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At the heart of general practice since 1960

Female genital

mutilation

­ what GPs

can do

Comfort Momoh gives an outline of who is most vulnerable to female genital mutilation and what GPs can do

Africans from Somalia, Eritrea, Sudan, Ethiopia, Sierra-Leone, Nigeria, Ghana, Senegal, Mali, Kenya, Gambia, Togo and Chad are the most vulnerable groups to undergo female genital mutilation (FGM). Some women from Mauritania and the Yemen are also vulnerable.

Estimates suggest there are around 70,000 women living here who have been subjected to FGM. A further 5,400 girls under 16 are considered to be at risk, according to Forward, a pressure group working against FGM.

How to detect

Women and girls may present to their GPs with a range of complications, such as recurrent urinary tract infection, urinary incontinence and bedwetting. Dysmenorrhoea or painful periods is very common due to a tight introitus.

A child may also present to the GP with behavioural disturbances as a result of psychological effects of FGM. Many reasons and myths are given for the existence and continuation of FGM:

·Tradition or cultural history is believed to be the primary reason.

·Religion ­ some Muslims believe FGM is a religious obligation; it is not mentioned in the Koran, it pre-dates Islam, and is

practised in many Muslim and Christian countries alike.

·Preservation of virginity ­ some

communities believe FGM ensures virginity as sex before marriage is taboo in some

communities that practise it.

·Promotes cleanliness, beautification, fear of social criticism and sense of belonging.

·Prevention of rape.

·FGM is a source of income for

circumcision practitioners.

·It is also performed for aesthetic reasons.

What to say to the patient

It is important to ask women and girls questions around FGM and to find out what complications they are experiencing. In most cases if GPs don't raise the issue, women/ girls will not volunteer information.

Once FGM is identified, a plan of care is necessary and referral to appropriate clinic for support and surgical intervention if necessary. Complications include:

·Recurrent urinary tract infection

·Pain during sexual intercourse/coitus and penetration can take up to six months

·Pain during periods

·Psychological problems such as

flashbacks, anxiety and depression

·Epidemoid cyst/abscess

·Pelvic infection

·Scarring/keloid formation

What can be done?

·The legislation against FGM is reinforced by child protection procedures, which came into effect in 2003.

·All social service departments must

adhere to it to ensure the protection of

children at risk of FGM.

·There should be guidelines and

procedures which would help GPs in

managing the effects of FGM.

·Sensitive action regarding child

protection should be taken where FGM has occurred or is likely to occur.

·The Children's Act of 1989 states that everyone has a duty and responsibility to protect children. The welfare of children is paramount.

·Government documents such as

'Working together to safeguard children' and a guide to inter-agency working to

safeguard and promote the welfare of

children also address child protection.

·GPs need to have a better knowledge and understanding of the cultural factors

relating to FGM in order to provide support for women and girls.

Comfort Momoh is specialist midwife at St Thomas' Hospital, London, and editor of the book Female Genital Mutilation

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