This chapter should be cited as follows:
Koigi MK, Kihara AB, et al, Glob. libr. women's med.,
ISSN: 1756-2228; DOI 10.3843/GLOWM.417843

The Continuous Textbook of Women’s Medicine Series – Gynecology Module

Volume 1

Female genital mutilation

Volume Editor: Professor Anne-Beatrice Kihara, University of Nairobi, Kenya,
President-elect. The International Federation of Gynecology and Obestetrics FIGO
President, African Federation of Obstetricians and Gynecologists (AFOG)

Special Feature

Female Genital Mutilation/Cutting (FGM/C) Screening Tool

First published: July 2022

FGM/C SCREENING TOOL

DATE _____/_____/________

NAME: __________________________________________________________________    AGE: _____

• Do you know what Female Genital Mutilation/Cutting (FGM/C) is?  Yes/No
  If yes, specify: ____________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
• Have you ever had any injury or cut to the female genital organs for non-medical reasons?  Yes/No
  If yes, tick the appropriate one:
  

  I (a) Removal of the prepuce only I (b) Removal of the clitoris and prepuce	II (a) Removal of the labia minora only II (b) Partial or total removal of the clitoris, and labia minora	II (c) Partial or total removal of the clitoris, labia minora and labia majora
  III (a) Removing and closing the labia minora	III (b) Removing and closing the labia majora	IV Pricking, piercing, incising, scrapping, burning

• How old were you when you went through this experience? _____ years
• Did anyone ever give you a reason to try to make you agree to have the cut?  Yes/No
  

  If yes, were any of these reasons part of what was used to make you agree to have the procedure? (Tick all that apply)
  To get rid of bad luck/evil spirits To make you more attractive To preserve your virginity and chastity It is a tradition in the family/community To make future child birth safer To uphold the honor of the family A rite of passage into womanhood To make you “marriageable” It is a religious obligation To cleanse and purify you So that you could remain part of the family You had no choice, so no reason was given to you	( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )
  Any other reason (specify): __________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________

• How many daughters are there in your home?  _____
• How many daughters in the home are younger than you?  _____
• How many daughters in the home have not yet had a similar experience?  _____
• Did you experience any complications after the procedure?  Yes/No
  If yes, specify: ____________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
• Do you recall who did the procedure?  Yes/No
  If yes, specify: ____________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
• Has anyone else in your family had an experience like the one that you have had?  Yes/No
  If yes, specify: ____________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________
  ___________________________________________________________________________________________________________________________________