FGM Flashcards
What are the types of FGM?
Procedures involving the damaging or removing or normal healthy woman’s external genitalia or injury to women’s genital for non medical reasons that impact on function
1 - partial/total removal of clitoris
2 - partial/total removal clitoris and labia minora +/- excision of labia majora
3 - infundibulation - as above then sewing together
4 - any other damage done to female genitalia e.g. piercing, removal/reduction of labia for cosmetic reasons
What are the reasons for FGM?
Respect and startups Preserve chastity Part of being a woman Rite of passage Upholds family honour Cleanses and purifies girl Social acceptance - required for marriage Masqueraded as religious but in no texts is it endorsed
What is the epidemiology of FGM?
Most common in African countries (also Indonesia and Latin America) and where people migrate to
Most densely prevalent:
Somalia - mostly type 3 - lots of people from here in Sheffield
Egypt - mostly type 1-2
What is the legal status of FGM?
Illegal in the UK - includes UK national travelling elsewhere to have the procedures - can be prosecuted on return
Mandatory to record it in patients records - no matter who discloses it or examines it - goes onto a national list - this is even the case for clitoral piercings done voluntarily (though being on the list isn’t necessarily a bad thing in this instance)
Anyone under 18 must be reported the police within the area the patient lives within 24hrs by the doctor finding the FGM- if over 18 don’t need to unless think it was recent and there’s still a current risk; still need to make patients aware of legal status
What are some gynae complications of FGM?
Dysparunia Sexual dysfunction + anorgasmia Keloid scar formation Chronic pain Dysmenorrhea - blood trickles out of tiny hole Urinary outflow obstruction - UTI PSTD Difficult to conceive
What are some obstetric complications of FGM?
Fear of childbirth
Increased risk of C-section, PPH, episiotomy, vaginal lacerations
Difficult to assess in labour, to obtain foetal blood sampling, to catheterise
How do you manage stage 3 FGM/infundibulation?
Ideally preconceptually
Failing that surgically managed by 20wks
De-infundibulation:
Diathermy then suturing separately to reduce risk of fusion of labia again
May also need to be done intrapartum - with scissors
