Canadian medical student knowledge and attitudes toward female genital mutilation.

Background: Despite female genital mutilation/cutting (FGM/C) practices being an illegal form of gender-based violence in Canada, this practice impacts many Canadians. Lack of education and training among Canadian health-care providers has resulted in systematic barriers to care. Awareness and FGM/C-related education among Canadian health-care providers must be urgently assessed. Methods: Canadian medical students were recruited to complete an anonymous survey via E-mails distributed through their schools' student organization between January and March 2021. We evaluated student understanding of FGM/C, attitudes toward medicalization and legislation, and prior clinical experience using multiple choice, Likert scale, and open-response questions. Results: Respondents (n = 135) performed poorly on knowledge assessment questions (mean percent correct <50%). Only 10.4% of respondents indicated knowing how to involve appropriate authorities when necessary, and most never evaluate FGM/C in patient history (86.7%) or clinical examination (57.1%). Subgroup analysis revealed that prior education significantly improved knowledge scores and influenced students' behaviors and attitudes. About 92.2% of respondents supported the integration of FGM/C curricula in undergraduate medical education. Discussion: This study reveals that Canadian medical students have a poor understanding of FGM/C and are not prepared to identify affected patients or intervene when necessary. These results provide rationale for the implementation of FGM/C-learning modules in undergraduate medicine.

Postoperative pain after clitoral reconstruction in women with female genital mutilation: An evaluation of practices.

INTRODUCTION: More than 200 million women and girls have undergone genital mutilation. Clitoral reconstruction (CR) can improve the quality of life of some of them, but is accompanied by significant postoperative pain. OBJECTIVE: Assess and describe the management of postoperative pain after CR, and the practices amongst specialists in different countries. METHODS: Between March and June 2020, 32 surgeons in 14 countries (Germany, Austria, Belgium, Burkina Faso, Canada, Ivory Coast, Egypt, Spain, United States of America, France, the Netherlands, Senegal, Switzerland, Sweden) responded to an online questionnaire on care and analgesic protocols for CR surgery. RESULTS: At day 7 post CR, 97% of the surgeons observed pain amongst their patients, which persisted up to 1 month for half of them. 22% of the participants reported feeling powerless in the management of such pain. The analgesic treatments offered are mainly step II and anti-inflammatory drugs (61%). Screening for neuropathic pain is rare (3%), as is the use of pudendal nerve block, used by 8% of the care providers and only for a small percentage of women. CONCLUSION: Pain after CR is frequent, long-lasting, and potentially an obstacle for the women who are willing to undergo clitoral surgery and also their surgeons. Most surgeons from different countries follow analgesic protocols that do not use the full available therapeutic possibilities. Early treatment of neuropathic pain, optimisation of dosing of standard analgesics, addition of opioids, use of acupuncture, and routine intraoperative use of pudendal nerve block might improve the management of pain after CR.

[No ban on hymen reconstruction surgery]. / Geen verbod op 'herstel maagdenvlies'.

The Dutch Ministry of Health, Welfare and Sport recently proposed a ban on hymen reconstruction surgery. In this article, we argue against this proposal by discussing different arguments used in this debate. We argue that defining this type of surgery as female genital mutilation (FGM) is not sufficient to justify a ban, as other forms of genital surgery in adults also fall within the definition of FGM. We also argue against the idea that a ban is justified because this type of operation is based on patriarchal ideas of sexuality and virginity. Rather than banning this practice, doctors should inform women and suggest possible alternatives.

Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway.

BACKGROUND: Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. METHODS: We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. FINDINGS: We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants' intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. CONCLUSION: The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.

Programa de Educación para la Salud: sexualidad en mujeres víctimas de mutilación genital femenina / Health Education Program: Sexuality in female genital mutilation victims

Se presenta un programa de educación sexual orientado a la mujer que ha sufrido mutilación genital femenina (MGF), que se incluye en grupos preconstituidos que abordan temas relacionados con el cuidado y la salud. Este programa estará dirigido por matronas y mediadores culturales, y requiere una colaboración interdisciplinar. El objetivo del programa es promover la vivencia positiva de la sexualidad en la mujer mutilada. Se propone un programa de salud de seis sesiones con objetivos educativos y criterios de resultado. Se sugiere realizar la evaluación mediante un cuestionario que permitirá conocer los cambios en conocimientos, habilidades y actitudes producidos, junto a indicadores de cobertura, proceso y resultados y un cuestionario de satisfacción

