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.

Match the patient's documented FGM/C type to the guidance below, then select the appropriate urine collection method.

Type I: The urethral meatus is typically accessible. A clean-catch midstream specimen is appropriate with standard positioning and patient guidance. If catheterization is indicated, straight (in and out) catheterization is acceptable using standard technique and careful visualization of the meatus.

Type II: The meatus may be partially obscured by scar tissue. A clean-catch specimen is often possible with assistance and positioning. Straight catheterization may be attempted with a smaller catheter and good lighting. If the meatus cannot be clearly visualized, stop and escalate to the provider.

Type III (Infibulation): The meatus may be hidden behind infibulation scar tissue, and the introital opening is narrowed. Do not attempt blind catheterization. Clean-catch results may be unreliable. A urology or gynecology consult is required, and deinfibulation or a suprapubic catheter may be needed for bladder drainage.

Type IV: Clinical impact varies. Assess the meatus individually and choose the least invasive method that yields an accurate specimen.

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.