Hesperian Health Guides

Hesperian Health Guides

Caring for a woman after female genital cutting  (circumcision)

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HealthWiki > A Book for Midwives > Chapter 19: Advanced skills for pregnancy and birth > Caring for a woman after female genital cutting (circumcision)


In some communities — mostly in Africa but also in some parts of Asia and the Middle East — girls and young women are cut on their genitals. Like many cultural practices, it is a way that girls’ bodies are changed so they are considered beautiful, acceptable, or clean. It is also seen as a passage to womanhood.

Sometimes just a small cut is made. Sometimes the clitoris and the inner lips of the vagina are removed. Sometimes the girl’s genitals are sewn partially closed. This kind of cutting has many names including circumcision, female genital mutilation, or the name we use, female genital cutting (FGC).

a woman thinking while she holds a younger, sick-looking woman.
I didn't want to hurt her!

While this tradition may be meaningful for the community, FGC has serious harmful effects on the health and well-being of the girls who are cut. In the long term, FGC can lead to urinary tract infections, emotional damage, loss of sexual sensation or ability to have sex as an adult, and long, unproductive labors which can lead to death of the baby or the mother.

If a woman has had FGC and her genitals have been sewn partially closed, her genitals need to be cut open before she gives birth.

illustration of the below: opening the scar.

Contents

To open a genital scar

  1. Wash your hands well and put on sterile plastic gloves.
  2. Put 2 fingers into the vagina and under the scar tissue.
  3. Inject a local anesthetic if you have it.
  4. Use a sterile pair of scissors to cut the scar open. Open
    the scar enough so you can see the urethra, but no farther.
    These cuts can bleed heavily, so be careful not to cut far.


circumcision repaired

To repair the cut

  1. Wash your hands well and put on sterile plastic gloves.
  2. Inject a local anesthetic on both sides of the scar.
  3. Loosely sew together raw surfaces with 000 chromic gut or Vicryl suture to stop any bleeding.

Emergency care for FGC

A girl whose genitals were recently cut can have serious problems including bleeding and infection, both of which can lead to shock — which is an emergency. Girls whose bleeding cannot be stopped need medical help right away. Midwives can help these girls by stopping the bleeding, treating for shock, and watching for signs of infection.

Bleeding and shock

of shock (one or more of the following):

  • severe thirst
  • pale, cold, and damp skin
  • weak and fast pulse (more than 100 beats a minute)
  • fast breathing (more than 20 breaths a minute)
  • confusion or loss of consciousness (fainting)


What to do for bleeding or shock

  • Get medical help immediately.
  • Press firmly on the bleeding spot right away. Use a clean, small cloth that will not soak up a lot of blood. Keep the girl lying down with her hips elevated while you take her to get medical help.
  • Help her drink as much as she can.
  • If she is unconscious and you are far from help, you may need to give her rectal fluids or IV fluids before transporting her.
Infection

If a cutting tool is not sterilized before and after each use, germs on it can cause a wound infection, tetanus, HIV, or hepatitis.


  • wound infection: fever, swelling in the genitals, pus or a bad smell from the wound, and pain that gets worse
  • tetanus: tight jaw, stiff neck and body muscles, difficulty swallowing, and convulsions
  • shock: (see the list above)
  • infection in the blood (sepsis): fever and other signs of infection, confusion, and shock

WARNING!   If a girl begins to show signs of tetanus, shock, or sepsis, get medical help right away.

What to do for infection

  • Keep watching for warning signs of tetanus and shock. If she has not yet had a tetanus vaccination, she should get one immediately.
  • Give modern or plant medicines for pain.
  • Keep the genitals very clean. Wash them with water that has been boiled and cooled and has a little salt in it.
  • Give an antibiotic, such as amoxicillin or erythromycin.

For infection from female genital cutting
  • give 500 mg erythromycin
by mouth, 4 times a day for 10 days


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