How do I discuss FGM/C with my patient?
Female genital mutilation/cutting (FGM/C) is an enormously sensitive topic for some women, while others are comfortable talking about it. Some women want to treat the symptoms, while others see FGM/C health consequences as a normal part of life. As you would with anyone else, pick up cues from your patient as to how she feels about living with FGM/C. Does she feel ashamed? Indifferent? Comfortable or nervous discussing health consequences? The tips below are a starting point on how to navigate a thorny topic.
|Use the same words your patient relies on to describe her experience with FGM/C.1||Use the word "mutilation" with your patient.2|
|Ask if your patient is willing to talk about their FGM/C.1||Insist on discussing FGM/C if the patient doesn’t want to.|
|Provide a professional interpreter/translator.3||Let a family member serve as the interpreter/translator.4|
|Limit the number of providers in the room when examining her.*||Invite other providers from the practice in the middle of a vaginal examination.|
|Use a nonjudgmental tone when discussing health consequences.4||React with shock and horror.|
|Keep an open mind about how your patient feels about life with FGM/C.||Assume all patients are necessarily unhappy living with FGM/C. Some may see consequences such as painful periods or infections as a normal part of life.*|
|Ask if your patient would like to be accompanied by family members.5||Discuss FGM/C with family members in the room unless the patient brings up FGM/C first.|
|Make FGM/C care a recurring part of your patient's routine visits in order to help her overcome her embarrassment.6||Assume the patient will bring up FGM/C care during visits.|
|Explain why some requests may not be legally or ethically possible (i.e. reinfibulation following deinfibulation is outlawed in some countries).7||Assume your patient knows FGM/C is illegal in the United States.|
|Give referrals to specific mental health services or other specialized physicians such as adolescent gynecologists and urogynecologists.8||Assume your patient will seek out these resources on her own.|
* George Washington University Milken Institute School of Public Health original study, 2018-19.
In their own words: health care providers talk about FGM/C
"When it’s an accepted practice in one culture and the provider is from a culture where it is not acceptable, then we have to be really careful not to judge. Because the person may not have a problem with the fact that they’ve had this procedure. Some may feel terrible about it. Some may think it’s a good thing. As a provider, I need to evaluate where [patients] are with this issue."
"FGM needs to be integrated into screening, pap smears and for when patients are preparing for children. There is a lot of self-blame and embarrassment. For many women, this was not a choice. For many women talking about it was not common."
"If [our patients] come from a place where 95% of women had FGM [and] it is a part of their growing up and what is normal in their society, you don’t want [to] re-traumatiz[e] someone. If it is an issue for them [they] know they can come to you and not have you judge them.And that’s one of the hardest parts--making sure [you] don’t come across [as] “oh my god, what happened to you.” You don’t have to accept everything, but you [do] need to understand."