O&G · Gynaecological health — sexual, cultural and safeguarding
Female genital mutilation (FGM/C): WHO Type I-IV classification, antenatal & intrapartum care, deinfibulation and cultural competence (RANZCOG C-Gyn 1)
Also known as FGM · FGM/C · Female genital cutting · Infibulation · Deinfibulation · WHO Type I-IV FGM classification · Cultural competence in gynaecology
Exam-exhaustive FRANZCOG fellowship foundation on female genital mutilation/cutting (FGM/C): the WHO Type I-IV classification reproduced verbatim with its subdivisions, the ANZ legal framework and mandatory-reporting duties, the antenatal and intrapartum management (including deinfibulation and mode of birth for Type III), the deinfibulation procedure and its timing, the obstetric and psychosexual sequelae, and trauma-informed, culturally competent care. Anchored to RANZCOG C-Gyn 1 (2023) and the WHO evidence base, globally tagged to MRCOG, ABOG, FRCSC and MRCPI.
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Red flags
- A child at risk of FGM is a mandatory-reporting scenario — refer to child protection; performing or facilitating FGM on a child or adult is a criminal offence in every ANZ jurisdiction
- Type III infibulation with a pinhole introitus in labour is not a trial-of-labour case — plan deinfibulation antenatally or at the onset of labour, and reserve caesarean for standard obstetric indications or an unreadily-reversible Type III
- Never reinfibulate after birth — WHO recommends against it on the strength of lifelong health risk
- Never use a family or community member as interpreter — it breaches confidentiality and may place the woman at risk
- FGM is a clinical diagnosis driven by examination — a woman who does not volunteer a history may still be identified on routine genital examination, and that finding changes the birth plan
- Post-traumatic and psychosexual consequences may surface for the first time in pregnancy — ask, screen, and offer referral
A woman newly arrived from a high-prevalence country sits in your booking clinic. She does not mention FGM; she may not know the term, or she may associate it with shame, fear, or belonging. Your job is not to extract a confession — it is to ask sensitively, examine carefully, document the WHO type, plan a safe birth, and offer care that is competent across culture and trauma. This topic is the framework for that encounter, from the verbatim WHO classification to the deinfibulation incision to the safeguarding referral.[6][8][10]
Overview and definition
The WHO definition is the anchor of every answer you give on this topic. FGM is defined as removal of female external genitalia, either partial or total, for non-medical purposes. It is embedded in tradition, including cultural beliefs about sexual behaviour, and is recognised internationally as a violation of the human rights of girls and women.[7][12]
Two features make this definition load-bearing. First, "for non-medical purposes" — there is no therapeutic FGM, and WHO and RANZCOG oppose the medicalisation of the practice. Second, "external female genitalia" — the organs affected are normal, healthy tissue; FGM removes and damages them, and it interferes with the natural functions of girls' and women's bodies. The associated risks include haemorrhage, infection, death, dyspareunia, childbirth complications, and psychological issues.[7][12]
Why this matters — the burden in numbers
References12ShowHide
- [1]Berg RC, Odgaard-Jensen J, Fretheim A, Underland V, Vist G An updated systematic review and meta-analysis of the obstetric consequences of female genital mutilation/cutting. Obstet Gynecol Int, 2014.PMID 25505915
- [2]Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet, 2006.PMID 16753486
- [3]Berg RC, Underland V, Odgaard-Jensen J, Fretheim A, Vist GE Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open, 2014.PMID 25416059
- [4]Rouzi AA, Berg RC, Sahly N, Alkafy S, Alzaban F, Abduljabbar H Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study. Am J Obstet Gynecol, 2017.PMID 28267442
- [5]Abdulcadir J, Marras S, Catania L, Abdulcadir O, Petignat P Defibulation: A Visual Reference and Learning Tool. J Sex Med, 2018.PMID 29463476
- [6]Abdulcadir J, Rodriguez MI, Say L Research gaps in the care of women with female genital mutilation: an analysis. BJOG, 2015.PMID 25514892
- [7]Wood R, Richens Y, Lavender T The experiences and psychological outcomes for pregnant women who have had FGM: A systematic review. Sex Reprod Healthc, 2021.PMID 34051456
- [8]Varol N, Hall JJ, Black K, Turkmani S, Dawson A Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation/cutting. Reprod Health, 2017.PMID 28521830
- [9]Njue C, Karumbi J, Esho T, Varol N, Dawson A Preventing female genital mutilation in high income countries: a systematic review of the evidence. Reprod Health, 2019.PMID 31331357
- [10]Abdulcadir J, Say L, Pallitto C What do we know about assessing healthcare students and professionals' knowledge, attitude and practice regarding female genital mutilation? A systematic review. Reprod Health, 2017.PMID 28532515
- [11]Balfour J, Abdulcadir J, Say L, Hindin MJ Interventions for healthcare providers to improve treatment and prevention of female genital mutilation: a systematic review. BMC Health Serv Res, 2016.PMID 27542732
- [12]Sarayloo K, Latifnejad Roudsari R, Elhadi A Health Consequences of the Female Genital Mutilation: A Systematic Review. Galen Med J, 2019.PMID 34466496