM?

Answer 35

Conversations should focus on the woman or girl and not solely on her FGM.