⚠️ Chapter 593 · Female Genital Mutilation (FGM)

Nelson Textbook of Pediatrics 22nd Edition — FGM is a human rights violation and form of child abuse affecting over 200 million women and girls worldwide. WHO classification: Type 1 (clitoridectomy), Type 2 (excision), Type 3 (infibulation), Type 4 (other). Complications include hemorrhage, infection, obstetric fistulas, chronic pain, and psychological trauma. Pediatricians must identify FGM, manage complications, perform deinfibulation when indicated, and activate safeguarding pathways.

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📋 30 Clinical Scenarios — Female Genital Mutilation

📇 High‑Yield Review Cards: FGM

🩺 Clinical Presentations: Female Genital Mutilation

Select a presentation for diagnostic approach and management.

📋 Stepwise Approach: Identification & Management of FGM

🔑 Key Principles (Nelson Ch.593)
• WHO Classification: Type 1 (clitoridectomy), Type 2 (excision), Type 3 (infibulation — vaginal sealing), Type 4 (pricking, scraping).
• Immediate complications: Hemorrhage, infection (tetanus, sepsis), urinary retention, death.
• Long-term complications: Chronic pain, dyspareunia, recurrent UTIs, infertility, obstetric fistulas, psychological trauma (PTSD, anxiety, depression).
• Deinfibulation: Minor surgical procedure to divide scar tissue obscuring vaginal introitus. Indicated for Type 3 FGM before sexual activity or if symptomatic.
• Safeguarding: Mandatory reporting to child protection authorities. Assess risk to siblings.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Female Genital Mutilation