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31 Mar 2017

By Dr Gino Pecoraro

Chair, FGM Working Group

Female Genital Mutilation (FGM) is the umbrella term for a range of procedures that involve the surgical manipulation of the clitoris or labia with the primary purpose of controlling female sexuality, specifically ensuring premarital virginity and sexual fidelity.  There is no therapeutic benefit to undergoing any of these procedures.

AMA uses the internationally accepted term “FGM” to reflect the severity of outcomes for patients who have been subjected to the practice.  However, some women who have undergone FGM do not identify with the term mutilation and prefer other terms more acceptable to them such as “cutting” or “khatna”.

FGM can lead to significant ongoing problems affecting a woman's urogenital tract including difficulties with menstruation, bladder emptying, sexual function, ongoing scarring leading to pain and specific complications pertaining to childbirth.  Superimposed on all of these physical consequences is the significant psychological trauma and need for often multiple surgical approaches to correct the initial damage.

Around the world, it is thought at least 200 million women and girls are affected by the consequences of FGM.  In Australia, FGM occurs largely within migrant communities, particularly those from countries that practise FGM.  Although secrecy surrounding the practice makes definitive data collection difficult, up to one in 10 paediatricians in Australia have treated patients who have undergone FGM.

FGM is illegal in Australia, as is taking a woman or girl overseas to undergo the procedure.

Many of the risk factors that increase the likelihood of a woman being subjected to FGM also reduce her propensity to proactively seek medical help for complications relating to the procedure.  Australian health care workers need to be appropriately trained to identify women affected by the practice and also able to detect women and girls at risk. Newly arrived Australians may experience difficulty negotiating our complex but comprehensive health service and require specific targeted help to access the services and treatment need.

The AMA believes that FGM risk factors, correct identification and treatment should be a major area of priority for ongoing training and professional development. Currently, the National Education Toolkit for Female Genital Mutilation/Cutting Awareness (NETFA) offers training modules to support clinicians to build their clinical knowledge and cultural competency around FGM.

I urge any doctor who comes into contact with a girl or woman who has experienced FGM or is at risk of becoming affected, to seek further training and skills acquisition in dealing with these patients, or at least become familiar with local practitioners who have received appropriate training in this area, to ensure the best outcomes for your patient.

The most significant risk factor for undergoing FGM is being born to a mother who has previously undergone the procedure. In recognition of this, any doctor who comes across an adult FGM survivor has a responsibility to open up a discussion with her to mitigate the risk of the practice being performed on her children, while ensuring that her own medical needs are being met.

While some defenders of FGM cite religious custom as justification for the procedure, it is important to note that there is NO mention of the practice in any major religious text or doctrine.  Claims that FGM is a fulfilment of religious duty is completely false and its sole aim is to control the female body and limit sexual pleasure. 

FGM is a violation of women’s human rights and its abolition is highlighted as a priority within the Sustainable Development Goals.  Doctors are in a unique position to lead in the eradication of these procedures.  We must be vigilant, in both preventing new victims and in caring from women who have already suffered from this practice.  Underlying all of this is the commitment to ongoing education of all of our patients of the potential harms of this unnecessary illegal practice that has no religious basis for its existence.  Although difficult, we must not shy away from our responsibility to tackle this problem head on and have what might be, on occasion, an uncomfortable discussion with our patients. 

Published: 31 Mar 2017