Pediatricians Can Play Role in Preventing Female Genital Mutilation and Cutting

By Will Boggs MD

July 29, 2020

NEW YORK (Reuters Health) - Pediatricians caring for girls at risk for female genital mutilation and cutting (FGM/C) should actively counsel families against performing it, including when families travel to countries where FGM/C is practiced, according to a new guidance from the American Academy of Pediatrics (AAP).

"There are girls and adolescent females in the United States with or at-risk for FGM/C; it is essential that front-line medical providers obtain training about FGM/C to provide culturally sensitive counseling and to learn to diagnose, manage, treat, and refer affected pediatric patients," Dr. Janine Young of Denver Health Refugee Clinic and Human Rights Clinic, University of Colorado Anschutz Medical Campus, in Aurora, told Reuters Health by email.

To advance that goal, Dr. Young and colleagues from AAP developed a guidance for clinicians on the diagnosis, management and treatment of FGM/C in girls, which appears in Pediatrics.

FGM/C is currently illegal in much of the world, but it continues to be performed, predominantly on children and adolescents ranging in age from newborn infants to 15 years, with higher prevalence in parts of the Middle East, Asia and Africa.

The procedure involves medically unnecessary cutting of parts or all of the external female genitalia, can be associated with significant morbidity and mortality, and is not associated with any medical benefit.

Most pediatricians surveyed reported having had no previous FGM/C education, did not feel confident in their ability to identify FGM/C types, and rarely discussed FGM/C with families.

The guidance provides nearly a dozen recommendations for clinicians. Healthcare providers should not perform any type of FGM/C on female infants, girls, or teenagers and should actively counsel families against performing FGM/C.

Not only is FGM/C illegal in the U.S., the authors note, it is also illegal to transport a child from the U.S. to another country to have FGM/C.

All children should have external genitalia examined at all health supervision examinations (with consent of the parent/guardian and/or child), and children with risk factors for FGM/C should have clinical assessment of FGM/C status and history of FGM/C before U.S. immigration documented in the health record, according to the group.

Pediatricians who are not comfortable with making an FGM/C diagnosis or discussing treatment options should consult a specialist trained in addressing pediatric FGM/C, the authors add.

For all girls and teenagers with type III FGM/C, healthcare providers should recommend defibulation by an experienced pediatric gynecologist, gynecologist, urologist, or urogynecologist.

If FGM/C is suspected to have occurred in the United States or during travel after immigration to the United States, the child should be evaluated for potential abuse. Expressed interest to engage in FGM/C should also prompt a report to child protective services if the parent or caregiver cannot be dissuaded.

The guidance also endorses the development and provision of standardized training related to the identification, treatment, management and culturally appropriate communication for healthcare providers who care for FGM/C-affected communities.

"In the outpatient setting, trained pediatricians, family medicine physicians, adolescent medicine, and pediatric/adult emergency room physicians are best positioned to counsel families about FGM/C and to identify girls and adolescent females with or at-risk for FGM/C," Dr. Young said.

"Required and standardized training is key here," she said. "Without training of these front-line medical providers (that includes standard of care examination of female external genitalia at all well child-care visits), it is presumed that the vast majority of affected and at-risk girls and adolescent females are not identified."

"Once FGM/C is diagnosed, pediatric and general urologists, gynecologists, and child-abuse pediatricians also need required and standardized training to manage identified cases," Dr. Young said.

SOURCE: Pediatrics, online July 27, 2020.