FEMALE GENITAL MUTILATION

• There are NO health indications for female genital mutilation
• Acute complications:
  - Haemorrhage
  - Shock
  - Urinary retention
  - Damage to urethra, anus
  - Cellulitis
  - Abscess formation

Treatment:

• Wound debridement, saline irrigation, remove all foreign material
• Remove minimal tissue, drain abscess
• Antibiotics for infected wounds, cellulitis, abscess
• Catheterize bladder
• Tetanus toxoid if non-immune
• Excise epidermal tissue, if present, to permit urinary flow and sexual intercourse

Chronic complications include:

• Sexual dysfunction, dyspareunia
• Psychological disturbance
• Urinary obstruction
• Keloids
• Large epidermal inclusion cysts
• Difficult urination
• Vaginal stenosis; may cause obstructed labour, often complicated by vesico- or recto- vaginal fistulae

DELIVERY IN THE PRESENCE OF INFIBULATION

Vaginal closure due to type III female genital mutilation

• Women with type III FGM – infibulation need to be opened for childbirth to reduce the risk of serious tears and obstructed labor.
• The first choice should be defibulation, opening of the infibulated scar, which is a less infringing procedure than episiotomy, as the seal of skin covering the vagina is usually thin with few nerves and blood vessels

Infiltrate 2-3 ml of local anesthetics into the area where the cut will be made, along the scar and in both sides of the scar With your finger or dilator inside the scar, introduce the scissors and cut the scar alongside the finger or fingers to avoid injury to the adjacent tissues The cut should be made along the mid-line of the scar towards the pubis Incise the mid-line to expose the urethral opening Review whether episiotomies will also be necessary to avoid tearing After childbirth, suture the raw edges separately using fine 3/0 catgut to secure hemostasis and prevent adhesion formation