Diagnosis, Management, and Treatment of Female Genital Mutilation or Cutting in Girls

Abstract

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.

Diagnoses and Procedures of Inpatients with Female Genital Mutilation/Cutting in Swiss University Hospitals: A Cross-Sectional Study

“…Only ve minor inpatients had an FGM/C code. Outpatient clinics may attend more children with FGM/C than university hospitals, but paediatricians may also miss and/or not record it, because they lack knowledge on FGM/C, or rarely perform a genital examination [53][54][55]. Alternatively, abandonment of the practice could explain why few minors had an FGM/C code.…”

Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines

“…The 31 documents that discussed the clinician-patient relationship emphasised the need to develop “trusting relationships” [ 75 , 85 , 88 , 92 ], and “rapport” [ 87 , 93 , 96 ] to “create [an] opportunity for the individual to disclose.” [ 97 ], “Make the woman/girl feel comfortable” [ 82 ] and to work “in collaborative partnerships” [ 83 , 98 ] and enable a “a plan of care [to] be made in collaboration with the woman” [ 63 ]. Documents identified the need to “establish trust-based relationships that foster respectful, transparent, evidence-based care” [ 65 ] and that “Clinicians are also urged to be clear about your role, scope, authority and responsibility” [ 99 ].…”

“…The girl or woman was acknowledged as a unique person in 38 documents by ensuring that “the voice of the child is heard when discussing issues surrounding FGM “[ 100 ], a “victim-centred approach” [ 87 ] or “woman-centred care” [ 75 ] where “each case is considered individually” [ 92 , 101 ], “as unique” [ 102 ] or “case by case” [ 89 ] to meet the needs of the woman or girl [ 61 , 75 , 86 , 103 , 104 ]. Documents identified a rights-based approach including the need for health professionals to “respect individual needs” [ 105 , 106 ], “wishes” [ 107 , 108 ], “privacy” [ 109 , 110 ], “dignity” [ 93 ] and “preferences” [ 65 , 88 , 90 ] of girls and women.…”

“…Documents call for professionals not to “make assumptions about a woman because of her religion or ethnicity” [ 82 ] and “adapt approaches accordingly” [ 80 ], taking into account “socio-cultural factors from both the client’s culture of origin and her place in the culture in which she currently resides” as well as how “Each client will have experienced this [FGM] trauma and its consequences in her own personal, unique way.” [ 78 ]. This also points to 60 documents that embraced a bio-psychosocial perspective that acknowledges physical, emotional and mental health and the need for “ holistic care” that involves “discussions about healthy choices” [ 75 ] and responds to women and girls culture and language, “health literacy” [ 84 , 92 ] and the “intersection of ethnicity, migration, sex, and gender” [ 92 ]. Some documents specifically mentioned the need for care to be “culturally competent” [ 74 , 75 , 104 ] and recognise the trauma of FGM and refugee experience [ 83 , 111 ].…”

“…Other documents suggest working with professionals who have expertise interacting with women and communities in relation to FGM, conducting regular multi-disciplinary meetings, and ensuring records or documentation to facilitate collaboration [ 123 ]. This assists women in accessing services by supporting her to navigate the health system and facilitate co-ordinated efforts to ensure referral and continuity of care to meet her needs [ 75 , 92 ].…”