American Academy of Pediatrics Offers Clinical Guidance on Female Genital Mutilation or Cutting

Pediatricians may find patients who have undergone the procedure in another country or in the U.S.

The American Academy of Pediatrics addresses the medically unnecessary practice of female genital mutilation or cutting (FGM/C) in a new clinical report that acknowledges that the procedure, while outlawed in most countries, is still being performed on girls and adolescents and can cause lifelong harm.

The clinical report, “Diagnosis, Management, and Treatment of Female Genital Mutilation/Cutting in Girls,” will be published in the August 2020 Pediatrics (published online July 27). The report provides guidance to pediatricians on how to counsel families and examine and treat patients who may have undergone or are considering the practice.

While outlawed in the United States, it does occur here, and pediatricians are likely to work with immigrant families who come from countries where FGM/C is performed. Most often, the practice is performed between infancy through adolescence. There are no medical benefits. The practice carries the potential for severe complications, pain and long-term harm.

“We know these procedures can cause physical and emotional harm, and can seriously affect a girl’s urologic, reproductive, sexual, and mental health,” said Janine Young, MD, FAAP, lead author of the report. “We hope to encourage sensitive conversations with families, to help pediatricians establish a trusting relationship and ask questions and offer counseling in a sensitive, nonjudgmental way.”

FGM/C involves medically unnecessary cutting of parts or all the external female genitalia. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. It is considered a violation of basic human rights and is performed without the assent of the child.

The AAP recommends:

• Physicians should not perform any type of FGM/C on female infants, girls, or adolescents, and should actively counsel families against carrying it out.
• All children should have external genitalia examined at all health supervision examinations (including the identification of clitoral hood, clitoris, labia majora and labia minora), with the child or adolescent’s assent or consent (as developmentally appropriate), the consent of parents or guardian, and with appropriate chaperoning provided.
• Consultations may be needed for diagnostic or treatment procedures with a specialist, such as an experienced child abuse pediatrician, pediatric gynecologist (for young children), gynecologist (for older children and teenagers), urologist, or urogynecologist.
• Standardized training related to the identification, treatment, management, and culturally appropriate communication approaches need to be developed and provided to health care providers who care for FGM/C affected communities.
• If FGM/C is suspected to have occurred in the United States—or as “vacation cutting” after immigration to the United States—the child or teenager should be evaluated for potential abuse.
• Expressed intention to engage in FGM/C, either in the United States or abroad, should also prompt a report to Child Protective Services if the child's parent or caregiver cannot be dissuaded.
• It is recommended to engage affected communities in developing community-based education and prevention strategies.

The AAP, the United Nations, the World Health Organization, the International Federation of Obstetrics and Gynecology and the American Medical Association are among the organizations that unequivocally oppose all forms of FGM/C.

The AAP Section on International Child Health, Committee on Medical Liability and Risk Management, and Committee on Bioethics developed the report. After the embargo lifts, the report will be available here.