So today I had a consult done in Emerg - it was a woman from Kenya who had a missed abortion (where the fetus is dead but the mom doesn't expel the product). I did the full history and physical exam, including a raging systolic murmur which is probably ASD. Then I did the pelvic exam and when I tried to open up her labia there was a very small opening to the vagina - very small and she has had 2 children. The speculum I had wasn't going to fit so my very lovely resident went to get a new one. On further inspection of her vulva we realized there were 2 openings and there was a skin bridge in between them formed by adhesions after the female genital mutilation she had received in Kenya. She has no clitoris because it was butchered from her and I'm sure birthing those babies was not a treat with that extra piece of tissue acting as a barricade.
Female genital mutilation http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm is one of the reasons I wanted to go into Obstetrics and Gynecology in the first place. It's still something we see in Canada because of immigration. The fact that a woman can get her clitoris hacked off and her vagina sewn up in 2006 is ridiculous to me. For people who say "feminism is dead" or that "there are no more women's rights issues anymore" obviously need to open their eyes.
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