GTG 53: FGM

Question 1

What legal framework exists for FGM?

Answer 1

Female Genital Mutilation Act 2003

Question 2

Approximately how many females have undergone FGM worldwide?

Answer 2

125 million

Question 3

Approximately how many females have undergone FGM in the UK?

Answer 3

137,000
including 10,000 girls <15 years.

Question 4

What proportion of females who undergo FGM are aged under 5 years?

Answer 4

50%

Question 5

What are the types of FGM and how are these defined?

Answer 5

Type 1:
Clitridectomy (partial or total removal of clitoris +/- preppuce.

Type 2:
Partial or total removal of clitoris and labia minora +/- excision of labia majora.

Type 3:
Narrowing of the vaginal orifice, creation of a seal by cutting and opposing the labia minora +/- majora. +/-clitridectomy.

Type 4:
Any other harmful (non medical) procedures including piercing.

Question 6

What are the short term complications of FGM procedures?

Answer 6

Haemorrhage (5-26%)
Urinary retention (8-53%)
Genital swelling (2-27%)
Infection, fever
3 deaths in UK directly linked to FGM.

Question 7

What are the long term risks associated with FGM?

Answer 7

Genital scaring - 3% (including epidermoid inclusion cysts).

Urinary complications:
LUTS (particularly with T2/3), poor urinary flow, urethral stricture or fistulae.

Sexual function:
Dyspaneunia or aparnunia
Reduced arousal, desire, lubrication or orgasms.

Psychological

Infection: BV and Herpes Simplex 2

Menstruation: haematocolpos and dysmenorrhoea

Question 8

What are the increased obstetric risks associated with FGM?

Answer 8

Prolonged labour
PPH
Perineal trauma
Increased LSCS rate
Increased NNU resuscitation requirement
Lochia retention
Difficulty examining in labour (VEs FSEs etc).

Question 9

What 4 points does the FGM Act 2003 highlight?

Answer 9

1. Illegal (unless part of surgical procedure) irrespective of age
   (unless required for psychological or physical health or as part of labour).
2. Illegal to arrange in UK or to be taken abroad.
3. Offence not to protect those you have parental responsibility for.
4. if FGM confirmed in <18 year old, mandatory to report this to the police.

Question 10

Which act reinforced FGM legislation and brought in mandatory reporting for <18 year olds?

Answer 10

Serious Crime Act 2015

Question 11

What is FGCS?

Answer 11

Female Genital Cosmetic Surgery

Anything that changes the structure of appearance of healthy external genitalia (or internally in case of vaginal tightening).

Illegal unless for physical or mental health (highly regulated).

Question 12

What is re-infibulation?

Is this legal?

Answer 12

Recreating the FGM appearance (eg covering in type 3) after de-infibulation or labour etc.

This is ILLEGAL therefore needs discussing in ANC.

Question 13

What is the difference between recording and reporting FGM?

Answer 13

Recording in hospital notes and HSCIC.

Reporting is mandatory in <18 year olds, or if a child is at risk.

Question 14

What should be discussed women regarding HSCIC?

Answer 14

Health and Social Care Information Centre is a database to monitor FGM rates in the UK to improve and target FGM support.

Patient data is submitted UNanonymised (but is later anonymised for statistical analysis).

Question 15

If a child with FGM is identified, to whom must this be reported?

In accordance with which legal act?

Answer 15

Police
GP
Health Visitor

Children Act 1989 (FGM is child abuse).

Question 16

Should clitoral reconstruction be carried out? Why?

Answer 16

No!
unacceptable complication rates without conclusive evidence of benefit.sma

Question 17

What is the appropriate technique for suturing labial edges following type 3 de-infibulation during labour?

Answer 17

Oversewing sutures.
(oversew labia either side to hold back the labia and leave vaginal opening for examination etc).
Running sutures are evidence based.