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Female Genital Mutilation/Cutting—Pediatric Physician Knowledge, Training, and General Practice Approach

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Abstract

Female genital mutilation/cutting (FGM/C) is outlawed in much of the world but still mainly occurs from infancy-age 15. Many at-risk and FGM/C-affected girls live in the US. No standard pediatric training exists. A questionnaire assessing FGM/C education, knowledge, diagnostic confidence and external genital examination (EGE) approach was sent to pediatric listservs at 3 hospitals and a child abuse pediatrician (CAP) network. Analysis used χ2 and Fisher’s exact tests. Compared to general pediatricians, CAP reported more FGM/C education (RR 2.0 [95% CI 1.3–3.2]), awareness of ICD-9/10 codes (RR 3.2 [95% CI 1.4–7.3]), confidence in identifying sub-types (RR 4.5 [95% CI 2.3–8.7]) and discussing FGM/C (RR 4.2 [95% CI 2.3–7.6]). For 6–12 month olds, 10% of general pediatricians reported never performing EGE at female well child visits (WCV), increasing to > 50% for 17–18 year olds. Pediatric physicians are not trained to diagnose or manage FGM/C. EGE are not done at WCVs and FGM/C diagnoses are missed.

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Abbreviations

AAP:

American Academy of Pediatrics

CAP:

Child abuse pediatrician

CHCO:

Children’s Hospital Colorado

DH:

Denver Health and Hospitals

EGE:

External genital exam

FGM/C:

Female genital mutilation/cutting

ICD-9,10:

International Classification of Diseases, 9th and 10th revision

PCH:

Phoenix Children’s Hospital

US:

United States

WCV:

Well-child visit

YRS:

Years old

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Funding

None.

Author information

Author notes

  1. Basel Imam

    Present address: Department of Obstetrics and Gynecology, Edward Hospital, Naperville, IL, USA

Authors and Affiliations

  1. Department of General Pediatrics, Denver Health and Hospital Authority, University of Colorado School of Medicine, 1001 Yosemite St., Denver, CO, 80230, USA

    Janine Young & Kristine Knuti Rodrigues

  2. Department of Pediatric and Adolescent Gynecology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Basel Imam

  3. Department of Obstetrics and Gynecology, Arizona College of Medicine, Phoenix, AR, USA

    Crista Johnson-Agbakwu

Authors
  1. Janine Young
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  2. Kristine Knuti Rodrigues
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  3. Basel Imam
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  4. Crista Johnson-Agbakwu
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Contributions

Drs JY, BI and CJA conceptualized and designed the study. Dr. Young drafted the initial manuscript and Drs JY, BI, KKR and CJA reviewed and revised the manuscript. Drs JY, BI and CJA designed the data collection instruments. Dr. BI collected the data. Drs JY and KKR performed the data analysis. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Janine Young.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

IRB

IRB was reviewed and approved by the Arizona Institutional Review Board who provided a non-human subjects research designation for this project.

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Appendix

Appendix

Select questions from questionnaire (please contact authors for full questionnaire):

  1. 1.

    What proportion of your patient population is considered an immigrant or refugee?

    0–20%, 21–40%, 41–60%, 61–80%, 81–100%

  2. 2.

    Have you ever received any formal education about FGC?

    Yes/no

  3. 3.

    When was the first time you received education on FGC?

    Medical school, residency, clinical practice, never, undergraduate education

  4. 4.

    Are you aware of the ICD-9/10 codes for FGC?

    Yes/no

  5. 5.

    How confident are you in distinguishing between the different types of FGC?

    Confident, somewhat confident, not confident, I am not aware of the different types of female circumcision

  6. 6.

    How confident are you that you can discuss the possible complications of FGC with parents from countries with a high prevalence of FGC?

    Confident, somewhat confident, not confident, I don’t discuss/address this issue in my practice

  7. 7.

    You are seeing a female newborn* for a well child visit. In what percentage of visits do you perform a complete external exam of female genitalia (including visualization of labia majora, minor and clitoris) in this age group?

    0%, 25%, 50%, 75%, 100%, N/A

    *This question was also asked for the following age ranges:

    6–12 month female

    13 month–2 year old female

    3–4 year old female

    5–8 year old female

    9–12 year old female

    13–16 year old female

    17–18 year old female

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Young, J., Rodrigues, K.K., Imam, B. et al. Female Genital Mutilation/Cutting—Pediatric Physician Knowledge, Training, and General Practice Approach. J Immigrant Minority Health 22, 668–674 (2020). https://doi.org/10.1007/s10903-019-00938-x

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  • DOI: https://doi.org/10.1007/s10903-019-00938-x

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