Overview

• FGM → surgically changing the genitals of a female for non-medical reasons.
  • Cultural practice that occurs in girls before puberty. A form of child abuse and a safeguarding issue.
• Common cultural practice in many african countries.
• Four Types ⇒
  • 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.

Making Diagnosis

Clinical Features

• Immediate Complications → pain, bleeding, infection, swelling, urinary retention, urethral damage and incontinence.
• Long Term Complications → vaginal infections (bacterial vaginosis), pelvic infections, UTIs, dysmenorrhoea, dyspareunia, infertility, psychological issues.

Investigations

Management Plan

• Mandatory to report all FGM cases in patients under 18 to the police.
• Individual risk assessment made by member of clinical team using an FGM safeguarding risk assessment tool. If the unborn child, or any related child, is considered at risk then a report should be made.
  • Not mandatory to report all pregnant women to social services or police → individual risk assessment should be done by member of clinical team.
• GP may refer to FGM services.
• De-Infibulation → in cases of type 3 FGM. Cutting open the scar tissue at the entrance to the vagina. Aims to correct the narrowing and closure of the vaginal orifice.
• Pregnancy
  • Screening for hepatitis C in addition to routine screening (hep B, HIV, syphillis).