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How much do you know about female genital mutilation (FGM)? You may have heard about it in the news, but would you know what to do if you thought a child was at risk? With increasing numbers of girls in the United Kingdom thought to be affected, the medical establishment has finally woken up to the need for a comprehensive and wide reaching approach. In 2011 the government published multiagency guidelines on FGM detailing the role of health professionals in offering high quality care to those affected and preventing future cases. 1 In May 2012, the chief medical officer issued a declaration that all health professionals should familiarise themselves with the actions they should take where they believe that a girl has undergone or is at risk of FGM.
These moves have established learning about FGM as integral to the basic medical curriculum. However, familiarity with how to manage a case is rather harder to acquire. No published data exist on the overall numbers who present to health services with FGM. Women tend to present to maternity services, whereas children tend to present as a child protection issue: the Metropolitan Police Service was involved with 135 so called incidents of concern relating to FGM in London between April 2008 and April 2011. 2 FGM is a sensitive and complex matter and few medical students will have direct exposure. Senior doctors will often exclude students and junior trainees from child protection consultations and specialist adult FGM clinics do not often welcome student observers. Although this might be understandable from the point of view of the patient and her family, it has obvious consequences for teaching and training. This article aims to offer medical students an overview of FGM and a clinical approach to its assessment, management, and prevention.
What is FGM?
FGM describes a range of procedures, often involving partial or total excision of the external female genitalia, for non-medical reasons (see box 1 and figures 1-4 for more detail). 3 Terminology can sometimes cause confusion in this area. The term "female genital mutilation" replaced "female circumcision" to emphasise the gravity of the act and distinguish the practice from male circumcision. It was adopted by the United Nations in the early 1990s and is now the...