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SAN DIEGO – Nearly 60% of ob.gyns. have seen patients who have experienced female genital mutilation (FGM), according to the results of a survey of 288 fellows of the American College of Obstetricians and Gynecologists.
Additionally, the survey found that there are few guidelines for care of these patients. Among fellows who had seen patients with FGM, 80.1% said their institutions had no policies or guidelines for management of these patients. Additionally, just 56.7% of fellows who had treated these women were aware that federal laws prohibit FGM.
Dr. Alireza Shamshirsaz
The findings came as a surprise to the study’s senior author, Alireza Shamshirsaz, MD, a maternal-fetal medicine specialist at Baylor College of Medicine, Houston. “I really see the gap of knowledge of [ob.gyns.] in the States, and the emergent need for guidelines and regulation.”
Ob.gyns. who cared for women who had experienced FGM reported that they used a combination of approaches in treating these patients. Nearly half of physicians (45.8%) said they generally treated FGM patients the same as their other patients, but nearly three-quarters said they also discuss potential complications of FGM procedures. About 28% of physicians reported providing information about surgical repair options, while less than 5% provided mental health referrals.
For minors who had experienced FGM, low numbers of survey respondents made law enforcement referrals (7.7%) or social service referrals (7.7%). There were a few respondents (5.4%) who said they didn’t feel comfortable managing patients who had experienced FGM.
In another surprise to the researchers, genital mutilation procedures were not all performed abroad. Three ob.gyns. reported caring for patients who had previously undergone FGM in the United States.
The findings highlight the need for structured education in ob.gyn. residency training programs regarding how to approach at-risk patients and those who have experienced FGM, Dr. Shamshirsaz said in an interview. He also called for specific guidelines from ACOG regarding virginity testing and hymenoplasty and for clearer statutes to guide physicians when patients request FGM or virginity testing procedures.
“All [ob.gyns.] should be aware that their at-risk patients may have a history of honor-related practices and should obtain a full history in a culturally sensitive and professionally responsible manner so that they may respond to and address the unique needs of these patients,” the researchers wrote.
The researchers reported having no relevant financial disclosures. The study was supported by a grant from ACOG.
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