Female genital mutilation or cutting — formative SAQs

SAQ 1 — Recognition, classification, and safeguarding (10 marks)

A six-year-old girl of Somali background is referred to your clinic with a three-month history of recurrent urinary tract infections. Her mother, who has recently migrated to Australia, speaks limited English and has brought the girl's maternal grandmother, who is visiting from Mogadishu. On genital examination you find the labia majora fused with a pinpoint opening, consistent with Type III infibulation. ^[4]

Questions

1. Describe the WHO Type I–IV classification of FGM and state which type this child has. Explain why FGM performed on a minor is always child abuse. (4 marks) ^[4]
2. Outline the immediate safeguarding and reporting steps you must take, including who you must screen and who you must not use as interpreter. (3 marks) ^[4]
3. Describe the physical and psychological complications this child is at risk of, and the investigations and referrals you would arrange. (3 marks) ^{[1] [2]}

Model answer

Classification and child-abuse status (4). Type I (clitoridectomy) is partial or total removal of the clitoris and or prepuce. Type II (excision) is partial or total removal of the clitoris and labia minora, with or without the labia majora. Type III (infibulation) is narrowing of the vaginal opening by cutting and appositioning the labia minora or majora, with or without excision of the clitoris — the most severe form. Type IV covers all other harmful procedures including pricking, piercing, incising, scraping, and cauterising. This child has Type III. FGM performed on a minor is always child abuse regardless of who performs it, the cultural motivation, or whether it is medicalised, because it causes immediate and lifelong harm with no health benefit and violates the child's right to bodily integrity. ^[4]

Safeguarding and reporting (3). Make a mandatory child-protection report immediately, because FGM is a criminal offence in all Australian states and territories and mandatory reporting applies to medical practitioners. Agree a multi-agency safety plan so the child is not returned to an environment where further harm is possible. Screen every sibling — particularly any younger sisters — because cutting is familial and recurrent. Use a professional interpreter, never a family member, because the safeguarding implications make family-member interpretation unsafe. Do not let the child leave the clinic without a safety plan in place. ^[4]

Complications, investigations, and referrals (3). Physical complications include recurrent UTI from urinary stasis, dysmenorrhoea, haematocolpos in adolescence, dyspareunia, and obstetric complications including prolonged labour, postpartum haemorrhage, and obstetric fistula. Psychological complications include PTSD, depression, and anxiety. Arrange a urinalysis and urine culture, a pelvic ultrasound to assess for haematocolpos or cysts, and a mental-health screen. Refer to a specialist FGM or gynaecology service for deinfibulation planning, and to psychology or psychiatry for trauma-focused therapy. ^{[1] [2]}