Female Genital Mutilation - World Health Organization

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76 FEMALE GENITAL MUTILATION STUDENT MANUAL Session 8: The procedure for opening up type III FGM (infibulation) Session objectives By the end of this session students should be able to: 1. Identify type III FGM. 2. Assess whether there is a need for opening up the infibulation. 3. Demonstrate the skills on opening up type III FGM. Introduction There are many situations in which opening up an infibulation will be necessary. However, such a procedure must only be done after the client has been thoroughly counselled. If the woman is married it is important to counsel the husband in separate sessions. Husbands need psychosexual counselling to assist them in dealing with the changes in sexual intercourse. The couple can be counselled together when it is necessary or appropriate to have them both in the same session. Indication for the opening up procedure Opening up an infibulation is indicated in many cases. These include the following: ● Urinary retention (common in children). ● Re-current urinary tract infection and or kidney infections. ● Severe genital tract infection. ● Haematocolpos (especially in adolescents). ● Severe menstrual problems. ● Difficulty in penetration during sexual intercourse. ● Incomplete abortion. ● Termination of pregnancy. ● Childbirth. ● Gynaecological problems of the genital tract. ● Gynaecological diseases in elderly requiring manual or speculum examination or treatment vaginally. ● For the use of certain contraceptive methods for family planning. ● For certain religious/purification purposes. Preparation of the client In order to prepare the client (and her husband/ partner or attendants where appropriate), the following procedure should be followed: ● Teach her about the genitalia – make her aware of the difference between normal and infibulated genitalia. ● Provide information about complications associated with infibulated genitalia. ● Inform her of the legal status of FGM in their country. ● Give full and clear information about the procedure and make sure she has understood. ● Also inform her that the sides will be sutured separately, and not re-sutured together to create a small opening. ● Inform her of the physical changes that will result from the procedure. This information must be given to her partner also, if she is married, because the procedure will result in changes in: urination, menstrual flow, sexual intercourse. ● If the family refuses to give consent for an adolescent or the woman to be opened up (because of fear of rejection by family and community members), the provision of a medical certificate may help to alleviate these concerns.
● Counsel the client on the procedure. Several sessions may be needed to prepare her psychologically for the procedure. Her partner and/or guardians should also be counselled where appropriate. ● Make it clear to the woman (and others as appropriate) why it is advisable that she has the procedure. Sometimes a woman may be in two minds about being opened up – i.e. she may want it on one level, but be fearful of the consequences on another level. ● Counselling should aim to help her reach an informed decision about which she is confident. ● Reassure the client about privacy and confidentiality. ● If the client is an immigrant who speaks a different language from the health staff, make sure the interpreter is appropriate and is acceptable to her. ● Discuss pain relief options. ● Make sure you complete the required records and documentation accurately. Preparation of equipment and materials Prepare a tray with antiseptic swabs, a pair of straight scissors, a dilator, two artery forceps, a gallipot with sterile swabs, sterile gloves, a 5ml. syringe and needles, local anaesthetic, catgut, lubricant, sterile towel/cloth or mackintosh, antiseptic solution, a receptacle for used instruments, soap water for hand washing The procedure ● Make the client comfortable in bed or on a couch. ● Remember to use all the interpersonal skills (facilitation skills). ● Introduce yourself to client if you have not already done so. ● Go over again what you have already discussed with her about the opening up. FEMALE GENITAL MUTILATION STUDENT MANUAL ● Emphasize that the main reason for the problems she has suffered is the infibulation and that opening the infibulation will relieve these problems. ● Ensure total privacy and confidentiality. ● Wash hands, put on gloves, expose the genitalia and clean the perineal area with antiseptic swabs. ● Introduce index finger or forceps or dilator slowly and gently into the opening to lift the scar skin (see figures 4.1 & 4.2). Figure 4.1: Introducing finger(s) under the scar Figure 4.2: Introducing a dilator under the scar 77
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WHO/FCH/GWH/01.4 WHO/RHR/01.17 Dist
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ACKNOWLEDGMENTS . . . . . . . . . .
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An estimated 100 to 140 million gir
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ideas given by students after a gro
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This module is intended to equip st
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Key reference ● Dorkenoo, E. Trad
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But there was one very old woman in
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Summary interpretation of the story
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STRUCTURE FUNCTION Skene’s and Ba
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FEMALE GENITAL MUTILATION STUDENT M
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Figure 1.7: It is performed on babi
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The origins of female genital mutil
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Page 29 and 30: threatening complication of female
Page 31 and 32: of feelings. The experience is a vi
Page 33 and 34: Legal implications of FGM ● The e
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Page 39 and 40: Session objectives Learning activit
Page 41 and 42: Value clarification Value clarifica
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Page 45 and 46: ● After they have shared their vi
Page 47 and 48: Student guideline for the community
Page 49 and 50: Because of the personal and cultura
Page 51 and 52: Introduction The involvement of pol
Page 53 and 54: partnership is to educate relevant
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Page 57 and 58: Session objectives Key references
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Page 65 and 66: Session objectives Introduction Cou
Page 67 and 68: Role Play Students should practice
Page 69 and 70: menstrual patterns and sexual relat
Page 71 and 72: ● If symptoms are severe, refer c
Page 73 and 74: expect and what to do at the referr
Page 75: Table 2: Family Planning Method and
Page 79 and 80: Figure 4.6: Sutured sides of the op
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Page 83 and 84: eassure them that you are comfortab
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Page 87 and 88: perineum as a result of scarring of
Page 89 and 90: Assessment of the introitus during
Page 91 and 92: Key references ● A Systematic Rev
Page 93 and 94: ● Assure client that you are avai
Page 95 and 96: CASE 1 Adela is a 27 years old woma
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Page 99 and 100: Films and videos APPENDIX 2: LEARNI
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Female Genital Mutilation - World Health Organization

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