We present a sexual education program targeted to women who have suffered female genital mutilation (FGM), to be included in pre-established groups addressing topics associated with care and health. This program will be led by midwives and cultural mediators, and requires interdisciplinary collaboration. The objective of this program is to promote a positive experience of sexuality in mutilated women. A six-session health program is put forward, with educational objective and outcome criteria. It is suggested to conduct the evaluation through a questionnaire that will allow to learn about the changes occurred in knowledge, skills and attitudes, together with indicators for coverage, process and outcomes, and a satisfaction questionnaire

The Problem of Female Genital Cutting: Bridging Secular and Islamic Bioethical Perspectives.

Recent events, including the arrest of physicians in Michigan, have renewed bioethical debates surrounding the practice of female genital cutting (FGC). The secular discourse remains divided between zero-tolerance activists and harm-reduction strategists, while Islamic bioethical debates on FGC similarly comprise two camps. "Traditionalists" find normative grounds for a minor genital procedure in statements from the Prophet Muhammad and in classical law manuals. "Reformers" seek to decouple FGC from Islam by reexamining its ethico-legal status in light of the deficiencies within narrations ascribed to the Prophet, the health risks posed by FGC, and contemporary perspectives on human rights, and thereby delegitimize the practice. This paper argues that alignment between secular and Islamic views can be found in a harm-reduction strategy by demonstrating that the impetus to reduce harms is found within Prophetic statements on FGC. From an Islamic ethico-legal standpoint, it is justified to acknowledge the permitted status of FGC procedures that do not harm-in other words, the ritual nick-and at the same time the prohibited status of procedures that lead to credible medical and psychological harms. Bringing these multiple perspectives and data points into conversation forges a common ground to delegitimize and eradicate harmful genital procedures among Muslim communities.

Female genital mutilation: an update for primary health-care professionals.

Female genital mutilation (FGM) has historically been seen as a health concern limited to women living in other parts of the world. However, with the rising number of migrants, refugees and asylum seekers, countries like New Zealand, Australia and Europe have seen a surge in the number of women and girls affected by FGM seeking medical care. This topic is increasingly becoming relevant to primary health-care providers in this country and therefore a good understanding of this practice is important.

Riesgo de mutilación genital femenina. Propuesta de diagnóstico de enfermería / Risk for female genital mutilation. Proposal for nursing diagnosis

Objetivo principal: Desarrollar un diagnóstico enfermero para la detección y prevención de la Mutilación Genital Femenina (MGF). Metodología: La creación del presente diagnóstico se basa en un exhaustivo estudio bibliográfico en bases de datos como LILACS, CUIDEN, TESEO y Web of Sciencie; y otras fuentes documentales de organismos internacionales. Propuesta diagnóstica: "Riesgo de Mutilación Genital Femenina" se define como: Susceptible a la ablación parcial o total de los genitales externos femeninos y otras lesiones de los genitales, ya sea por razones culturales, religiosas o por cualquier otra causa no terapéutica que pueda comprometer la salud. Se establecen para él los siguientes factores de riesgo: Falta de conocimiento familiar sobre el impacto de la práctica en la salud física; Falta de conocimientos familiares sobre el impacto de la práctica en la salud reproductiva; y Falta de conocimientos familiares sobre el impacto de la práctica en la salud psicosocial. Además se incluye la siguiente población en riesgo sobre la que se debe realizar el seguimiento: ser niña o mujer; residir en el país donde se acepta la práctica; pertenecer a un grupo étnico en el que se realiza la práctica; pertenecer a una familia en la que alguna mujer haya sido sometida a MGF; actitud favorable de la familia hacia la práctica; y planificación para visitar el país de origen de la familia. Conclusión: La creación de un diagnóstico de riesgo para la prevención de la MGF, sitúa a Enfermería como una pieza clave su erradicación

