Female Genital Mutilation

Female genital mutilation (FGM) involves surgically changing the genitals of a female for non-medical reasons. FGM is a cultural practice that usually occurs in girls before puberty. It is a form of child abuse and a safeguarding issue. 

Female genital mutilation is illegal as stated in the Female Genital Mutilation Act 2003, and there is a legal requirement for healthcare professionals to report cases of FGM to the police.

 

Epidemiology

UNICEF provides information and data on the epidemiology of FGM. FGM is a common cultural practice in many African countries. Somalia has the highest levels of FGM in any country. Other countries with high rates are Ethiopia, Sudan and Eritrea. It also occurs in Yemen, Kurdistan, Indonesia and various parts of South and Western Asia.

 

Types

There are four types of female genital mutilation:

  • 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. 

 

Identifying Cases

It is important to recognise risk factors for FGM to identify and ideally prevent cases from occurring. Two key risk factors to bear in mind are coming from a community that practise FGM and having relatives affected by FGM. 

There are scenarios where it is worth considering the risk 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 also present with the complications of FGM.

 

Complications

Immediate complications include:

  • Pain
  • Bleeding
  • Infection
  • Swelling
  • Urinary retention
  • Urethral damage and incontinence

Long term complications include:

  • 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

 

Management

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:

  • Social services and safeguarding
  • Paediatrics
  • Specialist gynaecology or FGM services
  • 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.

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.

 

Last updated June 2020
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