Treatment options for FGM survivors

You may have thought of lots of treatment options for FGM survivors in the last task.

Below is a list of treatment options for FGM survivors, this list is not exhaustive. This is more for your awareness so that you have an overview of the options available.

Summary of the recommendations (R) and best practice statements (BP)

DEINFIBULATION

• Recommendation 1 – Deinfibulation is recommended for preventing and treating obstetric complications in women living with type III FGM (strong recommendation; very low-quality evidence).
• Recommendation 2 – Either antepartum or intrapartum deinfibulation is recommended to facilitate childbirth in women living with type III FGM (conditional recommendation; very low-quality evidence).
• Recommendation 3 – Deinfibulation is recommended for preventing and treating urologic complications – specifically recurrent urinary tract infections and urinary retention – in girls and women living with type III FGM (strong recommendation; no direct evidence).
• Best Practice 1 – Girls and women who are candidates for deinfibulation should receive an adequate preoperative briefing
• Best Practice 2 – Girls and women undergoing deinfibulation should be offered local anaesthesia

MENTAL HEALTH

• Recommendation4 – Cognitive behavioural therapy (CBT) should be considered for girls and women living with FGM who are experiencing symptoms consistent with anxiety disorders, depression or post-traumatic stress disorder (PTSD) (conditional recommendation; no direct evidence).
• Best Practice 3 – Psychological support should be available for girls and women who will receive or have received any surgical intervention to correct health complications of FGM.

FEMALE SEXUAL HEALTH

• Recommendation 5 – Sexual counselling is recommended for preventing or treating female sexual dysfunction among women living with FGM (conditional recommendation; no direct evidence).

INFORMATION AND EDUCATION

• Best Practice 4 – Information, education and communication (IEC)4 interventions regarding FGM and women’s health should be provided to girls and women living with any type of FGM
• Best Practice 5 – Health education information on deinfibulation should be provided to girls and women living with type III FGM.
• Best Practice 6 – Health-care providers have the responsibility to convey accurate and clear information, using language and methods that can be readily understood by clients
• Best Practice 7 – Information regarding different types of FGM and the associated respective immediate and long-term health risks should be provided to health-care providers who care for girls and women living with FGM.
• Best Practice 8 – Information about FGM delivered to health workers should clearly convey the message that medicalization is unacceptable.

From WHO guidance.

When interacting with a girl or woman who is a survivor of FGM it is important that we get it right the first time. You may feel anxious about discussing FGM with a survivor. The SPIKES model is used for breaking bad news most commonly however it is applicable in this scenario.

S – Setting up the environment Some tips:

• Ensuring the location chosen to have the discussion is quiet and private
• Ensure the survivor feels safe in the chosen environment
• Ensure that the appropriate people are present, and the survivor feels safe with those people present
• Turn off your phone/ bleep etc to minimise disturbances, and to ensure the survivor has your full attention

P – Perception It is important that you allow the survivor to speak and allow them the chance to tell you what they know about what has happened to them. This allows you to learn the survivor’s perspective.

I – Invitation Asking the survivor if they would be ok to talk about their FGM and proceed with the discussion. This empowers the survivor to have a choice in having the discussion

K – Knowledge Provide information to the survivor; do this in small digestible chunks of factual information. It is important to use non-technical language and be as direct as possible, whilst remaining gentle and kind.

E- Empathy Ensuring that you appreciate and validate the survivor’s emotions, whilst not assuming that you know how they are feeling.

S – Strategy and Summary Briefly summarise the discussion, ensuring the survivor has understood what you have discussed together. At this point, you could provide some further reading, and make a plan for a follow-up discussion or onward referral.

Further reading:

• RCOG green top guidance on how to manage FGM
• WHO guidance
• Helpful further reading on the SPIKEs model