Female Genital Mutilation - World Health Organization

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FEMALE GENITAL MUTILATION
STUDENT MANUAL
Session 5: Management of girls or women with
psychosocial and sexual problems associated with FGM
Session objectives
By the end of this session students should be able to:
1. Manage girls and women with psychosocial and sexual problems associated with FGM.
Introduction
In some instances girls and women from FGMpractising
communities to visit a clinic complaining of a
wide variety of physical problems for which no sign can
be found when they are examined. Their complaints are,
in fact, “psychosomatic” – that is, they are psychological
problems which the client experiences, or disguises, as
physical discomfort. Anxiety about their genitals or
about sexual relationships may manifest themselves in
psychosomatic symptoms. Often the girl or woman is
unaware that her symptoms are based on psychological
anxieties. But in some cases the woman is aware of the
fact that the symptoms she is presenting are not the real
cause of her problems, but she is too shy to discuss them
directly and attends the clinic hoping the health care
provider will be able to read between the lines.
Key elements in managing
psychosocial and sexual
complications
The key elements in managing psychosocial and
sexual complications are:
● Identification of the problem by interviewing the
client (history taking).
● Counselling to help her identify the real problem
and accept it (girls should be referred for
counselling by their peers).
● Referral of clients who are severely disturbed for
more specialised care.
Counselling is the principle tool used in
managing psychosocial and sexual
problem. Counselling of a girl or woman
should be strictly confidential. If the
client has a partner, he should be
counselled separately if necessary, until
the right moment arrives for them to be
counselled as a couple. The aim of
counselling is to help a client, a couple,
or a family come to terms with, or solve
a problem they have.
Managing psychosocial problems
Psychosocial problems include: chronic anxiety,
and feelings of fear, humiliation, betrayal, stress, loss of
self- esteem, depression, phobias, and panic attacks.
These may manifest as psychosomatic symptoms such
as nightmares, sleeping and eating disorders,
disturbances of mood and cognition, loss of appetite,
excessive weight loss or gain, and negative body image.
The procedure for managing such symptoms is as
follows:
● Assess client to identify the exact problem (take a
detailed history).
● Counsel client, and partner where appropriate
● If the client has type III FGM, counsel her as to the
need for opening up.
● If she has other types of FGM, counsel her until
she is relieved of her symptoms.