Female genital mutilation or cutting OSCE — the at-risk girl and the acute complication

Station objectives

1. Recognise FGM on clinical findings, classify the WHO type, and state that it is child abuse when performed on a minor. [4]
2. Manage acute complications of FGM, including the emergency of urinary retention in Type III. [1]
3. Outline the deinfibulation pathway with correct timing, counselling, and multidisciplinary team. [2]
4. Discharge the safeguarding, mandatory-reporting, and sibling-protection duties. [4]
5. Address the mental-health needs and the longitudinal follow-up. [3]

Candidate brief

You are the paediatric registrar in the outpatient clinic. You have 10 minutes for Station A (identification of Type III at a routine visit and the safeguarding response) and 12 minutes for Station B (acute urinary retention in a fourteen-year-old with Type III and the deinfibulation pathway). Examiners score classification accuracy, safeguarding and reporting completeness, acute emergency management, deinfibulation planning, and cultural safety throughout. [4] [1]

Station A — Identifying Type III at a routine visit

Setup: A six-year-old girl of Somali background is referred with recurrent urinary tract infections over three months. Her mother migrated recently and speaks limited English. The maternal grandmother is visiting from overseas. On genital examination, the labia majora are fused with a pinpoint vaginal opening, consistent with Type III infibulation. [4]

Expected actions:

• Recognise the findings as Type III infibulation and state that FGM on a child is child abuse. [4]
• Classify the WHO Type I–IV accurately when asked. [4]
• Use a professional interpreter — never the grandmother or any family member — and offer a female examiner with chaperone. [4]
• Send a urinalysis and urine culture, and arrange a pelvic ultrasound to assess for haematocolpos or other structural complications. [1]
• Make a mandatory child-protection report immediately, screen every sibling for cutting or risk, and agree a multi-agency safety plan before the child leaves. [4]
• Refer to the specialist FGM or gynaecology service for deinfibulation planning and to psychology for mental-health screening and trauma-focused therapy. [3]

Common errors the examiner will trap: failing to recognise the finding as FGM; using a family member as interpreter; deferring the safeguarding report out of misplaced cultural sensitivity; not screening the siblings; and omitting the mental-health referral. [4]

Station B — Acute urinary retention and deinfibulation

Setup: A fourteen-year-old girl with Type III presents to the emergency department with severe lower abdominal pain and inability to pass urine for twelve hours. She is distressed, in significant pain, and ultrasound confirms early haematocolpos. [1]

Expected actions:

• Recognise acute urinary retention from the narrowed Type III introitus as a medical emergency requiring urgent relief of the obstruction. [1]
• Give adequate analgesia including opiates; do not undertreat the pain. [1]
• Relieve the obstruction by catheterisation if possible or incision of the infibulation scar under anaesthesia by a competent surgeon — do not defer for non-urgent workup. [1]
• Assess for local infection or sepsis and arrange urgent urogynaecology or surgical review. [1]
• Plan elective deinfibulation once the acute crisis resolves, performed by a gynaecologist or FGM specialist, with counselling addressing the girl's fears, expected outcomes, and consent as a mature minor. [2]
• Assemble the multidisciplinary team: surgeon, psychologist for trauma-focused support, specialist nurse or community health worker. [2]
• Close with mandatory reporting, sibling screening, a safety plan, and follow-up with the general paediatrician. [4]

Common errors the examiner will trap: deferring the obstruction relief for imaging; undertreating pain; omitting the deinfibulation plan; not addressing the mental-health needs; and failing to screen siblings or make the safeguarding report. [1] [4]

Marking domains

• Recognition and classification — WHO type named correctly; child-abuse status stated; cultural sensitivity and child protection held together. [4]
• Acute management — emergency of urinary retention recognised and relieved urgently; adequate analgesia; sepsis assessed. [1]
• Deinfibulation pathway — timing, counselling, and multidisciplinary team correct; consent as a mature minor addressed. [2]
• Safeguarding and follow-up — mandatory report made, siblings screened, safety plan agreed, mental-health referral and longitudinal follow-up arranged. [3] [4]