FGM experience and training needs of Italian Gyn&Obs medical staff: results from a pilot study

BACKGROUND: Female genital mutilation (FGM) includes removal or other injuries of the external female genitalia for non-medical reasons. The practice roots in cultural customs and is reported in over 90 countries. It is performed in the child and adolescent age and can cause physical and psychological consequences. In Italy, 60-80,000 are estimated to be affected and despite guidelines on FGM care in place since 2007, Gyn&Obs’ perspective has not yet been adequately analysed. METHODS: Based on literature review and focus groups, a questionnaire targeting Gyn&Obs’ FGM clinical experience (e.g. patients’ features; FGM complications; barriers in relating with patients; defibulation requests, etc.) and training needs was conceived followed by content and clarity validation by experts and a pre-test assessing its reliability. A web survey using the tool was launched in 2022 via Gyn&Obs’ associations. RESULTS: 129 Gyn&Obs participated in the survey. 86.8% stated to have visited FGM patients, in particular from Sub- Saharan Africa and aged 18-34 yo. Type II and I (58.9 and 52.7%) are the most frequently observed and urinary issues and dyspareunia are the symptoms most commonly reported. 57.3% had difficulty relating to patients mainly for cultural and linguistic issues, and 56.6% had perceived patients’ difficulties in relating also for fear to be judged. 27.1% received defibulation requests and 25.7% found the referral challenging for lack or unknowing devoted facilities or professionals. 67.4% consider Gyn&Obs’ training inadequate and 79.8% that residency is the optimal time to deliver it. CONCLUSIONS: Results highlighted Gyn&Obs’ difficulties in relating to FGM patients and in providing adequate referral. Moreover, FGM training is strongly perceived as inadequate. The survey offered hints to inform a large-scale study among Italian Gyn&Obs and other health professionals aiming to detect gaps and improve FGM patients’ care through training and health services strengthening. KEY MESSAGES: • Italian Gyn&Obs’ training on FGM seems to be inadequate. • Language and cultural barriers are perceived as the main barriers to interacting with FGM patients.