7.1 Red Flags
- A detailed explanation in the respective mother tongue is essential!
- Concerning FGM Type III with narrowed vagina (vaginal stenosis) extended periods of menstrual bleeding (often for one or two weeks) and very painful menstrual bleedings are common – for this reason, painkillers are demanded frequently! It is very important in this context to talk about a possible Defibulation!
- Necessary examinations related to women’s and girls’ menstrual problems, who are not married yet, should be only in form of an ultrasound of the belly and no vaginal examinations, if possible! However, if it is really necessary, a detailed and adequate explanation, also for the mother, is advised (the intact hymen is very important, attention should be paid to religion)!
- The hymen should be explained and described in detail, e.g. the different kinds of hymen, etc. (it is a soft tissue wrath inside the vagina; it is possible that the hymen is stretched or torn already or even not existent).
- Gynaecological conversations with young girls should only be conducted in presence of the mother, with detailed explanations for all necessary treatments. Neither questions should be asked about sexuality or sexual experiences (culture and religion should be taken into account)!
- Mothers often wish having conversations about hygiene and the premenstrual syndrome for their daughters. Please do not recommend tampons (the intact hymen is essential)!
- Gynaecological examinations should be conducted by a female physician/ health care worker only (for religious and cultural reasons)!
- It is very difficult for women and girls to remember the date of the last or the first menstruation – life in the home country does not take place strictly according to calender and dates as in Europe. Please give explanation and offer your help, e.g. in the form of a cycle calendar!
- If women already have their menopause (exact age is often disguised, too), please clarify if the woman still has the desire to have children!
Important to consider!
- Please also note that due to periods of stress, poor nutrition and poor sleep, such as during the flight, the menstrual cycle can change: the menstruation can be delayed, changed in its quality, or even be absent for some time!
- To offer sanitary towels and tampons sufficiently – which are often not available because of the lack of financial resources – represents one of the basic conditions for sanitary hygiene and therefore for the improvement of reproductive health!