Others

Question 1

Female genital mutilation (FGM)

Answer 1

Definition: injuring or removing part or all of labia, clitoris and other genital parts for non-medical reasons
Illegal as violates rights of girls and women
Commonly in parts of Africa, middle east and Asia
Can offer antenatal deinfibulation before pregnancy or during in 2nd trimester or during labour in 1st or 2nd stage

WHO CLASSIFICATION
Type 1
- Partial or total removal of clitoris

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

Type 3

• “Infibulation” - narrowing of vaginal orifice by creating a covering seal by cutting and appositioning labia minora +/- majora with or without excision of clitoris
• Deinfibulation is the procedure to restore vaginal introitus

Type 4
- All other harmful procedures to female genitals for non-medical purposes e.g. incising, scraping, cauterising

Complications:

• Impaired sexual function - dyspareunia, anorgasmia
• UTIs, difficulty voiding
• Recurrent vaginal infections
• Infertility
• Dysmenorrhoea
• Haematocolpos
• Chronic pain
• Difficult with minor procedures including CST, IDC insertion
• Psych - PTSD, anxiety, depression

Intrapartum complications:

• Difficulty with VE, ARM, FSE application
• Difficulty with IDC insertion
• Increased perineal trauma, episiotomy
• Increased risk of CS
• Fear of childbirth

Not an indication for CS offer elective episiotomy, consider IDC in labour, epidural if VE are painful