Objective: To develop a nursing diagnosis for the detection and prevention of Female Genital Mutilation (FGM). Methods: The creation of this diagnosis is based on exhaustive bibliographic research of databases such as LILACS, CUIDEN, TESEO y Web of Sciencie; as well as other documentary sources from international entities. Diagnostic proposal: "Risk for Female Genital Mutilation" is defined as: Susceptible to full partial ablation of the female external genitalia and other lesions or the genitalia, whether for cultural, religious or any other non-therapetic reasons, which may compromise health. The following risk factors are established for this diagnosis: Lack of family knowledge about impact of practice on physical health; Lack of family knowledge about impact of practice on reproducitive health; Lack of family knowledge about impact of practice on psychosocial health. It also includes the following at-risk population that should be monitored: To be female (woman or girl); Residing in country where practice is accepted; Family leaders belong to ethnic group in which practive is accepted; Belonging to family in which any female member has been subjected to practice favorable attitude of family towards practice; and Planning to visit family's country origin. Conclusions: The creation of an "at-risk" nursing diagnosis for the prevention of FGM would situate nursing at the forefront of efforts to eradicate this practice

Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a cultural practice that involves several types of removal or other injury to the external female genitalia for nonmedical reasons. Although much international research has focused on the health consequences of the practice, little is known about sexual functioning among women with various types of FGM/C. OBJECTIVE: To assess the impact of FGM/C on the sexual functioning of Sudanese women. STUDY DESIGN: This is a cross-sectional study conducted at Doctor Erfan and Bagedo Hospital, Jeddah, Saudi Arabia. Eligible women completed a survey and a clinical examination, which documented and verified women's type of FGM/C. The main outcome measure was female sexual function, as assessed by the Arabic Female Sexual Function Index. RESULTS: A total of 107 eligible women completed the survey and the gynecological examination, which revealed that 39% of the women had FGM/C Type I, 25% had Type II, and 36% had Type III. Reliability of self-report of the type of FGM/C was low, with underreporting of the extent of the procedure. The results showed that 92.5% of the women scored lower than the Arabic Female Sexual Function Index cut-off point for sexual dysfunction. The multivariable regression analyses showed that sexual dysfunction was significantly greater with more extensive type of FGM/C, across all sexual function domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and overall. CONCLUSION: The study documents that a substantial proportion of women subjected to FGM/C experience sexual dysfunction. It shows that the anatomical extent of FGM/C is related to the severity of sexual dysfunction.

Female genital mutilation in children presenting to Australian paediatricians.

OBJECTIVE: The WHO reports that female genital mutilation/cutting (FGM/C) is an ancient cultural practice prevalent in many countries. FGM/C has been reported among women resident in Australia. Our paper provides the first description of FGM/C in Australian children. DESIGN: Cross-sectional survey conducted in April-June 2014. SETTING: Paediatricians and other child health specialists recruited through the Australian Paediatric Surveillance Unit were asked to report children aged <18 years with FGM/C seen in the last 5 years, and to provide data for demographics, FGM/C type, complications and referral for each case. PARTICIPANTS: Of 1311 eligible paediatricians/child health specialists, 1003 (76.5%) responded. RESULTS: Twenty-three (2.3%) respondents had seen 59 children with FGM/C and provided detailed data for 31. Most (89.7%) were identified during refugee screening and were born in Africa. Three (10.3%) were born in Australia: two had FGM/C in Australia and one in Indonesia. All parents were born overseas, mainly Africa (98.1%). Ten children had WHO FGM/C type I, five type II, five type III and six type IV. Complications in eight children included recurrent genitourinary infections, menstrual, sexual, fertility and psychological problems. Nineteen children (82.6%) were referred to obstetrics/gynaecology: 16 (69.9%) to social work and 13 (56.5%) to child protection. CONCLUSIONS: This study confirms that FGM/C is seen in paediatric clinical practice within Australia. Paediatricians need cultural awareness, education and resources to help them identify children with FGM/C and/or at risk of FGM/C, to enable appropriate referral and counselling of children, families and communities to assist in the prevention of this practice.

