Acute phase

Acute pain (00132): The large amount of nerve endings present in the genital area and the insufficient, on occasion inexistent, use of anaesthesia mean the cutting procedure produces extreme pain, which gradually subsides over the healing period⁵⁾⁽⁷.

Risk of Infection (00004): Infection, together with haemorrhage and anaemia are the most frequent acute complications associated with FGM ^5),(7. Moreover as an additional complication, the damage to genital tissues produced by the cutting procedure and consequential microbial contamination creates a risk of recurring vaginal infections and pelvic inflammatory disease (PID) which can lead to infertility^8),(9.

Urinary retention (00023) and Rick for urinary retention: This can appear due to the intense pain produced during urination or resultant from inflammation secondary to a lesion in the urethral conduct^5),(6.

Chronic responses physical

Impaired urinary elimination (00016): Due to the presence of recurring urinary tract infections⁸⁾⁽¹⁰ as well as symptoms in the lower urinary tract¹¹ as a consequence of anatomical changes to the vagina and the urinary conducts resultant from FGM.

Chronic pain (00113). Associated with the modification of the genitals as a result of this practice⁵⁾⁽⁷.

Chronic pelvic infection^6),(10

Sexuality

Sexual dysfunction (00059): Due to the possible presentation of dyspareunia, vaginal dryness or the lack of lubrication during coitus, as a consequence of the structural changes produced in the external genitalia and the loss of elasticity due to the creation of scar tissue¹². Furthermore, the existence of one or more of these consequences has negative repercussions on the quality of sexual relations in those women affected¹³ and may lead to varying degrees of sexual phobia and dysfunction in sexual excitation.

Ineffective Sexuality Patterns (00065): In a great number of cases this is either diminished or completely omitted. The removal of erogenous zones of great importance to female sexuality, such as the clitoris and genital labia; the resultant scar tissue and pain-related phobias, are merely a few of the factors which can affect such women's ability to experience sexual arousal and pleasure during coitus^12),(13.

Chronic Obstetric Alterations

Episiotomy: The pressure generated in the birthing canal by the foetus can lead to perineal tearing and severe haemorrhage requiring surgical intervention^14);(15. In these cases, episiotomy is necessary due to the loss of elasticity of the vaginal vestibule as a result of scarring^14),(16. In addition, Birthing efforts are usual prolonged and extenuating in infibulated women, which promotes the appearance of obstetric fistulas as a result of the pressure of the foetus' head on the vaginal walls and adjacent organs^15),(17.

Labour pain (00256)⁵.

Psychological responses

Post-trauma syndrome (00141): The consulted bibliography describes a significantly greater prevalence of post-traumatic stress disorder in women subject to FGM^18),(19. The complexity and chronicity of this diagnosis will require the expertise of a mental health specialist (nursing, psychiatry).

Anxiety (00146): There is a significantly greater prevalence of psychiatric syndromes, such as anxiety, in women who have undergone FGM than in those who have not¹⁸.

Disturbed personal identity (00121) and Risk for disturbed personal identity (00225): The young or adult women who have been "cut" and later emigrated to western countries, may experience a number of psychological problems related with the differences between the cultures of their host country and country of origin, realizing that FGM is not only not a universal tradition, but considered in an extremely negative light in other cultures. This can result in serious internal conflicts regarding identity and loyalty towards one's own culture, leading to feelings of humiliation, confusion, powerlessness, a sense of being betrayed by their family and shame⁶.

Dysfunctional Family Processes(00063) and Risk for Dysfunction Family Processes. The consequences of FGM can affect family relationships⁶.

Figure 2 Summary of the Diagnosis 

Multiaxial Structure of the Diagnosis

Following the multiaxial structure of Nursing Diagnoses, seven dimensions of the human response have been defined which must be considered during the diagnostic process in the following manner:

Axis 1 The Diagnostic Focus: Female Genital Mutilation. As an essential and primordial element of the syndrome presented herein, "Female Genital Mutilation" is considered an inseparably unique element since it defines in an unequivocally specific and concrete manner the act via which the aforementioned human responses are produced and which may appear concomitantly as a result of FGM. Each separate term does not imply sufficient significance on its own in order to satisfy the description of the human responses comprising this syndrome.

Axis 2 Subject of the Diagnosis: Individual woman or girl (Female). The subject of the diagnosis is described in the diagnostic focus as the women or young girls having undergone Female Genital Mutilation.

Axis 3 Judgement. Deterioration of a range of a range of health domains as a result of female genital mutilation.

Axis 4 Location. Female genitals.

Axis 7 Status of the Diagnosis. Problem-focused. This syndrome is characterised by concomitant unwanted human responses resulting from genital mutilation.

Implications for Nursing Knowledge

In this sense, from a viewpoint which recognizes the intrinsic dignity and inalienable equal rights of all human beings, it can be vouched for that the nursing profession, focused on transcultural care planning and motivated by the recognition of the consequences of FGM, can endeavour in furthering the creation of specific nursing interventions centred on the palliative care of complications arising from, as well as the earlier detection of new cases of FGM, in order for them to be treated in a timely and appropriate manner.

In addition, the nursing community worldwide must be aggressive to openly discuss the issue of FGM as a human rights violation.