Female Genital Mu-la-on Dr Catherine White FMERSA March 2016 Dr Catherine White March 2016 FGM FGM describes any deliberate, non-­‐medical removal or cuDng of female genitalia. Different regions and communi-es prac-ce various forms of mu-la-on. Some forms of cuDng are quite common and they are classified as shown below. Dr Catherine White March 2016 Feb 2013 •  Key facts •  Female genital mu-la-on (FGM) includes procedures that inten-onally alter or cause injury to the female genital organs for non-­‐medical reasons. •  The procedure has no health benefits for girls and women. •  Procedures can cause severe bleeding and problems urina-ng, and later cysts, infec-ons, infer-lity as well as complica-ons in childbirth increased risk of newborn deaths. •  About 140 million girls and women worldwide are currently living with the consequences of FGM. •  FGM is mostly carried out on young girls some-me between infancy and age 15. •  In Africa an es-mated 101 million girls 10 years old and above have undergone FGM. •  FGM is a viola-on of the human rights of girls and women. Dr Catherine White March 2016 Procedures Female genital mu-la-on is classified into four major types. •  Clitoridectomy: par-al or total removal of the clitoris (a small, sensi-ve and erec-le part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). •  Excision: par-al or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina). •  Infibula-on: narrowing of the vaginal opening through the crea-on of a covering seal. The seal is formed by cuDng and reposi-oning the inner, or outer, labia, with or without removal of the clitoris. •  Other: all other harmful procedures to the female genitalia for non-­‐medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. Dr Catherine White March 2016 Type 1 FGM •  Clitoridectomy: par-al or total removal of the clitoris (a small, sensi-ve and erec-le part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). This prac-ce is extremely painful and distressing, damages sexually sensi-ve skin and is an infec-on risk. Dr Catherine White March 2016 Type 2 FGM •  Excision: par-al or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the ‘lips’ that surround the vagina). This prac-ce is extremely painf
ul and distressing, damages sexually sensi-ve skin and is an infec-on risk. Dr Catherine White March 2016 Type 3 FGM InfibulaBon: narrowing of the vaginal opening through the crea-on of a covering seal. The seal is formed by cuDng and sewing over the outer, labia, with or without removal of the clitoris or inner labia. This prac-ce is extremely painful and distressing, damages sexually sensi-ve skin and is an on-­‐going infec-on risk. The closing over of the vagina and the urethra leaves women with a very small opening in which to pass urine and menstrual fluid. The opening can be so small that it needs to be cut open to be able to have sexual intercourse. CuDng is also needed to give birth and can cause complica-ons which harm both mother and baby. Dr Catherine White March 2016 Type 3 Dr Catherine White March 2016 Type 4 FGM Other: all other harmful procedures to the female genitalia for non-­‐medical purposes, e.g. pricking, piercing, incising, scraping, stretching and cauterising the genital area. Dr Catherine White March 2016 •  Are there any benefits to it? Dr Catherine White March 2016 What are the health risks? •  Immediate •  Long term Dr Catherine White March 2016 Who is at risk? •  Procedures are mostly carried out on young girls some-me between infancy and age 15, and occasionally on adult women. In Africa, more than three million girls have been es-mated to be at risk for FGM annually. •  About 140 million girls and women worldwide are living with the consequences of FGM. In Africa, about 101 million girls age 10 years and above are es-mated to have undergone FGM. •  The prac-ce is most common in the western, eastern, and north-­‐eastern regions of Africa, in some countries in Asia and the Middle East, and among migrants from these areas. Dr Catherine White March 2016 Dr Catherine