Genital Trauma and FGM Awareness

Genital Trauma

• Refers to injury to external or internal female genitalia.
• Includes trauma to the labia majora, labia minora, vaginal opening, perineum, clitoris.
• Also includes injury to the hymen, vagina, cervix, anus, and rectum.
• Penetrating trauma, sexual abuse and assault are classified as genital trauma.

Female Genital Mutilation (FGM)

• Involves partial or total removal of external female genitalia or other injuries to the genital organs.
• Procedures may include piercing, stretching, or staining.
• Most commonly performed on young girls between infancy and the age of 15 before puberty.
• Classified as illegal in the UK and a form of child abuse.

Suspected FGM

• Safeguarding referral is necessary via EBS.
• Report any physical signs or disclosure of FGM in children under 18 to the police under the Serious Crime Act 2015
• Type 3 or Type 4 FGM, involving closure of the vaginal opening, requires a lower threshold for conveyance to the nearest obstetric unit in laboring women as it can cause complications for the mother and baby.

Termination of Pregnancy

• Also known as abortion.
• Age-standardized abortion rate in the UK was 18.6 per 1,000 women in 2021.
• Can be done for social or medical reasons including fetal abnormality or risk to the woman's health.
• Legal for social reasons up to 24 weeks.
• Can be done after 24 weeks in limited circumstances, such as when the mother's life is at risk or the baby has a severe or life-limiting disability.

Medical Termination of Pregnancy (MTOP)

• Often referred to as "Pills by Post", MTOP involves taking two medications, Mifepristone and Misoprostol, 24-48 hours apart.
• Mifepristone softens the cervix, while Misoprostol encourages the uterus to contract, ending the pregnancy.
• Ultrasound scans are usually performed to confirm gestational age, but telemedicine is increasingly being used to access MTOP in early pregnancy.

Surgical Termination of Pregnancy

• A procedure to remove the pregnancy done under local anesthetic, sedation, or general anesthetic depending on the gestation.
• Often carried out as outpatient surgery, with women returning home the same day.

Post-Termination

• Some bleeding and discomfort are normal for up to two weeks.
• Call 999 if you notice excessive bleeding (incontinence pad saturated with 500 ml).
• Excessive bleeding post-termination is considered a postpartum hemorrhage and requires a pre-alert to the nearest obstetric unit.

Prolapsed Uterus

• Defined as the uterus dropping down into the vagina, caused by weakened pelvic floor muscles.
• Not usually life-threatening, but can cause shock or vasovagal symptoms.

Prolapsed Uterus Symptoms

• Feeling of heaviness around the lower abdomen or genitals.
• Discomfort during sexual intercourse.
• Seeing or feeling a bulge or lump in or coming out of the vagina.
• Problems urinating.

Management of Gynaecological Conditions

• (C)A, B ,C, D, E approach:
  • Assess for any time-critical features or red flags (If yes, pre-alert).
  • Consider paramedic assistance.
  • Administer oxygen if the patient is shocked, hypoxic, or hypovolemic according to JRCALC guidelines.
  • Conduct a secondary survey and transfer to the emergency department for non-time-critical conditions.
  • Empathy, support, and pain relief should be offered in all cases.