FGM

Question 1

Definition and laws around FGM-C?

Answer 1

• FGM-C = female genital mutilation - cutting
• FGM-C is partial or full removal of external female genitalia or other injury to the female genital organs for non-medical reasons.
• FGM/C has no health benefits, results in harm
• Due to the harm, it is unlawful in Oz
• Re-infibulation = illegal
• After de-infibulation, repair is only to restore normal anatomy
• In Victoria - mandatory reporting of FGM/C to Child Protection

Question 2

How does de-infibulation of FGM-C (type III) affect obstetric outcome?

Answer 2

• reduce CS/PPH rate

Question 3

What are the impacts of FGM-C on non-pregnant women

Answer 3

• possibly worse sexual function
• possibly more dyspareunia/dysuria

Question 4

What are the benefits of de-infibulation for non-pregnant women?

Answer 4

• may be offered to women living with Type III, particularly those with health cx - dysuria, recurrent UTI, dyspareunia

Question 5

What is the evidence for clitoral reconstruction

Answer 5

• lack evidence for benefit
• surgical risks - graft necrosis, hematoma, suture failure

Question 6

What are the key points about expectations post de-infibulation

Answer 6

• surgical risks
• faster micturition
• increase vaginal discharge

Question 7

Hx/Exam

Answer 7

Hx
- dysuria/recurrent UTI
- hematocolps/recurrent vag infection/CST
- dyspareunia/no sexual pleasure
- scar complications - keloid, dermal cyst
- psychological
- risk of unborn be infibulated -> discuss legality and mandatory reporting

Exam
- degree of infibulation
- extent of scarring

Question 8

What are the implications of FGM (Type III) in intrapartum

Answer 8

• difficult intrapartum assessment
• difficult intrapartum procedure FSE/IDC
• perineal trauma/episiotomy/CS/PPH