FGM

Question 1

What is female genital mutilation?

Answer 1

Female genital mutilation (FGM) involves surgically changing the genitals of a female for non-medical reasons. FGM is a cultural practice that usually occurs in girls before puberty. It is a form of child abuse and a safeguarding issue.

Female genital mutilation is illegal as stated in the Female Genital Mutilation Act 2003, and there is a legal requirement for healthcare professionals to report cases of FGM to the police.

Question 2

Epidemiology FGM?

Answer 2

FGM is a common cultural practice in many African countries. Somalia has the highest levels of FGM in any country. Other countries with high rates are Ethiopia, Sudan and Eritrea. It also occurs in Yemen, Kurdistan, Indonesia and various parts of South and Western Asia.

Question 3

Types of FGM?

Answer 3

There are four types of female genital mutilation:

Type 1: Removal of part or all of the clitoris.
Type 2: Removal of part or all of the clitoris and labia minora. The labia majora may also be removed.
Type 3: Narrowing or closing the vaginal orifice (infibulation).
Type 4: All other unnecessary procedures to the female genitalia.

Question 4

Examples of scenarios were it is important to consider the risk of FGM?

Answer 4

Pregnant women with FGM with a possible female child
Siblings or daughters of women or girls affected by FGM
Extended trips with infants or children to areas where FGM is practised
Women that decline examination or cervical screening
New patients from communities that practise FGM

Women may also present with the complications of FGM.

Question 5

Complications of FGM?

Answer 5

Immediate complications include:

Pain
Bleeding
Infection
Swelling
Urinary retention
Urethral damage and incontinence

Long term complications include:

Vaginal infections, such as bacterial vaginosis
Pelvic infections
Urinary tract infections
Dysmenorrhea (painful menstruation)
Sexual dysfunction and dyspareunia (painful sex)
Infertility and pregnancy-related complications
Significant psychological issues and depression
Reduced engagement with healthcare and screening

Question 6

Management of FGM?

Answer 6

It is essential to educate patients and relatives that FGM is illegal in the UK. Discuss the health consequences of FGM.

It is mandatory to report all cases of FGM in patients under 18 to the police.

Other services should also be contacted:

Social services and safeguarding
Paediatrics
Specialist gynaecology or FGM services
Counselling

In patients over 18, there needs to be careful consideration about whether to report cases to the police or social services. The RCOG recommends using a risk assessment tool to tackle this issue (available on the gov.uk website). The risk assessment includes considering whether the patient has female relatives that may be at risk. If the unborn child of a pregnant woman affected by FGM is considered to be at risk, a referral should be made.

A de-infibulation surgical procedure may be performed by a specialist in FGM in cases of type 3 FGM. This aims to correct the narrowing or closure of the vaginal orifice, improve symptoms and try to restore normal function.

Re-infibulation (re-closure of the vaginal orifice) could be requested after childbirth. Performing this procedure is illegal.