a seminar presented at Alneelain University Faculty of Nursing sciences_ Obstetric and gynecological nursing department

1. FEMALE GENITAL MUTILATION
FGM

2. PRESENTED BY :
Asma al sadeg
Amira mohamed hassen
Amira mohamed ahmed
Amira isaac
Ekram osman

3. OBJECTIVES
By the end of this lecture the
learner will be able to :
• Know what is FGM
• Differentiate between Types of FGM .
• Identify short and long term
complications .
• Know The role of nurse to word
fighting FGM .

4. NORMAL FEMALE GENITALIA

5. INTRODUCTION
Definition:
According to the definition of the
WHO :
FGM comprises all procedures
involving partial or total removal of
all external female genitalia or other
injury to female genital organs for
non-medical reason .

6. CON..
 FGM also known as female circumcision [
FC] , or female genital cutting [FGC] and by
other term such as sunna , tahur and khitan
among others.
HISTORY :
 The practice’s are unknown .

7. WHY FGM IS CARRIED OUT ???
 FGM is carried out for various cultural ,
religious and social reasons within families and
communities in the mistaken belief that it will
benefit the girl in some way (for example, as a
preparation for marriage or to preserve her
virginity .
 However, no acceptable reasons that justify
FGM
 That is not required by religion and there are no
religious texts that say it should be done.

8. WHERE FGM IS CARRIED OUT????
 The practice is found in Africa Asia and middle
East, and within communities from countries in
which FGM is common.

9. INCIDENCES :
 [UNICEF] estimated in 2016 estimated in 200
million women living today in 30 countries -27 Africa
countries , Indonesia , image Kurdistan And Yemen
.
 In Sudan it’s about 90% .
 In Egypt about 97% .

10. CON..
 FGM has no place for as religion concerned
because islam forbids it , it has no place in
medicine because it is harmful and damaging . It
has no place to prevent promiscuity or preserve
virginity , because it is the upbringing of that girl
that protect her morals and her virginity so female
genital mutilation has no place in this day and age .

13. FEMALE GENITAL MUTILATION IS
CLASSIFIED INTO FOUR MAJOR TYPES :
1. Type 1 : Clitoridectomy
It is the partial or total removal of the clitoris (
small, sensitive and erectile part of the female
genitals ). In very rare cases ,only prepuce ( the
fold of skin surrounding the clitoris ).

14. 2. TYPE 2 : EXCISION
It is the partial or total removal of clitoris and the labia
minora ( the inner fold of the vulva ), with or without
excision of the labia majora ( the outer
fold of skin of the vulva ).

15. 3. TYPE 3 INFIBULATION
:
Also known as pharoanic circumcision ( most
severe form of FGM ).
It is the narrowing of the vaginal opening through
the creation of a covering seal. The seal is formed
by cutting and repositioning the labia minora or
labia majora, sometimes through stitching, with or
without
removal of clitoris.

16. 4. Type 4
It includes all other harmful procedures to the
female genitalia for non medical purposes, e.g.
pricking, piercing, incising, scraping and cauterizing
the genital area.

18. COMPLICATIONS
Of FGM

19. SHORT TERM COMPLICATION
Hemorrhage:
Hemorrhage is one of the most common
complication of FGM as excision of the clitoris
involve cutting across the high pressure clitoral
artery and attempts to stop bleeding may not be
effective ,acute extensive bleeding can lead to
hemorrhagic shock even sudden death .

20. CON..
 Shock:
It occurs because of blood loss and severe pain
and trauma of procedure .
 Pain:
The majority of mutilation procedures are
performed without anesthetics and cause the
girl severe pain , even if a local anesthetic is
used , multiple insertions of the needle are often
required .

21. CON..
 Urinary retention:
It is commonly due to pain , tissue swelling ,
inflammation , injury to urethra , and fear of
passing urine .
 Injury to adjacent tissue:
Injury to urethra , vagina , perineum , and
rectum can result from the use of crude
instruments , poor light , careless techniques .
 Failure to heal:
Wound may fail heal because of infection ,
irritation from urine , underlying anemia or
malnutrition .

22. CON..
Infection:
Due to unhygienic conditions , use of
unsterilized instruments , applications of
traditional herbs , septicemia and tetanus may
also develop .
Fracture or dislocation:
Fracture of clavicle , femur , humerus or hip
joint can occur if heavy pressure is applied to
struggling girl during the procedure also when
several adults hold her down .

