Female genital mutilation

Question 1

What is FGM?

Answer 1

Involves surgically changing the genitals of a female for non medical reasons.

Form of abuse & safeguarding issue.

Question 2

What are the four types of FGM?

Answer 2

• Type 1: removal of part or all of clitoris
• Type 2: removal of part or all of clitoris and labia minora - labia majora may also be removed
• Type 3: narrowing or closing the vaginal orifice - infibulation
• Type 4: all other unnecessary procedures to the female genitalia eg. pricking, piercing, incising, scraping, cauterisation.

Question 3

What are the main risk factors of FGM?

Answer 3

Coming from a community that practise FGM. Having relatives affected by FGM.

Question 4

Which scenario is worth considering the risk of FGM?

Answer 4

• Pregnant women with FGM with a possible female child.
• Siblings or daughters of women or girls affected by FGM
• Extended trips with infants or children to areas where FGM is practised
• Women that decline examination or cervical screening
• New pts from communities that practise FGM.

Question 5

What are immediate complications of FGM?

Answer 5

• Pain, bleeding & swelling
• Infection
• Urinary retention
• Urethral damage & incontinence.

Question 6

What are long term complications of FGM?

Answer 6

• Vaginal, pelvic & urinary tract infections
• Dysmenorrhea - painful menstruation
• Sexual dysfunction & dyspareunia. - Infertility & pregnancy related complications
• Significant psychological issues & depression
• Reduced engagement with healthcare & screening.

Question 7

How do you manage FGM?

Answer 7

Educate pts and make sure they know that FGM is illegal in the UK and discuss the health consequences of FGM. Mandatory to report all cases of FGM in pts under 18.

Question 8

What services can you contact?

Answer 8

Social services & safeguarding. Paediatrics. Specialist gynaecology or FGM services. Counselling.

Question 9

When do you report to the police?

Answer 9

Pts over 18 after doing a risk assessment. Risk assessment includes considering whether the pt has female relatives that may be of risk.

Question 10

What is de-infibulation?

Answer 10

Surgical procedure which may be performed by a specialist in FGM in cases of type 3 FGM which aims to correct the narrowing or closure of the vaginal orifice, improve symptoms and try to restore normal function.

Question 11

What is re-infibulation?

Answer 11

Re closure of vaginal orifice which could be requested after childbirth - performing this is illegal.