Gynae: FGM & congenital structural abnormalities Flashcards
(20 cards)
what is female genital mutilation?
(FGM)
surgically changing the genitals of a female for non-medical reasons
cultural practice but is child abuse and a safeguarding issue
legality around FGM
illegal as stated in the Female Genital Mutilation Act 2003
legal requirement for healthcare professionals to report FGM to police
what countries have high rates of FGM?
somalia
ethiopia
sudan
eritrea
(africa and parts of south and western asia have high prevalence)
what are the 4 types of FGM?
- 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.
what are the 2 main risk factors for FGM
coming from a community that practise FGM
having relatives that are affected by FGM
what are some scenarios where there should be high suspicion of FGM?
- 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 patients from communities that practise FGM
women may present with complications of FGM. what are some immediate complications?
- Pain
- Bleeding
- Infection
- Swelling
- Urinary retention
- Urethral damage and incontinence
women may present with complications of FGM. what are some long term complications?
- Vaginal infections, such as bacterial vaginosis
- Pelvic infections
- Urinary tract infections
- Dysmenorrhea (painful menstruation)
- Sexual dysfunction and dyspareunia (painful sex)
- Infertility and pregnancy-related complications
- Significant psychological issues and depression
- Reduced engagement with healthcare and screening
how is FGM managed
educate patients and relatives that FGM is illegal in uk
mandatory to report all cases under 18
contact: social services, safeguarding, paediatrics, specialist FGM or gynae services, counselling
should cases in patients over 18 be reported?
careful consideration about whether to report cases to police or social services
RCOG recommends using risk assessment tool looking at whether the pt has female relatives that may be at risk
if unborn child of pregnant women affected by FGM is considered to be at risk - referral should be made
what is de-infibulation?
surgical procedure performed by specialist in FGM cases of type 3 FGM - aims to correct the narrowing or closure of the vaginal orifice, improve symptoms and try to restore normal function
what is re-infibulation?
re-closure of the vaginal orifice
can be requested after childbirth but performing this is illegal
what do the upper vagina, cervix, uterus and fallopian tubes develop from?
paramesonephric ducts - Mullerian ducts
pair of passageways along the outside of the urogenital region that fuse and mature to become the uterus, fallopian tubes, cervix and upper third of the vagina
why do males not develop a uterus?
anti-Mullerian hormone
what is a bicornuate uterus?
two “horns” to the uterus, giving the uterus a heart-shaped appearance. It can be diagnosed on a pelvic ultrasound scan
adverse pregnancy outcomes
successful pregnancies are generally expected. In most cases, no specific management is required.
what are some complications of a bicornuate uterus?
- Miscarriage
- Premature birth
- Malpresentation
what is an imperforate hymen?
where the hymen at the entrance of the vagina is fully formed, without an opening
when is an imperforate hymen usually discovered?
discovered when the girl starts to menstruate and menses are sealed in the vagina - cyclical pelvic pain and cramping but without any vaginal bleeding
can be diagnosed during clinical exam
treat with surgical incision to create opening in hymen
what is transverse vaginal septae?
where septum froms transversely across the vagina
septum can either be perforate or imperforate
where perforate - still menstruate but difficulty using tampon and intercourse
imperforate - present similarly to imperforate hymen
can lead to infertility
diagnosed on exam, USS, or MRI
surgery to correct
complications - stenosis and recurrence
what is vaginal hypoplasia and agenesis?
Vaginal hypoplasia = abnormally small vagina
Vaginal agenesis = absent vagina
occur due to failure of mullarian ducts
manage with vaginal dilator over prolonged period of time to create adequate sized vagina
may need surgery
