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Q: Does Traditional Chinese Medicine  help with female genital multilation? Everything is still there but damaged a bit. There is still some feeling!

How can TCM help and in which country?

1. The clit has a small scar. Clit hurts. (It got operated many time to remove bad skin that started to grow after mutilation.)
2. The little lips were removed and they hurt too.
3. The vagina hurts and the skin inside feels strange. Someone has used some alcohol to damage vagina tissue.

- Sex is impossible.
- Patient has infections all the time.
- Pain is like volvodynia.



We have to admit to being somewhat uneasy about answering this question.

Since October last year it has been a legal requirement in the UK for medical and social care professionals to report cases of FGM in under -18s to the police, and from our perspective there should be no question of treating someone whose health and mental health issues were not already being addressed within the conventional medical system. We could not insist on this - it is always a patient's right to choose what they divulge and to whom - but our advice to members would be that this would be an area where we would expect them to tread very carefully indeed, and to be working with the involvement of the patient's conventional healthcare team. 

This is all the more so because treatment of the kind of damage which occurs in FGM may well be thought to need to involve local as well as distal treatment. There are no classical acupuncture points on the genitals themselves, although a small number proximate to the area, but in the treatment of nerve damage and scar tissue it would not be unusual to treat the affected area directly. We would have very serious reservations about anyone needling into genital tissue, especially since there is no research to which we can point which validates this as a useful approach.

There have been questions posed of us before about vulvodynia, one answer to which said:

There are a number of small studies such as
which seem to show that acupuncture may be of great benefit. However, these are very small studies, and a much larger trial would need to be conducted for us to make a positive recommendation.
However, when we were asked a similar question two years ago we mentioned the fact that a question had recently been posted on our website forums for members which had provoked very little response. By a rather strange coincidence a similar question about vulvodynia posted a fortnight ago has created a very productive dialogue, with over fifty contributions so far.
The upshot of all this traffic is that there are a number of ways in which vulvodynia can be understood in Chinese medicine, both as a local problem and as the local manifestation of a systemic problem. As you may know, the theories of Chinese medicine are premised on the flow of energy called 'qi' and the way in which this is balanced in the body. This balancing is carried out by the Organs (capitalised to distinguish them from the conventional medical understanding of an organ), and if these are affected, then the balance of the body will be affected. Similarly, if there are local reasons why the flow of energy may have been affected, these may generate symptoms in an otherwise healthy person.
The skill and art of the practitioner lies in the ability to make sense of the symptoms within the whole picture, and to determine what adjustments are needed and where. Most problems which appear to be isolated are in fact a part of a much wider picture of imbalance, the logic of Chinese medicine being refreshingly straightforward - if the system is in balance, the body heals itself. 
The best advice we can give is to visit a BAcC member local to you and ask their advice. Most will be able to offer a fairly good assessment based on a brief visit of whether the acupuncture treatment will be able to help. If they are not convinced that they can help you we are confident that they will be able to recommend other alternatives based on the signs and symptoms with which you present.     

So in summary we would have to say that there may be a point in asking a BAcC member whether they are able to treat someone with FGM-related problems using treatments within their current scope and limitations of practice, and using established protocols for treatment as the ones noted above are. However, anything more direct than that would almost certainly fall outside that scope, even if the patient were to give consent to treatment. We would be very concerned, however, that a patient was within the conventional medical system and getting the support and care which the problem warrants, and would not be entirely comfortable to hear of colleagues treating patients where this was not the case. 

A:  This depends a great deal where you are seeking treatment. In the Greater London area, it is not unusual to see fees for the initial consultation in the £50-£70 range, often because of the expense of running a London practice means recovering the overheads through the fee. In the areas outside London this figure can drop down to £40-£60.

There will obviously be considerable variations, and we have seen figures in London as high as £100 and figures in outlying areas as low as £30, but market forces tend to apply, and if people are charging too much they normally don't attract patients.

Most BAcC members are prepared to negotiate if the fees are too high for someone's purse, although most are cautious in advertising this fact because it can encourage people well able to afford the fees negotiating and haggling for the sport of it. There is also a growing number of what are called multibed clinics or community acupuncture clinics which offer treatments in a group setting at substantially lower fees, mainly in order to counter the possibility that acupuncture treatment becomes only available to those with higher disposable incomes.

A:  The regulation of a professional activity like acupuncture is extremely important. Registration with a professional body or with a statutory offers the general public some very clear guidelines about the training standards which someone has to achieve to belong to a register, what the requirements are for keeping their skills up to date, and how they are accountable for performance or conduct which falls below the standards which they have to meet. The alternative, a free for all where anyone could just set up in business and call themselves an 'x' , would give the public no assurances about standards or accountability.

The ideal situation for healthcare practitioners is for the regulation to be by law, what is called statutory regulation. The central most important feature of this is that it restricts the use of the professional title by law, so if someone who is not properly trained and on the register uses it they can be prosecuted. When the osteopaths were first regulated by law in the late 1990s some of the people who did not join the new register thought they could carry on as before using the title. They were wrong!

