Female Genital Mutilation/Cutting in Children and Adolescents

Abstract

Female Genital Mutilation/Cutting (FGM/C) comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs that are medically unnecessary (i.e., performed primarily for cultural or religious reasons), especially when done without the consent of the affected person. Such procedures are widely condemned as a violation of girls’ and women’s human rights (i.e., the right to bodily integrity) and are illegal in most countries. At least 200 million girls and women have undergone some form of cutting in more than 31 countries worldwide. While the practice is more prevalent in some areas of Africa, the Middle East, and Southeast Asia/the Asia Pacific, it is found in almost every nation as a result of emerging migration patterns. Different types and subtypes of FGM/C (Table 1) are carried out in different settings during infancy and childhood, usually before the age of 15 (Table 2). Although some pictorial and training tools are available, the existing literature has mainly focused on adults. Specific guidelines for the care of infants, children, and young people (I/C/YP) with FGM/C do not exist and iconographic training material is lacking. Some recommendations, good practice, and expert opinions have recently become available. In August 2020, a technical report from the American Academy of Pediatrics was published. It outlined a standard-of-care approach to FGM/C evaluation in children; encouraged examination of external female genitalia at all health supervision examinations; supported culturally sensitive discussion and counseling approaches; and described the legal and ethical considerations around FGM/C. We herewith provide a visual reference and learning tool containing information and comprehensive iconographic material to be used as a guide for diagnosis of different types, subtypes, and complications of FGM/C, as well as differential diagnosis of pre and postpubertal I/C/YP physiological variations. This visual reference may be used as a standalone guide for the management of I/C/YP FGM/C and may be consulted by health care professionals (HCPs) working in different countries when examining I/C/YP with equivocal findings. In addition, the guide and accompanying text can be used to facilitate training of HCPs globally in making accurate diagnoses and managing different genital conditions/issues, while enhancing patient–provider communication, and enabling precise recording and reporting to government agencies, where required.