Type I: Partial or total removal of the clitoris and/or the prepuce. Standard catheterization and clean-catch technique are generally possible with careful positioning and patient guidance.

Type II: Partial or total removal of the clitoris and labia minora, with or without excision of the labia majora. Modified positioning and patient-directed technique required. Speculum examination may require a smaller instrument.

Type III (Infibulation): Narrowing of the vaginal opening by cutting and repositioning the labia minora and/or majora, with or without excision of the clitoris. A small introital opening may remain. Standard catheterization is contraindicated without specialist evaluation.

Type IV: All other harmful procedures (pricking, piercing, incising, scraping, cauterizing). Clinical impact varies; assess individually.

1. Approach the assessment with culturally informed, trauma-sensitive communication. Do not use the term "mutilation" directly with the patient. Use "the procedure you had" or "a traditional practice" unless the patient uses other language first.

2. Explain every step of the perineal assessment before proceeding. Obtain verbal consent. If language access is needed, use a trained medical interpreter — do not use a family member for clinical explanations of this topic.

3. Document anatomical findings accurately in the medical record using WHO classification terminology.

4. If Type III is identified or suspected, do not attempt catheterization. Place a nursing note in the chart and contact the provider immediately. A urology or gynecology consult is required before any invasive procedure.

All patients with FGM/C must have a notation in the nursing assessment and the problem list. This ensures continuity of care across all providers who interact with the patient.

Mandatory reporting requirements vary by jurisdiction. Consult your facility's compliance officer if the patient is a minor or if there are concerns about ongoing harm to others.