Clinical update

Female genital mutilation

Posted 26 August 2015

The World Health Organization (WHO) defines female genital mutilation (FGM) as procedures that involve partial or total removal or other injury to female genitalia for non-medical reasons.

Essential facts

The World Health Organization (WHO) defines female genital mutilation (FGM) as procedures that involve partial or total removal or other injury to female genitalia for non-medical reasons. As many as 140 million girls and women worldwide have been affected by the most common types of mutilation, says the WHO. According to the Foundation for Women’s Health Research and Development, 137,000 girls and women in the UK are living with the consequences of FGM, and 60,000 girls are at risk.

According to research carried out by City University London and Equality Now, no local authority area in England or Wales is likely to be free of FGM. Published in July, its other key findings are that London has the highest city prevalence, with an estimated 2.1% of women affected. Outside the capital, the highest estimates were in Manchester, Slough, Bristol, Leicester and Birmingham. Recommendations for local authorities, formulated by Trust for London, Rosa, Equality Now and the Royal College of Midwives, include raising awareness, commissioning resources and support services, providing training and making prevention explicit in child protection policies.

Forms of mutilation range from clitoridectomy (partial or total removal of the clitoris) to infibulation (narrowing of the vaginal opening by cutting and sewing over the outer labia). Signs that a woman may have been cut include persistent and recurring urinary and vaginal infections, and reluctance to agree to vaginal examination, cervical smears or infection screening.

FGM has serious risks for a woman’s health, leading to death in some cases. In the short term, it can cause infections, severe pain, bleeding and tetanus. In the longer term, women can experience pain during sex, chronic pain, infection, cysts, abscesses, difficulties with periods and fertility problems. They may also experience mental health problems. Women who have undergone FGM are significantly more likely to experience difficulties during and after childbirth.

All healthcare professionals have a duty of care to those at risk of FGM or who have been cut in the past. If you suspect a woman or girl is at risk, you should act as you would with any suspected abuse, the RCN advises. Questioning requires sensitivity, but it is important to ask.

Expert comment

Carmel Bagness, RCN professional lead, midwifery and women’s health

‘It is good that we are finally getting some high-quality information coming through, and have mandatory reporting and recording, so statistics will become more accurate. We need this data to be able to provide the range of services that survivors need.

‘A key issue is to raise awareness of FGM across the whole of society. This includes better understanding of its consequences, whether physical, psychological or psychosexual. Services have improved in treating the physical complications, but less so the associated mental health issues.

‘FGM is wrong – it is abuse, it damages girls, women and families, and we need to work together to eradicate it.’