Policy briefing

Female genital mutilation

Read our clinical update on guidance from the Royal College of Emergency Medicine on female genital mutilation.

Read our clinical update on guidance from the Royal College of Emergency Medicine on female genital mutilation

fgm
Short-term risks posed by FGM include death, severe pain,
infection and haemorrhaging. Picture: Alamy

Essential facts

Female genital mutilation (FGM) is any procedure that removes all or part of the female genital organs for cultural or any other non-therapeutic reasons.

FGM is recognised as a form of child abuse and gender violence against women. An estimated 137,000 females in England and Wales have undergone it.

What’s new

The Royal College of Emergency Medicine has published advice for emergency department staff on FGM.

It states that front-line staff should be empowered to recognise and manage those patients who have undergone or are at risk by developing their knowledge and awareness of the subject.

It includes a referral flow chart for patients under and over the age of 18.

Signs and symptoms

FGM is classified into four major types including clitoridectomy (the complete or partial removal of the clitoris) and infibulation (narrowing of the vaginal opening).

Short-term risks posed by FGM include death, severe pain, infection and haemorrhaging. Long-term risks include death to mother and child during childbirth, chronic vaginal and pelvic infections, and infertility.

Causes and risk factors

Rates of FGM are particularly high in a number of countries including Somalia, Kenya, Ethiopia and Indonesia. Girls are also at risk if FGM has been carried out on a member of their family, or if their father comes from a community known to practise FGM.

Age is a key risk factor, with most procedures carried out on girls aged between infancy and 15 years old.

How you can help your patient

Ask females from high-risk areas or backgrounds if they have undergone FGM. If FGM is discovered or disclosed, it is mandatory to record this in the patient’s health records.

With anyone under 18 who has symptoms of FGM, who discloses the fact, or if you suspect they are at risk, it is your responsibility to report this to the police and implement relevant safeguarding procedures as with any child abuse case.

Females over 18 who have undergone FGM do not need to be referred to social services or the police, but should be supported and offered relevant follow-up.

Expert comment

julietJuliet Albert, midwife and FGM specialist at Queen Charlotte's Hospital, London

‘In the clinics I run for both pregnant and non-pregnant women who have had FGM, I see the wide range of serious physical and psychological effects they are left with.

But the women seeking help are just the tip of the iceberg and there are many women living in the UK with or at risk of FGM who are not in touch with services.

The most important thing that nurses in any setting, including emergency departments, can do is ask women if they have been cut or are at risk of being cut. Women from a community with high rates of FGM, with repeated urinary tract infections, infertility problems and painful sex are among those that should prompt the question from nurses.

While we have become better at recognising FGM, I still think some nurses lack the confidence to ask about it.’


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