Why screen for FGM/C?

Health care providers should actively screen for female genital mutilation/cutting (FGM/C) because women may be embarrassed to admit they have undergone the procedure. It is important for health care providers to consider different screening tools when examining patients who have undergone FGM/C .¹

Many patients may be reluctant to disclose they have undergone FGM/C. They may feel uncomfortable talking about it, especially if they are in to see you for a non-FGM/C related cause. We recommend including a question asking about FGM/C in intake forms. You can then follow-up with your patient by asking if they have any concerns or symptoms related to FGM/C that they would like to discuss.

FGM/C screening tools

Use our checklist to help determine whether your patient has undergone or is at risk of undergoing FGM/C. Click on one of the age categories below to download the checklist (pdf).

Women over age 18 Minors under age 18

How do I put a patient with FGM/C at ease during an examination?

Ask your patient what she calls FGM/C and use that word.¹
Be prepared to provide an interpreter/translator who is not a family member.²Your patient may not feel comfortable discussing intimate health problems with family members present. Your patient may also be feeling pressure from family members to not discuss FGM/C.
Limit the number of people in the room to protect the woman's or child’s privacy.³
Ask your patient if she is comfortable undergoing a vaginal exam to identify the type of FGM/C and any potential complications (particularly infection, labial fusion/vaginal stenosis, and keloids or other evidence of scarring).³
Schedule a separate appointment for a pelvic exam. Use this time to explain to your patient what to expect during her next visit.⁴
Document all information in her medical record to minimize repeated sharing and examinations. Our care checklist can help you keep track of your patient’s FGM/C concerns in her medical record.

Sample screening questions:

Many women from your country have been cut or “closed” as children. If you don't mind telling me, were you cut or closed as a child?
Do you have any problems peeing? Does it take you a long time to pee? Note: women with Type III may take several minutes to urinate.
Do you have any pain with your period? Do you feel that the blood gets stuck?
Do you have any itching, burning or discharge from your vaginal area?
(If sexually active) Do you have any pain or difficulty when having sex?

These questions were adapted from: Mishori, Warren, & Reingold (2018)

Questions you can prepare for

Use the sample questions below as a reference tool for questions you can expect from patients who have experienced FGM/C.

On overall health, you can expect:

I remember, as a child, having a traumatic experience where my parts of vagina were cut. I know this is called FGM and that there are several types. I’m unsure which type I have and how it could be affecting my health. Would you be able to help me with this?
Could my frequent urinary tract infections be a result of my FGM/C?
I’m afraid of undergoing a vaginal exam, will it be painful?
What is deinfibulation? Is it painful? How long is the recovery time following the procedure?

On experiences with sex, you can expect:

What can I do to make sex less uncomfortable and painful?

On pregnancy, you can expect:

How can my [type I, type II or type II] FGM/C affect my pregnancy?
I heard that I may need to undergo a C-section. Is that always the case?
I'm pregnant and have Type III FGM/C which means my vagina is sewn shut. What are my options for a safe delivery?

PDF Version

In their own words

A health care providers' suggestions on "Do's" and "Dont's" when examining a patient with FGM/C:

Conducting a vaginal exam

Reporting: recent FGM/C experience or imminent risk of FGM/C

Health care providers who suspect that a minor has had FGM/C recently or is at risk of FGM/C may contact or refer to the following resources:

National child abuse hotline: 1-800-4-A-CHILD (1-800-422-4453)
DC hotline for child abuse and neglect : 202-671-7233
DC metropolitan police department : 202-727-9099
Office of Women’s Health (U.S. Department of Health and Human Services) helpline : 1-800-994-9662
Other state-specific child abuse reporting