Tag Archives: Physician-Patient Relations

The interactions between physician and patient.

Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice

BMC Int Health Hum Rights. 2015 Dec 10;15(1):32. doi: 10.1186/s12914-015-0070-y.

Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice

Zurynski Y, Sureshkumar P, Phu A, Elliott E

ABSTRACT

BACKGROUND: The World Health Organisation (WHO) estimates that 100-140 million girls and women have undergone female genital mutilation or cutting (FGM/C). FGM/C is an ancient cultural practice prevalent in 26 countries in Africa, the Middle East and Asia. With increased immigration, health professionals in high income countries including UK, Europe, North America and Australia care for women and girls with FGM/C. FGM/C is relevant to paediatric practice as it is usually performed in children, however, health professionals’ knowledge, clinical practice, and attitudes to FGM/C have not been systematically described. We aimed to conduct a systematic review of the literature to address this gap.

METHODS: The review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42015015540, http://www.crd.york.ac.uk/PROSPERO/ ). Articles published in English 2000-2014 which used quantitative methods were reviewed.

RESULTS: Of 159 unique articles, 18 met inclusion criteria. The methodological quality was poor – six studies met seven of the eight quality criteria. Study participants included mainly obstetricians, gynaecologists and midwives (15 studies). We found no papers that studied paediatricians specifically, but two papers reported on subgroups of paediatricians within a mixed sample of health professionals. The 18 articles covered 13 different countries: eight from Africa and 10 from high income countries. Most health professionals were aware of the practice of FGM/C, but few correctly identified the four FGM/C categories defined by WHO. Knowledge about FGM/C legislation varied: 25 % of professionals in a Sudanese study, 46 % of Belgian labour ward staff and 94 % of health professionals from the UK knew that FGM/C was illegal in their country. Health professionals from high income countries had cared for women or girls with FGM/C. The need to report children with FGM/C, or at risk of FGM/C, to child protection authorities was mentioned by only two studies.

CONCLUSION: Further research is needed to determine health professionals’ attitudes, knowledge and practice to support the development of educational materials and policy to raise awareness and to prevent this harmful practice.

This article can be accessed in this LINK

Royal college strengthens its guideline on female genital mutilation

BMJ. 2015 Jul 9;351:h3709. doi: 10.1136/bmj.h3709.

Royal college strengthens its guideline on female genital mutilation.

Torjesen I

EXTRACT

The Royal College of Obstetricians and Gynaecologists has revised its guideline on female genital mutilation to clarify healthcare professionals’ legal responsibilities, the requirements to notify cases, and the management of women who have undergone mutilation who are pregnant or giving birth.

The update comes after the first attempted UK prosecution of a doctor for female genital mutilation. Dhanuson Dharmasena, a trainee registrar in obstetrics and gynaecology at the Whittington Hospital in north London, was acquitted earlier this year...

This article can be accessed in this LINK

Female Circumcision: An Emerging Concern in College Healthcare

Journal of American College Health, 1997, 45(5), 230-232

Female Circumcision: An Emerging Concern in College Healthcare

Woolard D & Edwards RM

ABSTRACT

Female circumcision (clitoridectomy), a traditional practice in some Third World societies, is discussed, and related medical procedures are described. Medical and psychosexual implications for the patient are considered, and college health clinicians are encouraged to be prepared to see patients who have been subjected to the procedure and help these young women deal with attendant medical, emotional, and cultural issues. One female student’s experience at her college health service is described.

This article can be accessed in this LINK

Female genital mutilation: Cultural and psychological implications

Sexual and Marital Therapy. 2002, 17(2):161-170.

Female genital mutilation: cultural and psychological implications.

Whitehorn J, Ayonrinde O & Maingay S

ABSTRACT

Female genital mutilation (FGM) is widely practised in several regions of the world. It is often associated with physical, psychological, sexual and social sequelae. Migration of persons from cultures that actively practice FGM to the UK and other Western countries increases the chances that clinicians will be faced with patients who have undergone this procedure. Clinical presentations often occur against a background of differences in culture and social identity, which may pose a challenge to any form of intervention. Perceptions of normalcy, human rights violation and gender roles may also differ. This paper discusses historical, cultural, gender and identity issues associated with FGM and its psychological and sexual implications.

This article can be accessed in this LINK

‘Gosh’: A cross-cultural encounter with a Somali woman, a male interpreter and a gynecologist on female genital cutting/mutilation.

Patient Educ Couns. 2014 Aug 28. pii: S0738-3991(14)00363-2. doi: 10.1016/j.pec.2014.08.014. [Epub ahead of print]

‘Gosh’: A cross-cultural encounter with a Somali woman, a male interpreter and a gynecologist on female genital cutting/mutilation.

