Pediatric female genital mutilation (FGM)

Ritual cutting and alteration of the genitalia of female infants, girls, and adolescents, referred to as female genital mutilation (FGM), is still practiced in parts of Africa and among certain communities in the Middle East and Asia. Immigrants in the United States from areas where FGM is endemic may have daughters who have undergone a ritual genital procedure. Children adopted from these regions may also be affected.

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What is pediatric female genital mutilation (FGM)?

The idea behind this dangerous and painful practice is that women who experience sexual pleasure are impossible to control and unfit for marriage.

The average age of girls who undergo mutilation is seven, and mutilation is often performed without anesthesia. It may include cutting out part of the clitoris or total removal of the clitoris and labia (infibulation), usually followed by sewing the remaining tissue closed except for a small opening for menstrual blood and urine. Traditionally, infibulated females are cut open on their wedding night.

Consequences of genital mutilation include bleeding, potentially life-threatening infection, scarring, and psychological problems. Infibulated women are more susceptible to AIDS, as well as hemorrhaging and infection during childbirth.

Many of these girls and women have long-term gynecological and urinary tract problems such as:

Painful cyst formation
Painful menstruation
Painful urination (dysuria)
Painful intercourse
Recurrent urinary tract infections
Chronic vaginal infections
Infertility

What are the different types of pediatric female genital mutilation (FGM)?

The World Health Organization describes four main types of female genital mutilation:

Clitoridectomy - Partial or complete removal of the clitoris and/or the prepuce
Excision - Partial or complete removal of the clitoris and the labia minora (small lips), with or without removal of the labia majora (large lips)
Infibulation - Complete removal of the external genitalia (clitoris and labia) usually followed by closure of the remaining wound except for a small opening for menses and urine
Other - Includes all other harmful procedures done to the female genitals for nonmedical purposes (such as pricking, piercing, carving (incising), scraping, and cauterizing the genital area)

How is pediatric female genital mutilation (FGM) diagnosed?

Girls who have undergone FGM will present with a reported history of prior genital instrumentation. Those that are unaware will likely report painful periods or pain with urination. Definitive diagnosis is done with a through physical exam including a pelvic exam.

How is pediatric female genital mutilation (FGM) treated?

Treatment of girls and young women who have undergone FGM is both physical and psychological. We recommend counseling and possible psychological treatment for all affected patients. Immigrant families should be educated about the dangers of this procedure.

When an FGM patient comes to Children’s Health, she will undergo examination by one of our pediatric gynecologists. If infection is present, we will first treat that infection with oral antibiotics – or intravenous antibiotics if the infection is severe.

Though we cannot restore sensitive tissue that has been removed, we can perform surgery to remove cysts and open up the lower vagina (defibulation) – which may help with childbirth in the future.