Female Genital Cutting: An Evidence-Based Approach to Clinical Management for the Primary Care Physician

Abstract

The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue.

Female genital mutilation – why does it still exist in Africa?

“…This statement is supported by the findings of several studies (UN, Klouman; Msuya; Snow, as cited in Ref. [11]). Hearst and Molnar [10] found that the mother's education has a crucial influence on whether they will allow FGM to be performed on their daughters.…”

“…This was also emphasised by UNICEF report, Kandala and Rahlenbeck's (as cited in Ref. [11]) findings, that showed that the higher the educational level of the mother, the lower the likelihood for them to let their daughters undergo FGM and show support for the perpetuation of the practice. Afifi et al (as cited in Ref.…”

“…According to Yirga et al (as cited in Ref. [11]), a woman that had undergone FGM is considered to be less likely to be promiscuous, sexually active or even sexually hyperactive and easier to control by their husband acting with proper sexual behaviour. Morison et al (as cited in Ref.…”

“…Source: http://neurologicalcorrelates.com/wordpress/2008/03/20/it-claims-that-female-genital-mutilation-is-no-basis-for-allowing-asylumclaims-as-once-the-mutilation-has-already-occurred-there-is-no-reason-to-believe-that-you-would-be-further-persecuted/ between and within different regions (e.g. urban and rural areas) and ethnic groups [10,11]. Nevertheless, immigrants from all these countries take the practice along to their new countries of residence, e.g., to the USA or Europe (Yoder et al, 2012 as cited in Ref.…”

“…Nevertheless, immigrants from all these countries take the practice along to their new countries of residence, e.g., to the USA or Europe (Yoder et al, 2012 as cited in Ref. [7], [11,12], Moukhyer, as cited in Ref. [13]) (Figure 2).…”