Caring for Women who have Experienced Female Genital Cutting скачать в хорошем качестве

Caring for Women who have Experienced Female Genital Cutting

Presented By Dr. Angela Deane Dr. Jasmine Abdulcadir Dr. Abheha Satkunaratnam Affiliations North York General Hospital & Geneva University Hospital, University of Toronto Read the full transcript here: https://cansagevideos.com/caring-for-women... Video Transcript: Caring for Women who have Experienced Female Genital Cutting Caring for women who have experienced female genital cutting. The objectives of this video are to review terminology in the WHO classification, provide an approach to vulva examination, review health consequences, and considerations for the procedure of defibulation. Data has shown that healthcare practitioners have challenges in providing quality care to women that have experienced female genital cutting. They’re often underprepared to assess and manage complications, lack technical skills to provide procedures such as defibulation, and face communication challenges. Additionally, women that have experienced female genital cutting have expressed concerns with the quality of care they’ve received. Female genital cutting is the ritual removal or injury to any part of the female genitals for non-medical reasons. The words we use matter. There is no international consensus on terminology. Female circumcision is problematic because it equates the practise with male circumcision. Female genital mutilation is an advocacy term, however, can be considered judgmental and stigmatising. As medical practitioners we should use the term female genital cutting as it is medically correct, neutral, and culturally sensitive. FGC is a complex global public health issue. It’s considered to be a harmful practise, a violation of human rights and the rights of a child. It is also a form of gender-based violence. The WHO estimates that over 200 million women and girls have experienced FGC, and 3 million girls are at risk each year. The practise is known to occur in over 40 countries with the highest prevalence in Somalia, Sudan, Egypt, Eritrea, Djibouti and Guinea. It is often misunderstood, even by healthcare practitioners, that the entirety of the clitoris is removed with female genital cutting. This is a misconception. The clitoris is a multiplanar structure that surrounds the urethrovaginal complex interior laterally. It is centrally attached to the urethra and vagina. The main components include the clitoral glands, body or corpora, the crura and the vestibular bulbs. The external components are the clitoral hood which connects to the labia minora via the frenulum, also known as the prepuce. It drapes over the clitoral glands. It’s these two components plus the clitoral body that are often cut. The World Health Organisation has classified FGC into four types, with subcategories. Briefly summarised they are, Type I A partial or total removal of the clitoral hood. Type I B, the clitoral hood plus the clitoral glands. Of note, when the WHO refers to clitoral glands excision, it can also include partial excision of the clitoral body. Type II A partial or total removal of the labia minora only. Type II B includes the labia menorah, clitoral glands and sometimes the clitoral hood. Whereas Type II C includes the clitoral glands, labia minora and labia majora, as well as sometimes the clitoral hood. Type III is infibulation, where the labia minora, labia majora are cut, and appositioned, narrowing the vaginal opening. Type IV is all other harmful procedures such as pricking, incising, scraping or cauterisation. They may have a normal appearing vulvar examination, however, have a significant history of a harmful genital procedure. A simplified approach to the classification would be to observe if the clitoral glands has been cut. This could be any type. If the clitoral hood has only been cut, it’s a Type I. If the labia minora or majora have been cut it as a Type II. And if there’s infibulation, this is Type III. FGC can alter the health trajectory of a woman’s lifetime. Consequences can be experienced in multiple spheres of health and wellness. Immediate consequences can include severe pain, bleeding haemorrhage, shock, infection, broken limbs, and even death. Sexual function can be impacted in terms of lack of sensation, dyspareunia, diminished arousal or desire, and anorgasmia. The psychological impacts can be significant and influence one’s identity, belonging, and body image. There’s also increased rates of anxiety, depression and post-traumatic stress disorder. Obstetrical consequences can include prolonged labour, increased perineal tearing, increased need for interventions such as episiotomy, instrumental delivery, and caesarean section. Long term complications include chronic pain, dysmenorrhea, genital tract infections, infertility, and difficulty with gynaecological procedures and screening. It can have keloid scarring, recurrent vulvar abscess, and epidermoid cyst formation.