Female Genital Mutilation Flashcards
Define FGM
all procedures involving partial or total removal of the external female genitalia or injury to the female genital organs for non-medical reasons
What are the other descriptive terms for FGM?
female circumcision
female genetical cutting FGC
female genital surgeries FGS
How is FGM classified?
Type I = excision of prepuce with or without part of or entire clitoris
Type II = excision involves part of or whole of labia minora or majora
Type III = excision of part of or who of the external genitalia with stiching/narrowing of the vaginal opening (infibulation) and creation of a neointroitus
What are the reasons for the practice of FGM?
tradition religion social acceptability rite of passage hygiene marriageability preserving chastity curbing female libido/sexual activity ensuring sexual pleasure for men
How is FGM done?
- traditional circumcisers
- unsterilised instruments e.g. knives, razors, scissors, snail shells
- sutures, thorns, homemade adhesive such as sugar, egg, warm oil, dung
- leg binding
- medicalisation by midwives, doctors, nurses
- time of FGM varies according to culture and opportunity
How is FGM a violation of a girls right to protection?
“children should have the opportunity to develop physically in a healthy way, receive adequate medical attention and be protected from all forms of violence, injury and abuse”
- convention of the rights of a child
How many girls in the UK are at risk?
20,000
What are the immediate complications of FGM?
pain haemorrhage infection: bacterial sepsis, HIV, hepatitis, tetanus urinary retention fractures shock: hypovolaemia, sepsis death
What are the long term complications of FGM?
dysmenorrhoea dyspareunia/apareunia coital lacerations chronic pain recurrent UTIs/urinary obstruction/chronic renal failure death difficulty coceiving genital fistulae PTSD keloids/sebaceous cysts difficulty gynaecological exams e.g. smear, miscarriage interventions labial fusion repeated mutilation e.g. defibulation for childbirth
What are the obstetric complications of FGM?
- difficult vaginal examinations
- difficult catheterisations
- difficult scalp electrode placement
- increased caesarians
- post partum haemorrhage
- perineal tears
- prolonged 2nd stage
- break down of episiotomy scars
- sepsis
- extended hospital stay
What are the foetal consequences of FGM?
- lower Apgar scores
- more infant resus
- more LBW
- more neural damage
- more IUGR
- extra 1 to 2 perinatal deaths per 100 deliveries
When is defibulation indicated?
At what point in pregnancy should it be performed?
What precautions should be taken?
- indicated only in type III FGM
- 20 weeks gestation
Ensure - adequate counselling
- written consent or verbal if during 2nd stage labour
- adequate anaesthesia
- adequate analgesia and post op advice
- follow up appt.
What response is needed for acute FGM?
- If fresh mutiilation repsnsd as in any acute injury e.g. stop bleeding, analgesia, antibiotics, may need cauterisation
- involve consultant gynaecologist/pediatrician
- well documented history
Escalate immediately - police
- safeguarding team if vulnerable or under 18yrs
- social services
Is genital piercings FGM?
need to be recorded as Type IV FGM
What is stated in the 1985 Prohibition of Female Circumcision?
Act states that it is an offence for any person:
a) to excise, infibulate or otherwise mutilated the whole or any part of the labia or clitoris of another person or
b) to aid, abet, counsel or procure the performance by another person of any of those acts on that other person’s own body
What is in the genital mutilation act 2004?
- made the penalty for a persons found guilty of an offence under the act up to 14 years in prison
- offence also committed if arrangements made for FGM to be carried out abroad
- no offence committed in associated with cutting while giving birth provided the purpose is connected with the labour or birth
- liberal interpretation in proving surgery for comfort, sexual confidence, body image and self esteem
What is the most important risk factor for FGM?
country of origin
also a child whose mother or siblings have had FGM is at a higher risk of having FGM
What was made mandatory from June 2015?
Acute bursts to collect data as specified on an enhanced dataset via the FDM Clinical Audit Platform, National official statistics will be published periodically
