What approach should be used in the care of a woman affected by FGM?

It is important that health practitioners examine their own personal attitudes towards the practice of FGM. While health practitioners may regard FGM as an oppressive act against girls, women affected by the practice view FGM as part of their ‘honour’ and self-identity (Denholm, 1998).

The practice is carried out with the best interests of young girls at heart. However harmful it may seem from a western viewpoint, FGM is commonly sanctioned by the community and endorsed by loving parents in the belief that it will ensure their daughter’s health, chastity, hygiene, fertility, honour and eligibility for marriage (Denholm, 1998).

When caring for a woman with FGM, consider the following issues:

• Use FGM resources to increase your knowledge about FGM, including the beliefs which sustain the practice.
• Let the woman know of your understanding of FGM: this may make her feel comfortable raising any concerns.
• Consider referral to a female doctor.
• Document findings in detail, to minimise the need for repeat examinations.
• Avoid discussing FGM in a family consultation.
• Be aware that the woman may never have had a gynaecological examination.
• Be aware that pelvic examination may be difficult, painful or impossible, and consider not continuing if it is unduly uncomfortable or painful, or careful angulation of instruments and one-finger examination may be necessary.
• Recognise that a woman may regard her genitalia as normal, she may be unaware that she has undergone FGM, or deny that this is the case.
  Recognise that women may be unaware that there are medical complications associated with FGM, as these have been considered ‘normal’.