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Female Genital Cutting (Mutilation)

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Approved by Council: February 2001
Reviewed and Updated: November 2004, September 2011

 

Policies of the College of Physicians and Surgeons of Ontario (the “College”) set out expectations for the professional conduct of physicians practising in Ontario. Together with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering physician practice or conduct.

Within policies, the terms ‘must’ and ‘advised’ are used to articulate the College’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

 

Definitions

Female genital cutting/mutilation: Involves the cutting and removal of the female genitalia, and permanent mutilation of the sexual organs of young females for non-medical reasons.1

 

Policy

Patient Care

  1. Physicians must not perform or refer patients to any person for the performance of any female genital cutting/mutilation (FGC/M) procedures.2
  2. During the course of a vaginal delivery of a woman who has been previously subjected to an FGC/M procedure, it may be necessary to surgically disrupt the scar tissue resulting from the earlier procedure. In this circumstance, at the conclusion of the delivery, the physician must confine activities to repairing the surgical incision or laceration required during the delivery, and must not, for example, endeavor to reconstruct an infibulation.
  3. Wherever possible physicians must inform the patient of this limitation prior to delivery, although are advised to do so prior to pregnancy or during the course of prenatal care.
  4. Where there is doubt about whether a procedure is considered to be FGC/M, physicians are advised to seek independent legal advice.
  5. Physicians are advised to:
    1. provide culturally sensitive counseling regarding the dangers related to performing FGC/M, and
    2. educate themselves on the appropriate management of possible complications in order to provide appropriate counsel and care when they encounter patients subjected to FGC/M.

Reporting

  1. Physicians who have reasonable grounds to believe that another physician is performing FGC/M procedures must immediately bring the issue to the attention of the College.
  2. Physicians who have reasonable grounds to believe that an FGC/M procedure has been performed on, or is being contemplated for, any female under the age of 18, must notify the appropriate child protection authorities, regardless of where the procedure has been or will be undertaken.3
 

Endnotes

1. Ontario Human Rights Commission. Policy on Female Genital Mutilation. See also Section 268.3(a-b) of the Criminal Code, R.S.C., 1985, c. C-46 (hereinafter, Criminal Code), which defines the act as involving the infibulation, excision or mutilation, in whole or in part, of the labia majora, labia minora or clitoris of a person, except where performed for the purpose of the person having normal reproductive function, sexual appearance or function or the person is at least 18 years of age and there is no resulting bodily harm.

2. The Criminal Code prohibits the performance of or referral for FGC/M (see Sections 268(3), 21-22 and 273.3(1)). Physicians are reminded that it is an act of professional misconduct to contravene a federal law, where the purpose of the law is to protect the public’s health or the contravention is relevant to the member’s suitability to practise (See Section 1(1) par. 28 of the Professional Misconduct, O. Reg. 856/93 enacted under the Medicine Act, 1991, S.O. 1991, C.30).

3. Pursuant to Child and Family Services Act, R.S.O. 1990, c. C.11, s.72(1) and Section 273.3(1) of the Criminal Code, as well as the College’s Mandatory and Permissive Reporting policy.