Propuesta de diagnóstico de Síndrome Post Mutilación Genital Femenina / Proposal for nursing diagnosis: Post Female Genital Mutilation Syndrome

Objetivo: Desarrollar un diagnóstico enfermero para la detección y prevención de la MGF. Metodología: La creación del presente diagnóstico se basa en un exhaustivo estudio bibliográfico en bases de datos como LILACS, CUIDEN, TESEO y Web of Sciencie; y otras fuentes documentales de organismos internacionales. Resultados principales: Síndrome post Mutilación Genital Femenina se define como: el deterioro de una serie de dominios de la salud como consecuencia de una mutilación genital femenina. Este diagnóstico se sitúa en el dominio 11, seguridad/protección y se posiciona en la clase 3: violencia. Se establecen para él las siguientes características definitorias: fase aguda, respuestas físicas crónicas, respuestas relacionadas con la sexualidad, alteraciones obstétricas crónicas y respuestas psicológicas. Conclusión principal: La creación del presente diagnóstico de síndrome facilita a los y la profesionales de enfermería el abordaje de las consecuencias sobre la salud de la Mutilación Genital Femenina y sitúa a Enfermería como una pieza clave para su abordaje y erradicación (AU)

Objective: To develop a nursing diagnosis for the detection and prevention of FGM. Methods: The creation of this diagnosis is based on exhaustive bibliographic research of databases such as LILACS, CUIDEN, TESEO y Web of Sciencie; as well as other documentary sources from international entities. Results: Post Female Genital Mutilation Syndrome is defined as: Deterioration of a range of health domains as a result of female genital mutilation.This diagnosis belongs to domain 11: safety/protection and class 3: violence. The following defining characteristics are established for this diagnosis: Acute phase, chronic responses physical, sexuality, chronic obstetric alterations and psychological responses. Conclusions: Via the diagnosis presented herein, early detection might be procured by nursing professionals of those women and young girls having undergone this traditional practice, thereby being able to treat any possible resultant sequelae (AU)

Punishment of Minor Female Genital Ritual Procedures: Is the Perfect the Enemy of the Good?

Female genital alteration (FGA) is any cutting, removal or destruction of any part of the external female genitalia. Various FGA practices are common throughout the world. While most frequent in Africa and Asia, transglobal migration has brought ritual FGA to Western nations. All forms of FGA are generally considered undesirable for medical and ethical reasons when performed on minors. One ritual FGA procedure is the vulvar nick (VN). This is a small laceration to the vulva that does not cause morphological changes. Besides being performed as a primary ritual procedure it has been proposed as a substitute for more extensive forms of FGA. Measures advocated or taken to reduce the burden of FGA can be punitive or non-punitive. Even if it is unethical to perform VN, we argue that it also is unethical to attempt to suppress it through punishment. First, punishment of VN is likely to cause more harm than good overall, even to those ostensibly being protected. Second, punishment is likely to exceed legitimate retributive ends. We do not argue in favor of performing VN. Rather, we argue that non-punitive strategies such as education and harm reduction should be employed.

Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on "FGM".

The spectrum of practices termed "Female Genital Mutilation" (or FGM) by the World Health Organization is sometimes held up as a counterexample to moral relativism. Those who advance this line of thought suggest the practices are so harmful in terms of their physical and emotional consequences, as well as so problematic in terms of their sexist or oppressive implications, that they provide sufficient, rational grounds for the assertion of a universal moral claim--namely, that all forms of FGM are wrong, regardless of the cultural context. However, others point to cultural bias and moral double standards on the part of those who espouse this argument, and have begun to question the received interpretation of the relevant empirical data on FGM as well. In this article I assess the merits of these competing perspectives. I argue that each of them involves valid moral concerns that should be taken seriously in order to move the discussion forward. In doing so, I draw on the biomedical "enhancement" literature in order to develop a novel ethical framework for evaluating FGM (and related interventions--such as female genital "cosmetic" surgery and nontherapeutic male circumcision) that takes into account the genuine harms that are at stake in these procedures, but which does not suffer from being based on cultural or moral double standards.

Mutilación genital femenina: elementos necesarios para su enfrentamiento / Female Genital Mutilation: necessary elements for its confrontation