White March 2016 In your area •  What is the prevalence of FGM? Dr Catherine White March 2016 Case 1 Miriam Miriam 8 years old born in Sudan. Recently moved to UK. Mum, has disclosed at antenatal clinic that both she and Miriam have had FGM (type 2) as babies. Dr Catherine White March 2016 Case 2 Syma Syma Syma is 5 years old. She was born to Pakistani parents. She has always lived in the UK. In school she complains of genital soreness. She says that it started when she visited her aunt in the school holidays. Dr Catherine White March 2016 Case 3 Dareen •  Dareen is 7 years old. •  She was born in the UK. Her mother has had FGM. •  Her father has asked school if he can take Dareen out of school for a visit to rela-ves in Sudan. Dr Catherine White March 2016 Case 4 Irdina •  Irdina is 10 years old. She was born in Malaysia and came to the UK last year. •  Her parents say that she had FGM (against their wishes) in Malaysia when she was 3 years old. •  A check of the GP records shows that she last afended the surgery a year ago for a foot problem. Dr Catherine White March 2016 The forensic / medical response •  Is an examina-on needed? •  If yes: –  When should they be done? –  Where? –  Who should do them? –  What else might be required? •  If no-­‐ why not? Dr Catherine White March 2016 Case 5 Vanna •  Vanna is 11 years old. •  She had FGM when she was 6 months old and living in Egypt. •  She has been asymptoma-c from it. •  She has a medical examina-on today and you note Type 1 FGM Dr Catherine White March 2016 Vanna •  What should you tell Vanna regarding the examina-on findings? •  When should you tell her? Dr Catherine White March 2016 Dr Catherine White March 2016 •  Mul-disciplinary approach to the management of children with female genital mu-la-on (FGM) or suspected FGM: service descrip-on and case series. •  By: Creighton SM; Dear J; de Campos C; Williams L; Hodes D, BMJ Open [BMJ Open], ISSN: 2044-­‐6055, 2016 Feb 29; Vol. 6 (2), pp. e010311; Publisher: BMJ Publishing Group Ltd; PMID: 26928027. •  Design and SeKng: A prospec-ve study of all children seen in a dedicated mul-disciplinary FGM clinic for children over a 1-­‐year : Dr Catherine White March 2016 Results: 38 children were referred of whom 18 (47%) had confirmed FGM; most frequently type 4 (61%). Social care and police referred 78% of cases. According to UK law FGM had been performed illegally in three cases. Anonymous informa-on given to police led to the referral of six children, none of whom had had FGM. Type 4 most common seen Dr Catherine White March 2016 Dr Catherine White March 2016 Dr Catherine White March 2016 •  FGM Risk and Safeguarding; Guidance for professionals: hfps://www.gov.uk/
government/uploads/
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_Accessible_v0.1.pdf Dr Catherine White March 2016 •  2014 •  hfps://www.gov.uk/
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female-­‐genital-­‐mu-la-on-­‐
guidelines Dr Catherine White March 2016 Dr Catherine White March 2016 •  hfp://www.e-­‐lr.org.uk/home/ Dr Catherine White March 2016 Dr Catherine White March 2016 Dr Catherine White March 2016 FGM and the Serious Crime Act 2015 • 
Five key legisla-ve changes on FGM were introduced into the Serious Crime Act 2015, which was given royal assent on 3 March 2015 •  1. Offence of FGM: extra-­‐territorial acts 2. Anonymity for vic-ms of FGM 3. Offence of failing to protect girl from risk of genital mu-la-on 4. Female genital mu-la-on protec-on orders 5. Sec-on 74: Duty to no-fy police of FGM •  hfp://www.familylawweek.co.uk/site.aspx?i=ed145848 Dr Catherine White March 2016 Dr Catherine White March 2016 GMP Divisions 31 children St Mary's SARC Nov 2014-­‐ Jan 2016 36 Age FGM thought to have been done St Mary's SARC Nov 2014-­‐ Jan 2016 37 FGM noted on examina-on St Mary's SARC Nov 2014-­‐ Jan 2016 38 Type of FGM iden-fied St Mary's SARC Nov 2014-­‐ Jan 2016 39 Ques-ons • 
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Who examines? When? Where? What? How? Why? Dr Catherine White March 2016