Gynaecology: FGM Flashcards
What is female genital mutilation (FGM)?
Involves any procedure resulting in the partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical purposes.
It is illegal to carry out FGM in the UK and it is internationally recognised as a human rights violation.
It is estimated that how many women and girls globally have undergone FGM?
125 million
Which countries have the highest incidence of FGM?
1) Somalia
2) Guinea
3) Dijbouti
Rates over 90%.
Why is FGM performed?
FGM is practiced for a number of complex social, cultural and religious reasons, based on the mistaken belief that it will somehow provide benefit to the girl.
For example, to preserve virginity, to uphold family honour or as a rite of passage.
FGM is mainly performed on girls below the age of 15.
Usually, it is carried out by traditional practitioners with no formal training. Worrying recent trends have shown that it is becoming increasingly common for FGM to be performed by medical professionals.
There are 4 classifications of FGM.
What does type 1 involve?
Type 1:
The partial or total removal of the clitoris. This sometimes may involve the partial or total removal of the clitoral hood.
What does type 2 FGM involve?
Type 2:
- The partial or total removal of the clitoris and the labia minora.
- This sometimes may also occur with removal of the labia majora (excision).
What does type 3 FGM involve?
Type 3:
- The making of a covering seal in order to narrow the vaginal opening (infibulation).
- This is done by cutting and altering the placement of the labia minora or majora, sometimes involving stitching.
- This may also be performed with the removal of the clitoris.
What does type 4 FGM involve?
Type 4:
- This involves any and all other harmful procedures to the female genitalia for non-medical needs.
- This includes piercing, cutting, burning, scraping and pricking.
Short-term complications of FGM?
1) bleeding
2) urinary retention
3) genital swelling
4) severe pain
5) infection
6) poor wound healing
Long-term complications of FGM?
1) scarring
2) dyspareunia
3) urinary tract problems e.g. infections, dysuria, urinary stricture or fistulae
4) impaired sexual function
5) dysmenorrhoea
6) chronic infections e.g. increased of risk Herpes Simplex type 2 and Bacterial vaginosis infections
7) psychological problems e.g. PTSD, anxiety
8) increased risk of obstetric complications – including prolonged and difficult labour, postpartum haemorrhage, needing neonatal resuscitation and stillbirth
Who should be screened for FGM?
1) ALL patients should be screened for FGM at the time of booking their pregnancy, regardless of their country of origin, or ethnic background.
2) Patients who present in GP (or other clinical settings) with signs/indications
What signs and scenarios in GP practice (or other clinical settings) may point to those at a higher risk of FGM?
1) The patient is known to have other family members that have undergone FGM
2) The patient is part of a community known to practice FGM
3) Women who refuse examination or cervical screening
4) Discussion of extended visits with girls to countries where FGM is practised
5) Girls presenting with repeated urinary, menstrual or abdominal problems
6) Girls having difficulty sitting still for long periods
If FGM is suspected in a child, what should you do?
Must be reported by making a referral to the police or social services.
Healthcare professionals have a mandatory duty to report any confirmed cases of FGM to children under the age of 18.
This should be done via the 101 non-emergency number within 1 month of the consultation.
If a child is believed to be at risk of FGM then it is vital to seek guidance and report to social services and safeguarding.
What is the mandatory duty of HCWs regarding FGM in children?
Healthcare professionals have a mandatory duty to report any confirmed cases of FGM to children under the age of 18
If FGM is suspected in an adult, what should you do?
1) There is a requirement to record data for all women identified as having FGM. This should be documented in their medical records.
2) For non-pregnant women aged 18 and over, there is no duty to report unless a risk is posed to a related child.
3) For pregnant women aged 18 and over, each case needs to be risk assessed individually.
4) If the unborn child or any other related child are at risk of FGM then this must be reported to the police or social services.
This then needs to be recorded in antenatal records, maternity documentation and the child’s personal health record.
