WHO Guidelines on the Management of Health Complications from Female Genital Mutilation

Overview

This Guidelines summary of the World Health Organization (WHO) guideline includes recommendations on the management of health complications from female genital mutilation (FGM) that are relevant to primary care. The original guideline provides standards that may serve as the basis for developing local and national guidelines and healthcare provider training programmes.

FGM comprises all procedures that involve the partial or total removal of external genitalia or other injury to the female genital organs for nonmedical reasons. The procedure has no known health benefits. Moreover, the removal of or damage to healthy genital tissue interferes with the natural functioning of the body and may cause several immediate and long-term health consequences.

For further information on FGM, recommendations on deinfibulation, and details of recommendation strength, refer to the full guideline.

Reflecting on your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

Guiding Principles

• Girls and women living with FGM have experienced a harmful practice and should be provided quality healthcare
• All stakeholders—at the community, national, regional, and international level—should initiate or continue actions directed towards the primary prevention of FGM
• Medicalisation of FGM (that is, performance of FGM by healthcare providers) is never acceptable because this violates medical ethics, since:
  • FGM is a harmful practice
  • medicalisation perpetuates FGM
  • the risks of the procedure outweigh any perceived benefit.

Deinfibulation

• Deinfibulation is a minor surgical procedure carried out to reopen the vaginal introitus in women living with type III FGM
• A trained health professional performs an incision of the midline scar tissue that covers the vaginal introitus until the external urethral meatus, and eventually the clitoris, are visible. The cut edges are then sutured, which allows the introitus to remain open
• This procedure is performed to improve health and wellbeing, as well as to allow intercourse and/or to facilitate childbirth.

For recommendations on deinfibulation for obstetric or urological complications, deinfibulation for facilitating childbirth, preoperative briefing, and local anaesthesia, refer to the full guideline.

Mental Health 

• Cognitive behavioural therapy (CBT) should be considered for girls and women living with FGM who are experiencing symptoms consistent with anxiety disorders, depression, or post-traumatic stress disorder (PTSD)
  • CBT may be considered provided that:
    • a psychiatric diagnosis of anxiety disorder, depression, or PTSD has been established, and
    • it is offered in contexts where individuals are competent (that is, trained and supervised) to provide the therapies
  • because web-based programmes can be accessed anonymously and anywhere a computer is available, these services have the potential to surmount stigma, as well as geographical and financial barriers to accessing mental health treatment, making them a plausible therapeutic option for this population
• Psychological support should be available for girls and women who will receive or have received any surgical intervention to correct the health complications of FGM.

Female Sexual Health

• Sexual counselling is recommended for preventing or treating female sexual dysfunction among women living with FGM.

Information and Education

• Information, education, and communication (IEC) interventions regarding FGM and women’s health should be provided to girls and women living with any type of FGM
  • the WHO defines IEC interventions as ‘a public health approach aiming at changing or reinforcing health-related behaviours in a target audience, concerning a specific problem and within a predefined period of time, through communication methods and principles’
  • educational interventions should be:
    • evidence-informed and scientifically accurate
    • nonprejudicial
    • nonjudgemental
    • sensitive and respectful
    • nonstereotypical
    • based on adolescents’ evolving capacities (when provided to this group)
• Health education and information on deinfibulation should be provided to girls and women living with type III FGM
  • health education is the provision of accurate and truthful information so that a person can become knowledgeable about a subject and make an informed decision
  • in the case of deinfibulation for girls and women living with type III FGM, health education aims to provide scientific, noncoercive information to help clients understand the surgical procedure, its benefits, and its potential associated complications. Health education on deinfibulation should contain the following:
    • a description of the surgical procedure
    • health benefits of deinfibulation
    • potential immediate and long-term adverse surgical outcomes
    • anatomical and physiological changes clients may experience after the procedure
    • information on adequate postoperative care
    • information about the health consequences of reinfibulation and the benefits of not reinfibulating
• Healthcare providers have the responsibility to convey accurate and clear information, using language and methods that can be readily understood by clients
• Information regarding different types of FGM and the associated respective immediate and long-term health risks should be provided to healthcare providers who care for girls and women living with FGM
• Information about FGM delivered to health workers should clearly convey the message that medicalisation is unacceptable. All provided information should:
  • specifically address medicalisation and its risks
  • contain scientifically accurate and evidence-based content
  • also target nonmedical staff, who in certain settings perform some healthcare tasks
  • be delivered in local languages (that is, with proper translations) to ensure adequate comprehension.