Courtesy of UB Jacobs School of Medicine
The Human Rights Initiative (HRI), a student organization of the Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, is educating providers and fellow classmates about the medical and psychological consequences of female genital cutting (FGC) among those seeking asylum in Buffalo. The effort comes at a time when an increase in immigration means that more U.S. physicians will encounter FGC at a time when the topic is not covered in the training of health care professionals.
“Everyone lacks knowledge in this topic,” says Alyssa D. Reese, a Jacobs School student and HRI member. “But as we see more refugees, we are going to see a lot more of it, especially among practitioners involved in primary care or the delivery of babies.” Reese has been working to improve knowledge of FGC since her first year in medical school, and HRI has held conferences and grand rounds (medical teachings) on FGC. Reese recently presented at a national conference about her FGC projects, including a review of health care provider knowledge of FGC and HRI’s experience with gynecological exams for these clients. She is also developing a handbook about FGC for providers and medical students.
“We talk about domestic violence and physical abuse, but this is a taboo topic,” says Reese, who conducted the research for her honors thesis under the supervision of Kim Griswold, MD, HRI founder, faculty advisor, and professor emerita of family medicine and psychiatry in the Jacobs School. “As medical students, we are responsible for learning about taboo topics so that we can talk about them in a trauma-informed way and provide trauma-informed care to our patients.”
FGC involves the forced partial or total removal of the external genitals of girls and women for religious, cultural, or other nonmedical reasons. It has been illegal in the U.S. since 1996, and is internationally condemned by the World Health Organization and the United Nations as a human rights violation. The procedure is performed throughout the world, but primarily in sub-Saharan Africa, the Middle East, and Asia. It is a leading cause of death among girls and women in those regions. Performed on females as young as infants and up through the teen years or later by non-medical individuals — often close female relatives — without anesthesia, FGC is seen in these cultures as a kind of “women’s rite.” It is based on false beliefs that the procedure will increase the male partner’s pleasure, make the girl more desirable for marriage, increase hygiene, preserve virginity, or promote fertility.
Acute medical consequences of FGC include severe pain, bleeding, and loss of consciousness. Chronic consequences include urinary tract infections, pain with sex, inability to have intercourse, infertility, pain during menses, clitoral neuroma, and abnormal growth of neural and other tissue, along with obstetric complications. And because FGC is typically done in non-sterile conditions, there is the risk of serious, even life-threatening, infection. In some instances, the physical condition can be surgically repaired but the procedure can also cause lifelong psychological consequences, from depression and anxiety, to post-traumatic stress disorder.
