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FGM guidance relevant all year round

GPs should be vigilant for cases of female genital mutilation that may have taken place over the summer holidays, according to the chair of the BMA ethical committee.

The BMA has published guidance alerting GPs on when to suspect a case of FGM, which may occur in some young girls, most commonly aged between 7 and 9 fromsome ethnic groups.

Countries where FGM occurs include Egypt, Eritrea, Ethiopia, Gambia, Iraq, Kenya, Kurdistan, Liberia, Mali, Nigeria, Sudan, Sierra Leone and Somalia, and the procedures can include a combination of total or partial removal of the clitoris, labia minora, labia majora and the narrowing of the vaginal orifice.  

Dr Tony Calland, a former GP and chair of the BMA ethics committee, said GPs should be particularly aware of suspected cases after the summer school holidays, but added GPs needed to be vigilant throughout the year.

‘I think it is something that goes on a lot of the time and GPs need to be aware, especially GPs with patient populations that come from the type of countries where this is traditional. I think you need to be aware of unusual consultation patterns in young women from all these different areas.'

In the event that a GP suspects FGM may have taken place, the guidance advises GPs that they can disclose information to social services or the police even if parental permission has not been given, as 'relevant information can still be disclosed to the appropriate authority to prevent serious harm to the child.'

Dr Calland said GPs would be 'honour bound' to break patient confidentiality and report susepcted cases.

‘You can ask some general question, depending on the age of the girl. Gently start probing the parents and if you are led to have serious worries, I think you do need to talk to someone in a confidential way and, initially with an anonymous case history rather than tell the safe guarding people names and addresses, start off in a anonymous way but obviously if there is a significant risk you are honour bound to break the confidence.'

Dr Calland added: ‘It's difficult, this isn't a quick fix, it's just about raising awareness and making sure that doctors understand that they can break confidentiality. It is safeguarding issue, so all the same sort of rules of confidence and behaviour around children that are being abused apply to this, as they do to more traditional forms of abuse.'

In 2005, the Department of Health published figures that found over 21,000 girls in England and Wales were at high risk of FGM which can cause haemorrhage and tetanus at the time of procedure and canlead to reproductive and mental healthcomplications later in life.

Download the guidance here.