Clinical management of women with female genital mutilation (FGM) requires high quality care that is accessible, sensitive and informed, while safeguarding girls at risk, according to revised guidelines published today (10 July) by the RCOG.
FGM refers to ‘all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons’. An estimated 137,000 women and girls in England and Wales have undergone the practice which affects those from certain communities from Africa, Asia and the Middle East who often have complex healthcare needs.
Pregnancy presents a key opportunity for healthcare professionals to identify women with FGM, provide information and advice, address healthcare needs and assess the risk to the unborn child or other female family members. This Green-top Guideline provides evidence-based advice for obstetricians and gynaecologists on the clinical care of women with FGM before, during and after pregnancy, including legal and regulatory responsibilities. It is also relevant for other healthcare professionals caring for women with FGM.
Clinicians must be aware of the short and long term complications of FGM, including scarring, urinary infections, menstrual difficulties, impaired sexual function, painful sexual intercourse, obstetric complications and psychological trauma.
The guideline also emphasises that all healthcare professionals must be aware of the Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland, and the Prohibition of Female Genital Mutilation Act 2005 in Scotland, which state that:
- FGM is illegal unless it is a surgical operation on a girl or woman which is necessary for her physical or mental health or for purposes connected with labour or childbirth.
- It is illegal to arrange, or assist in arranging for a UK national or UK resident to be taken overseas for the purpose of FGM.
- It is an offence to fail to protect a girl from risk of FGM, including those who have parental responsibility.
- If FGM is confirmed in a girl under 18 years of age, reporting to the police is mandatory.
In order to ensure a consistent approach to data monitoring, the Department of Health has implemented the FGM Enhanced Dataset in England, which requires all acute trusts, general practices and mental health trusts to record data about women with FGM on a monthly basis. Healthcare professionals must understand the difference between recording FGM (for the purpose of the FGM Enhanced Dataset), and reporting FGM (making a referral to the police and/or social services), and their responsibilities with respect to each of these. There should be a lead consultant and/or midwife responsible for the care of women with FGM in all hospitals.
The guideline addresses de-infibulation and clitoral reconstruction. Women who are likely to benefit from de-infibulation should be counselled and offered the procedure before pregnancy and ideally before first sexual intercourse. Clitoral reconstruction should not be performed because current evidence suggests that there are associated complication rates without conclusive evidence of benefit.
Re-infibulation is illegal, there is no clinical justification for the procedure and it should not be undertaken under any circumstances.
Dr Naomi Low-Beer, lead author of the guideline said:
“FGM is a violation of human rights and a form of child abuse for which there can be no justification. Thousands of vulnerable women in the UK are living with the long-term physical and psychological consequences of FGM, and these women must receive high quality care by obstetricians, gynaecologists and other healthcare professionals.
"We must be aware of our pivotal responsibility to provide accessible advice, treatment and support whilst ensuring that children are protected.”
Dr Manish Gupta, Co-Chair of the RCOG Guidelines Committee said:
“This guideline, drawing on the latest scientific evidence and expert opinion, provides further clarity on how healthcare professionals should manage FGM, as well as the organisation of services for women with FGM. The guideline is intended for use alongside established training programmes and we urge all healthcare professionals caring for women and girls to undertake Health Education England’s FGM e-learning programme.
"Trusts have a responsibility to ensure that all women with FGM can access specialist FGM services, and that their staff have received appropriate training.”
For further information, please contact the RCOG Media and PR team on +44 20 7772 6300 or email firstname.lastname@example.org.
This is the second edition of the guideline, previously published under the same title in 2009.
Read the Q&A on the revised RCOG Green-top Guideline on the management of FGM here.
The Department of Health has also published a letter today reminding healthcare professionals about their duties during the ‘cutting season’. Included in this letter are links to the FGM e-learning training programme for clinicians and guidance on safeguarding.
The Intercollegiate report: Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting is available here.
Health Education England have developed an e-FGM educational programme for healthcare professionals which is available here.
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The Royal College of Obstetricians and Gynaecologists - Bringing to life the best in women’s health care. The RCOG is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.