Family planning considerations

Many women affected by FGM have not accessed family planning services, and may have limited knowledge of their reproductive cycle and the types of contraception available. The Female Genital Mutilation 2008 Health Care Survey indicated that only 20% of Somali women were using any form of contraception, while 82% stated they would like more information about sexual and reproductive health issues (Denholm & Powell, 2008).

Women with FGM Type 3 have fewer effective contraception options. Natural family planning can be restrictive for infibulated women, who may have difficulty assessing the state of their mucus. Diaphragms and IUDs including Mirena may be difficult to insert due to a narrowed introitus. Depo Provera or Jadelle may be a preferred contraception option for some women affected by FGM (Denholm & Powell, 2009).

Sexual health screening for women with FGM

Performing vaginal examinations on infibulated women (prior to giving birth and/or sexual intercourse) is often difficult due to the narrowed introitus and requires sensitivity. Screening for some STIs and cervical smear taking may not be possible.

Discussing sexuality

Sexual and reproductive health issues are very sensitive topics among women affected by FGM; discussing these issues requires a trusting relationship between the woman and her health practitioner. Women with FGM Type 3 may require deinfibulation prior to marriage. However, a woman may feel reticent about discussing deinfibulation with her doctor. General practitioners are encouraged to raise the issue with women affected by FGM. Other areas that may need to be addressed include painful intercourse (particularly initial intercourse), fear of intercourse, decreased sexual fulfilment and vaginismus (Denholm & Powell, 2008).