The only form of regulation which offers more than this is protection of function, where by law no-one else can practise a mode of healthcare. In this country only vets and midwives have protection of function, meaning that only they can do what they do. With protection of title anyone can do what, for example, an osteopath can do, but simply cannot call themselves an 'osteopath'. You will find a number of ways that people using osteopathy describe themselves to get around this, and as long as they do not mislead the public into thinking they are registered by law, there is nothing to stop them.

We had hoped that the acupuncture profession would be the next complementary therapy to be regulated by statute after the osteopaths and chiropractors, and there were three government working groups which made this very recommendation. However, the nature of statutory regulation changed over the years. Whereas it had been largely about professional recognition in earlier times, it became more closely associated with protection of the public, and more recently with the level of risk involved. Setting up regulatory bodies is expensive, and where there is perceived to be little risk from what the profession does, and where the conduct record of the professionals has been good, statutory regulation has been seen as unnecessary. This was the government's last stated position on acupuncture in 2012.

However, mindful of the fact that there are many hundreds of thousands of healthcare professionals in action, all of whom were what is described as voluntarily self-regulated, the government-backed Professional Standards Authority set up an Assured Voluntary Register scheme, and we were proud of the fact that we were one of the first two bodies to be accredited. This still has the disadvantage that someone can use title without belonging to a  professional body, but over time the aim is to ensure that the public go to accredited schemes as a mark of quality assurance.

From a regulatory perspective this scheme does have teeth. If a statutory register has a bad apple, they get removed from the Register. If an accredited scheme does not police its bad apples properly the whole professional body could lose its accreditation, so in many ways there is a greater onus on the regulator, even though voluntary, to ensure that its registrants do what they are supposed to.  

Q:  I read your answer to  another person about shaky hands. The answer is not in a straight forward manner and vague. Please clearly and directly tell that can acupuncture play an effective role in tremor management?. 


A:  We are sorry that you found our answer vague.

There are two reasons why we could not say with certainty that acupuncture will be an effective treatment for essential tremor. The most important one, which all of our answers on tremor say, is that Chinese Medicine treats people, not symptoms, and so there are no guaranteed treatments for specific conditions. From our perspective the same symptom could arise in a dozen people and be treated in a dozen different ways. The exact treatments will be geared to the individual, and a great deal will depend on their overall state of health and balance. Clearly a young person with good energy is likely to respond a little more quickly to treatment than someone of 70 years of age who has lived a hard life. However, even that is not a certainty; we have seen patients of 90 who have responded magnificently to treatment.

The other reason that we cannot give a more definite answer is that all advertising and marketing on the internet is now governed by the same restrictions as print media. The Advertising Standards Authority has very strict rules on claims for efficacy, and in healthcare provision the bar has been set at the level of randomised double blind control trials. This criterion of research works well for drug trials but is inappropriate for acupuncture treatment (and surgery!), which is why there is a very small number of problems for which we can make unequivocal claims for efficacy. This is in spite of the fact that there are many thousands of studies which show very positive results.

This is why we are cautious in what we say, but also why we recommend in nearly every case that the best way to find out whether treatment may be beneficial is to visit a local BAcC member for an informal assessment of what may be possible. A practitioner who sees the symptom in the context of the person's overall health is likely to be able to give a much more useful opinion than we can at a distance.

We are sorry if this sounds equally vague.

Q: Is there a minimum number of sessions needed for acupuncture to reduce pain levels in a chronic (symptoms of 6 months or more) TMD sufferer?
How many sessions, as a ballpark figure, would you estimate to be reasonable to achieve reductions in pain levels that would be present 3 months after the last treatment?

A:  We're sorry to say that there is no real answer to this question. From a Chinese medicine perspective each patient is unique and different, which is its very great strength since it individualises treatment. The obverse, of course, is that any symptom needs to be seen in the context of someone's overall balance, and for this reason the answer could be anything from one session to fifty sessions. The same applies to the enduring effect of treatment. In someone who is otherwise healthy (in Chinese medicine terms), a symptom can sometimes go and stay gone. However, if there are constitutional weaknesses it may be necessary to continue to have maintenance treatment every 6 to 10 weeks to maintain progress.

Were you to present at our clinic we would be immediately asking questions about how the problem developed. TMD and related TMJ disorders often have their roots in things like aggressive dentistry or minor accidents which slightly displace the jaw, and this can have a major impact on the assessment and treatment of the problem. However, there is far from general agreement about the causes of the problem, as you will see from any medical advice sites.

Many patients find it very useful to combine acupuncture with cranial osteopathy which can often realign the bones in subtle ways which enable the acupuncture treatment to encourage better functional support in the musculature to retain the re-adjustment. We believe that this would also be a productive line of enquiry.

As far as research is concerned, there is a systematic review of trials which makes encouraging noises, as they often do, with the proviso that more and better research is undertaken.

You than have a number of individual studies like this one

which report favourable results but not the detail of how many sessions.

We think the best advice we can give is that you visit a BAcC member local to you who can probably by face to face assessment give you a far better view of how rapidly you might progress and how sustainable that progression might be.

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