Female Genital Mutilation - World Health Organization

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FEMALE GENITAL MUTILATION
STUDENT MANUAL
Infiltrate 2–3 mls of local anaesthetic into the area
where the cut will be made, along the scar and in both
sides of the scar (see figure 4.3).
Figure 4.3: Infiltrating the scar area with local
anaesthetic
● With your finger or dilator inside the scar,
introduce the scissors and cut the scar alongside
the finger or fingers to avoid injury to the adjacent
tissues (or to the baby, if the procedure is done
during labour).
● The cut should be made along the mid-line of the
scar towards the pubis (see figure 4.4).
● Take care that you do not cause injury to the
structures along the scar. It is common with type
III FGM to find the structures below the scar
intact, e.g. clitoris and labia minora.
● Incise the mid-line to expose the urethral opening.
(see figure 4.5) Do not incise beyond the urethra.
Extending the incision forward may cause
haemorrhage, which is difficult to control. A cut of
about 5-7 cm towards the urethra is usually
appropriate. Generally speaking there is little
bleeding for the relatively avascular scar tissue.
Figure 4.4: Cutting open the scar
Figure 4.5: An opened infibulation
● Suture the raw edges separately using fine 3/0 plain
catgut to secure haemostasis and prevent adhesion
formation (see figure 4.6).
● Women should not be allowed to suffer pain as this
may reinforce negative ideas about being opened
up. Therefore, analgesia should be prescribed
following the opening up procedure.
● Antibiotic may also be prescribed depending on
the situation.