QuestionSBA
QuestionChoice
It is inappropriate to contact the police on the emergency line as there is no imminent threat of harm to the patient. She is also an adult who should consent to you notifying the police. If they want the police to be notified, it is advised that cases are reported using 101.
53018
b
Contact the police immediately on 999
QuestionChoice
The patient is not a child and there is no mention of a particular vulnerability or other relatives at risk. Therefore, it would be best to explore this with the patient and then notify if there were any concerns. It would be most suitable to discuss whether she would want any psychological support and refer to gynaecology if they have experienced any physical complications from FGM, for example, incontinence, painful menstruation and frequent urinary tract infections.
53020
d
Refer to safeguarding team
QuestionChoice
This patient is a competent adult and there is no apparent immediate risk to others or legal obligation to break her confidentiality. Therefore, one should only offer to contact the police and respect her wishes if she chooses not to. It is advised that FGM, which is illegal, should be reported to the police; however, in an adult patient (over 18), this should be done with her consent. In a patient less than 18 years of age (ie. a child), it is a legal duty to contact the police via 101 to disclose this information and you are therefore allowed to break confidentiality in this case. As ever, if breaking confidentiality, it is important to inform the patient of this and the rationale, that is, a legal obligation.
53017
a
Offer to contact the police
QuestionChoice
This patient is a competent adult and there is no apparent immediate risk to others or legal obligation to break her confidentiality. Therefore, one should only offer to contact the police and respect her wishes if she chooses not to. It is advised that FGM, which is illegal, should be reported to the police but in an adult patient (over 18), this should be done with her consent. In a patient less than 18 years of age (ie. a child), it is a legal duty to contact the police via 101 to disclose this information and you are therefore allowed to break confidentiality in this case. As ever, if breaking confidentiality, it is important to inform the patient of this and the rationale, that is, a legal obligation.
53019
c
Contact the police immediately on 101
QuestionChoice
Examination at this moment would provide little added useful information and may potentially cause unnecessary distress in the context of a first disclosure. It is sensible to examine the patient at one point, with a chaperone present, to determine the extent of the injury and guide further management but this is usually within an expert setting.
53021
e
Ask to examine the patient
Concept
Chapter
# Summary


Female Genital Mutilation (FGM), often referred to as ""cutting"" or ""female circumcision,"" involves the injury or cutting of the female genitalia without medical justification. It comes in four types, ranging from clitoridectomy to other non-medical procedures like piercing. Complications include major tearing during labour, urethral damage and increased pain. Management of FGM, which is illegal in the UK, includes making a child protection referral if FGM is suspected, and performing an anterior episiotomy under local anaesthetic or regional block during the second stage of labour.


# Definition


Female Genital Mutilation (FGM) is the harmful practice of injuring or cutting the female genitalia for non-medical reasons, often referred to as ""cutting"" or ""female circumcision.""

# Classification

FGM is classified into four types:

- Type I – Clitoridectomy: Partial or total removal of the clitoris and/or the prepuce.
- Type II – Excision: Partial or total removal of the clitoris and the inner labia, with or without excision of the outer labia.
- Type III – Infibulation: The narrowing of the vaginal opening by repositioning the inner or outer labia, with or without removal of the clitoris.
- Type IV – Other: All other harmful procedures to the female genitalia for non-medical purposes, such as piercing, incising, scraping, or cauterising.

These procedures can cause significant complications including major tearing during labour, urethral damage and increased pain.


# Management

FGM is illegal in the UK. If there's suspicion that a child may be at risk of FGM, an immediate child protection referral must be made. Current management recommendations include performing an anterior episiotomy during the second stage of labour under local anaesthetic or regional block. Deinfibulation should be performed by experienced healthcare professionals, with careful measures to protect the urethra.

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Female Genital Mutilation (FGM)
Topic
38
Obstetrics
10664
Healthcare professionals must report suspected cases of female genital mutilation in under-18s to the police within 28 days of discovery.
A 21-year-old woman attends her GP to renew her oral contraceptive prescription. The patient would like to try an intrauterine device but indicates that there may be issues with inserting it due to previous female genital mutilation (FGM). She says she has never discussed this with anyone before and becomes visibly upset. She tells you it was done during early childhood in her home country by a relative who has since passed away.

Which of the following is the most appropriate response to the situation?
a