Schuster S.

ABSTRACT

I saw the woman for the first time on the gynecological emergency at a Swiss University Women’s Hospital. She was referred for assessment of lower abdominal pain, which turned out to be a ‘cover-up’ for the subsequent case presentation. The 22-years old, married woman had a low proficiency in English and none in German, and was an asylum seeker from Somalia. The history and clinical examination for lower abdominal pain revealed no pathological results – but her female external genitalia presented an unforgettable finding I had never seen before during my clinical career in Switzerland and also in Cameroon.

This article can be accessed in this LINK

Female genital cutting: A survey among healthcare professionals in Italy.

J Obstet Gynaecol. 2014 Sep 29:1-4. [Epub ahead of print]

Female genital cutting: A survey among healthcare professionals in Italy.

Surico D, Amadori R, Gastaldo LB, Tinelli R, Surico N.

ABSTRACT

This study aims to evaluate the knowledge of female genital cutting (FGC) in a tertiary teaching hospital in Italy. A survey questionnaire on FGC was given to paediatricians, nurses, midwives, gynaecologists and residents in paediatrics and gynaecology in a tertiary teaching hospital in Italy. The results of the survey were then analysed. The results showed that 71.5% (73/102) of healthcare professionals dealt with patients presenting with FGC. Gynaecologists (83%) and paediatric nurses (75%) were the only ones who declared to be aware of Italian law on FGC. In detail, 55% of midwives, 50% of paediatricians, 50% of paediatrician residents and 28.5% of gynaecological residents were aware of this law. The general knowledge of Italian National Guidelines on FGC is even worse: most professionals are not aware of protocols of action. Considering the increasing extension of FGC due to immigration, improvement of care through specialised education of healthcare providers is mandatory.

This article can be accessed in this LINK

Referrals for female genital mutilation must rise, say MPs.

BMJ. 2014 Jul 6;348:g4447. doi: 10.1136/bmj.g4447.FREE

Referrals for female genital mutilation must rise, say MPs.

Dyer C.

EXTRACT

government should make the failure of professionals to report concerns a criminal offence unless reports rise substantially, a committee of MPs has said.

In a hard hitting report that denounces the practice as an “extreme form of child abuse,” the House of Commons home affairs committee called the UK’s failure to tackle FGM a “national scandal” and urged the adoption of a national action plan.

The report described the record of referrals of cases to social services by healthcare professionals as “extremely poor” and said many cannot even recognise the signs that a child is at risk. “It is unacceptable that those in a position with the most access to evidence of these crimes do nothing to help the victims and those at risk,” the MPs said…

This article can be accessed in this LINK.

First UK prosecution for female genital mutilation raises concerns among doctors.

BMJ. 2014 Mar 27;348:g2424. doi: 10.1136/bmj.g2424.

First UK prosecution for female genital mutilation raises concerns among doctors.

Dyer C.

EXTRACT

Obstetricians have said that the first prosecution for female genital mutilation (FGM) in the United Kingdom could lead doctors to fear criminal charges if they carry out repairs to stop post-birth bleeding in women who have previously been subjected to the illegal procedure, which has been a specific crime in the UK since 1985.

The first prosecution for the offence has been launched against a doctor who, the Crown Prosecution Service alleges, “repaired FGM that had previously been performed on the patient, allegedly carrying out FGM himself,”1 after a patient had given birth…

This article can be accessed in this LINK

Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

Mayo Clin Proc. 2013 Jun;88(6):618-29. doi: 10.1016/j.mayocp.2013.04.004.

Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

Hearst AA, Molnar AM.

Department of Medicine, University of Washington, Seattle, WA 98104, USA.

ABSTRACT

The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue.

This article can be accessed in this LINK

Swedish Health Care Providers’ Experience and Knowledge of Female Genital Cutting

Health Care for Women International. 2006 (27)8709-722

Swedish Health Care Providers’ Experience and Knowledge of Female Genital Cutting

Leila Tamaddon, Sara Johnsdotter, Jerker Liljestrand &Birgitta Essén

ABSTRACT

We sought to evaluate the experiences and knowledge of health care providers in Sweden regarding female genital cutting (FGC) as a health issue. Questionnaires (n = 2,707) were sent to providers in four major cities in Sweden and evaluated by means of descriptive statistics. Twenty-eight percent (n = 769/2,707) responded, of whom 60% had seen such patients. Seven providers, including 2 pediatricians, were suspicious of patients with signs of recent genital cutting. Ten percent had been asked to perform reinfibulation after delivery. Thirty-eight providers had received inquiries about the possibility of performing FGC in Sweden.

This article can be purchased in this LINK