1. FEMALE GENITAL MUTILATION Alison Byrne 14 th June 2014 African Women’s Service Heart of England NHS Trust

2. What is FGM?  The term “Female Genital Mutilation” [also called “female genital cutting” comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non medical reasons.  WORLD HEALTH ORGANISATION 2008

3. Female Genital Mutilation Type 1 Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, rarely, the prepuce (the fold of skin surrounding the clitoris) as well.

4. Female Genital Mutilation Type 2 Excision: partial 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).

5. Type 2 FGM

6. Female Genital Mutilation Type 3 Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, and sometimes outer, labia, with or without removal of the clitoris.

7. TYPE 3 FGM

9. Female Genital Mutilation Type 4 Other: all other harmful procedures to the female genitalia for non- medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

10. FGM -a major issue  The World Health Organisation estimate that between 100-140 million women have had FGM performed.  6000 new case per day  5 each minute  65,790 women in the UK [FORWARD 2007]  24000 girls under 15 at risk of type 3  9000 girls at risk of types 1 and 2.

11. GEOGRAPHICAL SPREAD

12. COMPLICATIONS-SHORT TERM  Haemorrhage  Shock  Acute urinary retention  Fracture of dislocation  Damage to other organs  Infection  Failure to heal  10%mortality from immediate complications

13. COMPLICATIONS-LONG TERM  Difficulty passing urine  UTI  Difficulties with menstruation  Chronic pelvic infection  Infertility  Vulval abcess/cyst/calculus  Neuroma  Keloid scarring  Fistula  25% mortality from secondary complications

14. KELOID SCARRING

15. VULVAL CYST

16. COMPLICATIONS FOR DELIVERY  Physical barrier –Inability to stretch –Prolonged second stage-? Fistula formation –? Caesarean section –Ruptured uterus –Death woman (x2)  Death baby [x4]

18. AFRICAN WOMEN’S SERVICE

19.  Identification  Assessment  Planning  Follow- up  Child protection

20. Useful web sites www.rcm.org.uk www.who.int www.amnesty.org www.fgmnetwork.org www.forwarduk.org.uk www.fgmnationalgroup.org Alison.byrne@heartofengland.nhs.uk 07817534274/0121-424-3909