Female Genital Mutilation: Cultural Awareness and Clinical Considerations

Braddy, Cathleen M.; Files, Julia A.

doi:10.1016/j.jmwh.2006.11.001

Cited by 36 publications

(31 citation statements)

References 18 publications

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“… Sources: Braddy and Files, 22 Dundek, 13 Horowitz and Jackson, 23 Leininger and MacFarland, 35 Leval et al, 19 Ogunsiji et al, 15 Royal College of Obstetricians and Gynaecologists, 36 and Widmark et al 25 …”

Section: Discussionmentioning

confidence: 99%

Knowledge of Female Genital Cutting and Experience With Women Who Are Circumcised: A Survey of Nurse‐Midwives in the United States

Hess

Weinland

Saalinger

2010

J Midwife Womens Health

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Thousands of women with a history of female genital cutting (FGC) have immigrated to the United States. The purpose of this study was to assess certified nurse-midwives' (CNMs') knowledge of FGC and to explore their experiences caring for African immigrant women with a history of genital cutting. A descriptive survey design was used. A random sample of 600 CNMs from the member list of the American College of Nurse-Midwives was surveyed. Two hundred forty-three CNMs completed a survey of FGC knowledge and provider experience. The respondents exhibited more correct medical knowledge about FGC than knowledge of cultural and legal issues. Differences in correct or incorrect knowledge were statistically significant based on provider experience. Almost 70% of respondents could identify infibulation. Less than 20% knew that both Muslim and Christian women are circumcised. Fifty-seven percent knew that it is illegal in the United States to circumcise women younger than 18 years of age. We found that discussions between CNMs and clients who were circumcised regarding FGC-related concerns and complications were minimal. Women with a history of FGC want female providers. Reinfibulation poses an ethical dilemma for some CNMs. Nurse-midwives in the United States need to learn more about FGC and the cultures of their clients in order to provide culturally competent care.

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Section: Discussionmentioning

confidence: 99%

Knowledge of Female Genital Cutting and Experience With Women Who Are Circumcised: A Survey of Nurse‐Midwives in the United States

Hess

Weinland

Saalinger

2010

J Midwife Womens Health

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“…Several excellent reviews provide information about the range of procedures and resulting anatomical findings, cultural rationale and the potential medical complications. [69][70][71][72] Pelvic examination in a woman who has undergone infibulation (clitoridectomy, excision of the labia minora, and partial excision and reapproximation of the labia majora) may be impossible due to the narrowed introitus, scarring with introital/vaginal stenosis, and/or frequent occurrence of vaginismus requiring referral to a gynecologist with this particular expertise for examination and to discuss potential benefits of deinfibulation.…”

Section: Female Genital Circumcisionmentioning

confidence: 99%

The Challenging Pelvic Examination

2011

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While there is a large body of evidence on the effectiveness of Pap smears for cervical cancer screening and on screening for cervical gonorrhea and Chlamydia, there is sparse evidence to support other portions of the pelvic examination and little guidance on examination logistics. Maximizing comfort should be the goal; lubrication use and careful speculum selection and insertion can ease this intrusive procedure. This is particularly important in adolescent and menopausal women, sexual minorities, obese women, women with disabilities, and women with a history of trauma or prior instrumentation affecting the genitalia. We review the evidence and provide guidance to minimize physical and psychological discomfort with pelvic examination. P elvic examinations are performed to evaluate pain, bleeding, and vaginal discharge and to screen for cervical cancer and sexually transmitted infections. Little attention has focused on the mechanics of pelvic examination technique, yet the examination is an intrusive experience for many women who feel exposed and lack control. 1 Emotional distress and fear of pain are cited as reasons for reduced adherence to cervical screening especially among adolescents, 2 racial/ethnic 3-5 and sexual minority groups, 6 obese women, 7 victims of sexual assault and other trauma, 8 and women with disabilities. 9 Therefore, examination should be limited to components with proven utility and should be performed with cultural sensitivity and procedural excellence, especially in clinical situations that require particular finesse. Accordingly, we review the clinical evidence as it exists, and in areas that lack evidence offer our own experience to optimize technical aspects of speculum choice and insertion, and suggest strategies to manage challenging circumstances. When recommendations are not referenced, we are relating our experience in the absence of evidence. Bimanual examination is not useful as a screening test for ovarian cancer because of limited sensitivity and specificity. In one study, ovaries were palpable in 55% of women under 200 lbs during examination under anesthesia, but in only 9% of women over 200 lbs. 14 In another study under similar circumstances, uterine size and contour were correctly assessed in over 50% of patients; however, sensitivity of examination for adnexal masses of 5 cm or greater was only 28% among attending gynecologists and 16% among gynecology residents. 15 The USPFTF acknowledges poor performance characteristics of the bimanual examination in its recommendation about screening for ovarian cancer. 11 In the non-screening setting, bimanual examination is inadequate to evaluate acute abdominal pain or vaginal bleeding, 16 since ultrasound is so much more sensitive and specific. COMPONENTS OF THE FEMALE PELVIC EXAMINATIONThe most evidence-based approach would therefore suggest Pap smear collection alone and the speculum examination required to achieve that goal. We suggest that bimanual and sometimes rectovaginal examinations may be important in evaluating pelvi...

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“…Clinicians should consult sources that detail the increased risk of medical sequelae such as extreme pain associated with scar tissue, restricted examinations resulting in imprecise assessment, difficult bladder management, lacerations, peri-urethral tears, and hemorrhage at delivery. Resources that should be made available include a worksheet to help plan care for pregnant patients with FGM (Campbell, 2004), informative drawings of FGM (Braddy & Files, 2007), and a slide-lecture kit with delivery-related surgical options for any necessary vaginal repair (American College of Obstetricians and Gynecologists, 2006). 2.…”

Section: Implications For Future Research and Clinical Practice (Withmentioning

confidence: 99%

The Cultural Context of the Sierra Leonean Mende Woman as Patient

Kallon

Dundes

2010

J Transcult Nurs

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This article provides a clinically pertinent overview of Sierra Leonean immigrants, a growing patient population that most health care workers know little about. The focus is on Sierra Leonean Mende women and the relevance of their cultural perspective to clinical care. A literature review and interview responses from seven Sierra Leoneans are the sources of data. Immigrants from Sierra Leone are coming from a country that since the late 1990s has been ranked at the bottom of the United Nations' Human Development Index. Practitioner knowledge of cultural norms such as female genital mutilation and discomfort with opposite sex health practitioners can improve cross-cultural interactions in the health arena. Given that most clinicians are unfamiliar with this unique patient population, this article provides background information including special attention to medically relevant aspects of the Sierra Leonean cultural milieu that will enhance the rapport between health care workers and these patients.

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Female Genital Mutilation: Cultural Awareness and Clinical Considerations

Cited by 36 publications

References 18 publications

Knowledge of Female Genital Cutting and Experience With Women Who Are Circumcised: A Survey of Nurse‐Midwives in the United States

Knowledge of Female Genital Cutting and Experience With Women Who Are Circumcised: A Survey of Nurse‐Midwives in the United States

The Challenging Pelvic Examination

The Cultural Context of the Sierra Leonean Mende Woman as Patient

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