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Female genital infection — Clinical Guidelines

Overview

Female genital mutilation (FGM) involves the partial or total removal of external female genitalia for non-therapeutic reasons, impacting physical, psychological, urogynecological, obstetrical, and sexual health globally 1 3 4 6 17.

Diagnosis

Clinical History: Essential for identifying FGM, including type and age of procedure 1 3 6.

Physical Examination: Vital for assessing anatomical changes and complications 1 3 9.

Grading Systems: Utilize WHO classification (Types I-III) to standardize diagnosis 1 3 17.

Management

Psychosocial Support: Critical for addressing psychological impacts 1 2 4.

Medical Care: Focus on managing complications such as infections, pain, and obstetric issues 3 10.

Surgical Interventions: Reconstructive surgery may be necessary for severe cases (e.g., infibulation) 3 7.

Special Populations

Pregnancy: Enhanced surveillance for obstetric complications; tailored care plans required 4 5 10.

Comorbidities: Addressing concurrent health issues while considering FGM-related risks 10.

Key Recommendations

Enhance Clinician Awareness and Training: Regular training on FGM recognition and management is crucial for healthcare providers 3 12 15 (Evidence: Moderate).

Culturally Sensitive Care: Implement culturally sensitive approaches to improve patient experiences and outcomes 2 4 6 (Evidence: Moderate).

Systematic Screening: Routinely screen for FGM in women from high-prevalence regions to identify and manage complications early 9 12 (Evidence: Moderate).

Multidisciplinary Teams: Utilize multidisciplinary teams to address comprehensive health needs of women with FGM 1 16 (Evidence: Expert opinion).

Legal and Ethical Considerations: Address requests for re-infibulation with ethical principles and legal frameworks 7 (Evidence: Expert opinion).

References

1 Rodríguez-Sánchez V, Ventura-Miranda MI, Berthe-Kone O, Hernández-Padilla JM, Fernández-Sola C, Molina JG et al.. Understanding the consequences of Female Genital Mutilation: a phenomenological study in sub-Saharan women living in Spain. Midwifery 2023. link 2 Jacobson D, Grace D, Boddy J, Einstein G. Reproductive health care appointments: How the institutional organization of obstetric/gynecological work shapes the experiences of women with female genital cutting in Toronto, Canada. PloS one 2023. link 3 Thomas HS, Mmonu NA, Amend G, Dubinskaya A, Johnson-Agbakwu C, Rowen TS et al.. Awareness, Clinical Experience and Knowledge of Female Genital Mutilation/Cutting Among Female Pelvic Medicine and Reconstructive Surgeons in the United States. Urology 2022. link 4 Turkmani S, Homer CSE, Dawson AJ. Understanding the Experiences and Needs of Migrant Women Affected by Female Genital Mutilation Using Maternity Services in Australia. International journal of environmental research and public health 2020. link 5 Scamell M, Ghumman A. The experience of maternity care for migrant women living with female genital mutilation: A qualitative synthesis. Birth (Berkeley, Calif.) 2019. link 6 Turkmani S, Homer CSE, Dawson A. Maternity care experiences and health needs of migrant women from female genital mutilation-practicing countries in high-income contexts: A systematic review and meta-synthesis. Birth (Berkeley, Calif.) 2019. link 7 Saleh M, Friesen P, Ades V. On Female Genital Cutting: Factors to be Considered When Confronted With a Request to Re-infibulate. Journal of bioethical inquiry 2018. link 8 Moaddab A, McCullough LB, Chervenak FA, Stark L, Schulkin J, Dildy GA et al.. A survey of honor-related practices among US obstetricians and gynecologists. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2017. link 9 Abdulcadir J, Dugerdil A, Boulvain M, Yaron M, Margairaz C, Irion O et al.. Missed opportunities for diagnosis of female genital mutilation. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2014. link 10 Zenner N, Liao LM, Richens Y, Creighton SM. Quality of obstetric and midwifery care for pregnant women who have undergone female genital mutilation. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2013. link 11 Perron L, Senikas V, Burnett M, Davis V. RETIRED: Female genital cutting. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2013. link30792-1) 12 Purchase TC, Lamoudi M, Colman S, Allen S, Latthe P, Jolly K. A survey on knowledge of female genital mutilation guidelines. Acta obstetricia et gynecologica Scandinavica 2013. link 13 Moeed SM, Grover SR. Female genital mutilation/cutting (FGM/C): survey of RANZCOG fellows, diplomates & trainees and FGM/C prevention and education program workers in Australia and New Zealand. The Australian & New Zealand journal of obstetrics & gynaecology 2012. link 14 Dave AJ, Sethi A, Morrone A. Female genital mutilation: what every American dermatologist needs to know. Dermatologic clinics 2011. link 15 Zaidi N, Khalil A, Roberts C, Browne M. Knowledge of female genital mutilation among healthcare professionals. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2007. link 16 Thierfelder C, Tanner M, Bodiang CM. Female genital mutilation in the context of migration: experience of African women with the Swiss health care system. European journal of public health 2005. link 17 Morrone A, Hercogova J, Lotti T. Stop female genital mutilation: appeal to the international dermatologic community. International journal of dermatology 2002. link 18 Collinet P, Stien L, Vinatier D, Leroy JL. Management of female genital mutilation in Djibouti: the Peltier General hospital experience. Acta obstetricia et gynecologica Scandinavica 2002. link

Female genital infection