23. LONG TERM COMPLICATIONS
 Difficulties with micturition:
Due to damage to urethral opening , obstruction
of the urinary opening .
 Recurrent UTI :
Partial occlusion of vagina and urethra means
the normal flow of urine is deflected and the
perineum remains constantly wet and susceptible
to bacterial growth .
 Chronic pelvic infections:
Partial occlusion of vagina and urethra increases the
likelihood of infection and ascending pelvic infection
are common .

24. CON..
 Infertility :
It is occur due to chronic pelvic infection causing
irreparable damage to the reproductive organs .
 Vulvul abscesses :
Due to deep infection resulting from faulty healing
causing formation of abscess .
 Fistula :
Vesico vaginal or recto vaginal fistula can form as
result of injure during circumcision ,de infibulations
,re infibulations ,sexual intercourse ,or obstructed
labor .

25. CON..
 Difficulties with menstruation :
Partial or total occlusion of vagina opening commonly
results of dysmenorrheal or amenorrhea
 Increase of HIV and hepatitis transmission :
Due to use of the same unsterile instruments in group
circumcisions .
 Keloid formation :
from slow , incomplete wound healing
leading to deposition of excess connective tissue
and vulval granulation .

26. CON..
 Sexual complications :
May include fear associated with initial sexual
intercourse , dyspareunia , difficult or inability to have
sexual intercourse .
 Psychosocial complications :
Include anxiety , fear , loss of trust , feeling of
incompleteness , loss of self esteem , panic disorders .

27. CON..
 Childbirth complications :
This complication depending on factor such
as the type of FGM , parity , and the nature of
scar tissue
o Incorrect assessment of the stage of labor ,
cervical dilation , fetal presentation due to
inability to perform vaginal examination .
o Difficulty identifying some obstetric
emergencies such as cord prolapsed due to
inability to perform a vaginal examination .

28. CON..
o Prolonged and obstructed labor due to partial
or total occlusion of the vaginal opening this
can lead to increased risk of uterine rupture or
prolapse , tearing to the perineum , hemorrhage
, and fistula formation .
o Repetition of deinfibulation and reinfibulation
weakens the scar tissue .

29. ROLE OF NURSE TOWARD
FIGHTING FGM

31.  Nurses with their variety specialists play an
important vital role in eradicating FGM.
 They have the responsibility to ensure
family know that the practice of FGM is
illegal because it affects girls health.

32. ROLE OF NURSES ACCORDING TO THEIR
SITTINGS :
Community Nurses :
Community nurses work closely with
families in their homes and have a key role to
play in health promotion and education from an
early age in a girl's life, this include helping and
supporting families to explore ways of braking
the cycle of ritual abuse.
Also they work with other Anti-FGM
organizations and help them in data collection
and arrangement of local gathering for
education and raising the awareness among
communities .

33. SCHOOL NURSES :
They play a major role in raising the awareness of
FGM among young girls.
Their role include:
1. Education about FGM .
2. Screening girls affected with FGM .
3. Provide psychological support as needed .
4. Contact with CHN to communicate with the girls
families .

34. FULL SECTOR NURSES :
Nurses working across the full spectrum of acute
services such as a neonatal and child health,
sexual health, accident and emergency, gynecology
or other related areas should be aware of FGM. It’s
important to respond appropriately in the best
interests of any girl who may be at risk of FGM
abuse or have already been mutilated.

35. MIDWIVES NURSES :
Midwives are most likely to encounter
women who have been mutilated.
Maternity services especially where
there are known FGM practicing
communities will have specialist midwife
who take the lead on supporting those
woman in better understanding the issues
surrounding FGM .

36. :NURSING STUDENTS
Class Participation
☺♥

37. SUMMARY
 FGM comprises all procedures involving partial or total
removal of all external female genitalia or other injury
to female genital organs for non-medical reason .
 It has four types
1_ Clitoridectomy
2_ Excision
3_ Infibulation
4. Type 4
 Its complications include long and short term
complications .
 Nurses have important role in eradicating FGM .

38. REFERENCES
1. www.helthline.com.
2. Abdalla,R (1982) sisters in affliction
:circumcision and infibulation of women
in Africa .
3. Skaine, R ,(2005). Female genital
mutilation .
4. Royal College Of Nursing
5. WHO
6. www.endfgm.eu
7. The Inter-African Committee on
Traditional Practices Affecting the
Health of Women and Children (IAC)