FGM (Female Genital Mutilation)

Question 1

4 types of FGM:

Answer 1

Type 1: Removal of part or all of the clitoris.

Type 2: Removal of part or all of the clitoris and labia minora. The 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.

Question 2

FGM complications:

Answer 2

Immediate complications include:

1. Pain
2. Bleeding
3. Infection
4. Swelling
5. Urinary retention
6. Urethral damage and incontinence

Long term complications include:

1. Vaginal infections, such as bacterial vaginosis
2. Pelvic infections
3. Urinary tract infections
4. Dysmenorrhea (painful menstruation)
5. Sexual dysfunction and dyspareunia (painful sex)
6. Infertility and pregnancy-related complications
7. Significant psychological issues and depression
8. Reduced engagement with healthcare and screening

Question 3

Management of FGM:

Answer 3

It is essential to educate patients and relatives that FGM is illegal in the UK. Discuss the health consequences of FGM.

It is mandatory to report all cases of FGM in patients under 18 to the police.

Other services should also be contacted:

1. Social services and safeguarding
2. Paediatrics
3. Specialist gynaecology or FGM services
4. Counselling

In patients over 18, there needs to be careful consideration about whether to report cases to the police or social services. The RCOG recommends using a risk assessment tool to tackle this issue (available on the gov.uk website). The risk assessment includes considering whether the patient has female relatives that may be at risk. If the unborn child of a pregnant woman affected by FGM is considered to be at risk, a referral should be made.

A de-infibulation surgical procedure may be performed by a specialist in FGM in cases of type 3 FGM. This aims to correct the narrowing or closure of the vaginal orifice, improve symptoms and try to restore normal function.

Re-infibulation (re-closure of the vaginal orifice) could be requested after childbirth. Performing this procedure is illegal.

Question 4

Answer 4

> 18: safeguarding midwife
(if <18–> police)