People who have experienced female genital cutting

Find information and resources on how to engage people who have experienced female genital cutting in cervical screening.

Resources

For patients

You can provide these resources to patients to help them before, during and post screening. See the full resource library.

    Before screening appointment

    During screening appointment

    Post screening appointment

    For health care providers

    You can use these resources to prepare for an appointment with a patient who has experienced female genital cutting (FGC), also known as traditional cutting, female genital mutilation, female circumcision.

    Female genital cutting (FGC) and cervical screening – a guide for practitioners.

    Considerations

    Twenty-nine countries around the world practice female genital cutting. It is most prevalent in Africa (particularly Somalia, Guinea, Djibouti, Egypt, Eritrea, Mali, Sierra Leone, and Sudan). Some parts of the Middle East and Asia also take part in the practice

    People are increasingly migrating to Australia from countries that practice female genital cutting. About 120,000 migrant women in Australia who have undergone the practice in their countries of birth. Often these countries do not have organised cervical screening programs.

    In Australia, there is a low uptake of preventive health services by African women. People from culturally and linguistically diverse backgrounds are less likely to have Cervical Screening Tests.

    Women who have experienced female genital cutting may face barriers to screening associated with psychological trauma, pain (real or anticipated) and embarrassment. Women who have experienced type 3 FGC (where the labia have been sewn together to make the vaginal opening smaller) may physically be unable to have a speculum examination. Similarly, for women who have genetic abnormality/dysmorphia of the vagina where the opening is too small to introduce even the smallest speculum.

    Self-collection is an important and potentially a more comfortable and acceptable option for these women.

    Healthcare providers will need to use their judgement to determine if and when to ask about FGC. While the practice of FGC may conflict with your own value system, it is important not to show judgement in your words or reactions. Do not use the term ‘mutilation’ or make comparisons to ‘normal’ genitals.

    Barriers

    There are general barriers and barriers specific to people from CALD backgrounds that people face in participating in cervical screening. People who have experienced female genital cutting can face extra barries relating to:

    • psychological trauma of female genital cutting
    • pain due to scar tissue and infection
    • anticipation that the cervical screening test will be painful/uncomfortable/difficult
    • lack of knowledge of the availability, importance, options and benefits of cancer screening
    • negative cultural perceptions about cancer – for example fatalistic and superstitious attitudes (i.e. cancer is the will of God) – which may lead some people to perceive cervical screening as unnecessary
    • embarrassment associated with female genital cutting (i.e. anticipating the healthcare provider to have a shocked reaction)
    • language, communication and literacy difficulties
    • fear of the test
    • lack of availability of female healthcare providers.
    • difficulties accessing and navigating the Australian healthcare system (particularly, newly arrived patients)
    • competing priorities such as employment, housing and family, particularly newly arrived patients.

    Ways to engage

    The following strategies are effective in engaging women who have experienced female genital cutting in cervical screening.

    Strategy

    Detail

    Appropriate communication

    • Provide time to explain the test and allow patients to ask any questions, including that they have the right to request a female provider.
    • Provide clear information about the screening options available, including self-collection as a potentially more comfortable and acceptable option.
    • If a patient discloses FGC during a preliminary appointment, in order to build rapport and trust, you may need to offer a subsequent appointment for return consultation.
    • Use simple language and pictures where appropriate/available. Patients may not be familiar with basic health topics and concepts.
    • Reassure the patient that the consultation is private and confidential.
    • Let the patient know they can bring a friend or relative with them to their appointment.
    • Provide written information in simple plain language (English or other language) but be aware that not all people are literate and/or may prefer to receive information in oral form.
    • Use a telephone interpreter if required.
    • Be non-judgemental and empathetic to the patient’s situation. Many patients are proud to have undergone FGC but are aware that in Australia it is a judged procedure.
    • Offer culturally appropriate resources such as translated fact sheets.
    • Provide suitable, trained female interpreters, as it may not be appropriate to use a family member, friend, or even an interpreter from the same community.

    Cultural training

    • Offer cultural safety training for all health service staff.
    • Provide specific training for healthcare providers around how and when to ask about female genital cutting (i.e. country of birth is a good indicator; use simple language; be sensitive; use value neutral non-judgemental language).
    • Develop a practice guide for healthcare providers that includes examples of how to ask patients about female genital cutting and tips to support them to screen.

    Make the procedure as comfortable as possible

    • Offer self-collection as a more comfortable and acceptable option for screening.
    • If clinician-collection is chosen, some of the below points may assist.
      • Offer patients the opportunity to perform the test in a different position (e.g on their side rather than their back, letting them have their hands and arms free during the examination).
      • Consider use of a smaller speculum.
      • Some patients may prefer to insert their own speculum and it can be helpful to offer this option.
      • Providing instructions on calming and deep breathing techniques can also help the patient to relax.

    Patient records

    • Record interpreter requirements and female genital cutting status in medical records for future consultations.

    Choice of screening method

    • Offer the choice of either self-collection or clinician-collection screening options.
    • Explain the pros and cons of each option, including follow-up requirements if HPV is detected on a self-collected vaginal sample.
    • Consider offering home-based self-collection (e.g. via a telehealth consultation) where appropriate.

    Choice of cervical screening provider

    • Ensure female cervical screening providers are available.
    • Refer patients to a cervical screening provider who speaks their language (preferably female) or to a service that may be more acceptable (i.e. a healthcare service for migrant and refugee women).
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