GD07 The role of the dermatologist in the fight against female genital mutilation

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Abstract Female genital mutilation (FGM) is a practice that the World Health Organization (WHO) estimates to affect 200 million women globally. The practice of FGM is often attributed to the Middle East, sub-Saharan Africa, North Africa and, to a lesser extent, Asia; however, it is now being witnessed in cities worldwide with high numbers of FGM-practising communities. The WHO defines FGM as ‘all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reason’. While FGM has no health benefits, in certain cultures, the practice confers upon women full social acceptability and integration into the community and serves as a rite of passage to womanhood and marriage (Mpinga EK, Marcias A, Hasselgard-Rowe J et al. Female genital mutilation: a systematic review of research on its economic and social impacts across four decades. Glob Health Action 2016; 4:9). This systematic review aimed to assess the dermatological impact of FGM on women and the role dermatologists can play in the fight against the practice. A systematic review was carried out in accordance with the PRISMA guidelines. PubMed (n = 98), Cochrane (n = 1), CINAHL (n = 8) and Embase (n = 38) were searched for articles published between January 1990 and January 2023 with the phrase ‘female genital mutilation and skin or dermatology’. A total of 148 studies were initially identified; following screening, 21 articles were deemed suitable for inclusion and analysed. The literature highlighted that the main dermatological consequences of FGM were severe keloid formation, hypertrophic scars, vitiligo lesions, clitoral neuromas and, most commonly, epidermal inclusion cysts (Dave AJ, Sethi A, Morrone A. Female genital mutilation: what every American dermatologist needs to know. Dermatol Clin 2011; 29:103–9). A study of women in Somalia who had been admitted to the hospital following complications due to FGM noted that 55.1% of women (n = 65/118) had developed epidermal inclusion cysts. The literature suggests women often feel shame approaching clinicians for help; however, without support, these women can experience years of dyspareunia, dysuria, pruritus, pelvic pain and obstetric complications, as well as increased transmission of sexually transmitted infections and HIV following damage to the vaginal epithelium. By analysing the literature, it is clear further research into the dermatological consequences of FGM is necessary so that a conversation can be had about the ways in which dermatologists can effectively support survivors of FGM. It is important that each woman is recognized as an individual with her own story to tell, her own lived experience and her own humanity.