Loading ...

In 2020, the United Nations estimated that more than 200 million girls worldwide had undergone female genital mutilation (FGM). This figure reflects only documented cases, and the actual prevalence is likely to be higher, according to José Ignacio Pérez Candás, MD, a pediatrician.

Pérez Candás, coordinator of the Social and Community Pediatrics Working Group at the Spanish Association of Primary Care Pediatrics, confirmed that clinicians should remain vigilant for signs of FGM. These include visible scars on the vulva, partial or complete removal of the clitoris or labia minora, chronic genital pain, and recurrent vaginal infections.

Speaking with El Médico Interactivo, he emphasized that early detection is critical for primary care physicians because FGM is irreversible and has serious physical and psychological consequences.

Types and Risks

FGM is classified into four types, which can complicate diagnosis.

Type I, clitoridectomy, involves the partial or total removal of the clitoris and/or clitoral hood.

Type II, excision, is the partial or total removal of the labia minora, sometimes including the labia majora and clitoris.

Type III, infibulation, is the most severe form and involves narrowing of the vaginal opening by cutting and repositioning the labia with or without removal of the clitoris.

Type IV covers all other harmful procedures for nonmedical reasons, including pricking, piercing, scraping, and cauterization.

The timing varies, but the procedure is often performed during puberty. However, some girls undergo FGM before age 5. “It is a ritual practice tied to cultural beliefs and remains deep-rooted behavior,” Pérez Candás explained.

Immediate health risks include acute pain, hemorrhage, severe infection, sepsis, and even death, depending on the conditions under which the procedure is performed. 

Long-term effects include anxiety, depression, posttraumatic stress disorder, altered body image, difficulties with sexual identity, and community stigmatization.

Clinicians should carefully assess girls from high-risk regions and ethnic groups. “Ethnicity is often the stronger predictor because this is a cultural practice,” Pérez Candás noted. “Any minor from a risk group should undergo a complete assessment, including a genital examination.”

If signs of FGM are identified, physicians should document them thoroughly in the medical record and, when required, notify child protection services or the juvenile prosecutor’s office.

This protocol also applies to situations with heightened risks. For example, if a family that has already subjected a girl to FGM plans to travel to their country of origin, both pre- and posttravel visits are mandatory. If mutilation is detected after travel, clinicians must report it immediately.

If a family fails to attend a posttravel visit, the Primary Care Pediatric Functional Units (PCPFU) is responsible for coordinating with social and health workers to locate them. If the family cannot be found, authorities such as child protection services or the prosecutor’s office must be contacted.

Primary Care Role

In Spain, detection often begins in PCPFU, comprising pediatricians specializing in specific areas and pediatric nurses.

Nursing staff oversee the child health program and biopsychosocial risk identification program, which are both essential tools for detecting at-risk cases.

Follow-up takes place within these units, but Pérez Candás stressed that prevention remains paramount because FGM cannot be reversed.

Spain adopted a national healthcare protocol developed by the Commission on Violence against Children and Adolescents within the Interterritorial Council of the National Health System to guide clinicians.

The protocol is grounded in Organic Law 8/2021, which provides for the comprehensive protection of children and adolescents from violence. “This protocol is essential because it addresses cases of mutilation, and all clinicians need to be familiar with the specific common protocol for the prevention of female genital mutilation,” Pérez Candás said.

“FGM irreversibly alters [a] child’s body,” Pérez Candás concluded. “Safeguarding children’s rights is essential, as guaranteed by international law.”

This story was translated from El Medico Interactivo.