Introducción: La mutilación genital femenina (MGF) es una costumbre violatoria de los derechos humanos de las niñas y las mujeres. Objetivo: Describir elementos necesarios relacionados con la mutilación genital femenina. Material y Métodos: Se realizó una revisión bibliográfica en bases de datos disponibles en la plataforma Infomed (Pubmed, EBSCO, Hinari, Scielo) de 18 materiales científicos impresos y electrónicos relacionados con el tema, todos en el último quinquenio y utilizando los descriptores de búsqueda: mutilación genital femenina, tipos, complicaciones, factores de riesgos y prevención. Desarrollo: El número de niñas y jóvenes en riesgo de padecer mutilación genital aumenta en Europa y África, no se puede establecer una religión única, la práctica de la mutilación genital femenina es anterior al Islam y no es habitual entre la mayoría de los musulmanes. Existen diferentes tipos de mutilación: I, II, III, IV, depende de la región anatómica comprometida. Las complicaciones más sobresalientes son: dolor intenso, hemorragias, tétanos, septicemia y psicológicas. Se citan elementos preventivos por el sistema de salud que disminuye la práctica. Conclusiones: La MGF constituye una de las técnicas nefastas más significativas, sumado a ello los principios de internacionalismo del médico cubano prueba que la descripción de los componentes epidemiológicos, tipos, complicaciones de la práctica y el enfoque social de las acciones preventivas; ayudan a los trabajadores de la salud a revertir tal proceder(AU)

Introduction: Female genital mutilation is a violation of human rights of girls and women. Objective: to describe necessary elements related to female genital mutilation. Material and Methods: A literature review of 18 printed and electronic supported scientific materials related to the topic available in Infomed platforms databases (Pubmed, EBSCO, Hinari, Scielo) was performed, all included in the last five years and using searching describers: female genital mutilation, types, complications, risk factors and prevention. Development: The number of girls and young women at risk of genital mutilation increases in Europe and Africa, it is not possible to establish a single religion; practice regarding female genital mutilation predates Islam and is not common among most Muslims. There are different types of mutilation: I, II, III, IV, depends on the anatomical region. The most significant complications include severe pain, hemorrhage, tetanus, septicemia and psychological. Preventive elements are referred by the health system that reduces its practice. Conclusions: female genital mutilation is one of the most significant fateful techniques, added to it, the internationalism principles of the Cuban doctor, proof that the description of epidemiological components, types, complications of it practice and a social approach of preventive actions, help health workers to revert this conduct(AU)

Algoritmo de actuación en la prevención de la mutilación genital femenina. Estudio de casos desde atención primaria / Algorithm for the prevention of female genital mutilation. Case study from primary care

OBJETIVO: Crear e implantar un algoritmo para identificar y prevenir la MGF en un municipio de la Región de Murcia. DISEÑO: Para la creación del algoritmo de actuación se ha realizado una revisión bibliográfica, consultando las bases de datos: Cuiden, Dialnet, Medes, Medline y otras fuentes documentales de interés. El instrumento para la recogida de datos se cumplimenta mediante entrevista a los padres de las niñas en riesgo. REDACCIÓN E IMPLEMENTACIÓN: Se formó al equipo multidisciplinar, se captaron los casos de riesgo de MGF y fueron citados en la consulta de enfermería. Dos niñas habían sido mutiladas, el resto presentaba riesgo de MGF y en uno de los casos el riesgo era inminente. CONCLUSIÓN: El algoritmo diseñado orienta a los profesionales en su actuación, consiguiendo una eficaz detección y prevención de mutilación genital de las niñas y resulta una primera aproximación para el desarrollo de un protocolo regional

OBJECTIVE: Create and implement a protocol for identifying and preventing female genital mutilation in a municipality of the Region of Murcia. DESIGN: A bibliographical review and significant databases were consulted for the creation of the algorithm performance. These include Cuiden, Dialnet, Medes, Medline, and other documentary sources of interest. The instrument for data collection was completed by interviewing parents of girls at risk. DRAFTING AND IMPLEMENTATION: The multi-disciplinary team was formed; the female genital mutilation risk cases were collected, and were summoned to the nursing consulting room. Two girls had been mutilated, the rest were at risk of female genital mutilation, and in one case the risk was imminent. CONCLUSION: The algorithm designed guides practitioners in their performance, achieving an effective detection and prevention of genital mutilation of girls. This is a first approach to the development of a regional protocol

Female genital alteration: a compromise solution.

Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration (FGA) in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced. In order to better protect female children from the serious and long-term harms of some types of non-therapeutic FGA, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. We offer a revised categorisation for non-therapeutic FGA that groups procedures by effect and not by process. Acceptance of de minimis procedures that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights. More morbid procedures should not be performed. However, accepting de minimis non-therapeutic f FGA procedures enhances the effort of compassionate practitioners searching for a compromise position that respects cultural differences but protects the health of their patients.