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)

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In this chapter:

 

In this chapter:

In some communities — mostly in Africa, but also in Asia, the Middle East, and countries where people from these regions have migrated — girls and young women are cut on their genitals. Like many cultural practices, it is a way that girls’ bodies are changed to be beautiful, acceptable, or clean. It is seen as a passage to womanhood.

Sometimes just a small cut is made. Sometimes the outer 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 female genital cutting (FGC).

I didn't want to hurt her!

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 trauma, loss of sexual feeling or ability to have sex as an adult, and long, unproductive labors ending in the death of the baby, the mother, or both.

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

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 include 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

• Wash the genitals with boiled, cooled water that has a little salt in it.
• If she shows signs of wound infection, give an antibiotic (see box below).
• Give modern or traditional medicines for pain.
• Watch for warning signs of tetanus, sepsis, and shock. If she has not had a tetanus vaccination (or if you do not know if she has), give one immediately.

To treat wound infection from female genital cutting
1 g (1000 mg) cephalexin		by mouth, 2 times a day for 7 to 10 days
or
give 875 mg amoxicillin + 125 mg clavulanic acid		by mouth, 2 times a day for 7 to 10 days

This page was updated:28 Aug 2024