Time to talk about FGM

Nurses working in community settings can make a significant difference by talking to women about FGM and asking about their health and asking the right questions   

Nurses working in community settings can make a significant difference by talking to women about FGM and asking about their health and asking the right questions   

The Department of Health Female Genital Mutilation (FGM) Prevention Programme was launched in 2014 to improve the way the NHS identifies and responds to FGM. Our team works across government departments and with stakeholders to provide healthcare and support to those affected and to raise knowledge and awareness among healthcare professionals to prevent FGM from happening. Data is collected to identify how many women and girls are involved and the scale of FGM in the NHS.

Health trusts and GP practices have to send information after attending to FGM patients
Picture: iStock 

What is female genital mutilation?

The World Health Organization (WHO) (2016) describes FGM as ‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’. WHO (2016) classifies FGM into four types, ranging from a small nick to the clitoral hood, to total removal of the female genital organs with the formation of a scar to cover the urethra and vaginal opening.


the year FGM became illegal in the UK

At least 200 million women worldwide have undergone some form of FGM in more than 30 countries (UNICEF 2016). Many people from practicing communities are unaware of the link between FGM and subsequent poor physical and mental health. In countries where FGM prevalence is high, many women experience health difficulties, but do not seek medical advice as they are often a common occurrence. Additionally, women may be expected not to talk about these issues, so they remain undetected and untreated.

The Mandatory Reporting Duty 

The Serious Crime Act 2015 in England and Wales introduced FGM Protection Orders and the Mandatory Reporting Duty for regulated professionals to report known cases of FGM in those under 18 to the police.


What do community nurses need to know?

All health trusts and GP practices have to send information to NHS Digital when they treat patients with FGM. You should make sure your organisation is submitting this information if it is required to do so and that you are routinely capturing the right information in the patient’s healthcare record and that it is sharednappropriately to support safeguarding. The data submitted to NHS Digital are used to support commissioning and service provision.

All healthcare professionals must care for those affected by the practice and safeguard those at risk of harm. Nurses working in community settings are vital when it comes to talking to patients about FGM and their health.

FGM leads to short and longer-term physical and mental health problems, which often last throughout the woman’s lifetime and can have a huge impact on well-being. In type 3 FGM, sometimes called infibulation, most of the external genitalia is removed, leaving a long scar that covers the vaginal opening and urethra.


Legislation was amended and strengthened in England, Wales and Northern Ireland under the FGM Act 2003

This type can cause problems passing urine and difficulties with menstruation. It can lead to recurrent urinary tract infections (UTI), which may lead to renal impairment. Women presenting repeatedly at a clinic or GP surgery with symptoms of UTI need to be asked if they have had FGM. If the FGM scar tissue is closed or intact, a procedure called de-infibulation may be required.

Nurses need to make sure they are aware of any specialist services in their locality and how to refer women into these care pathways.

Talking to women about FGM requires sensitivity, but direct and non-judgmental questions are important. This may be difficult for survivors of the practice who may never have talked about their experiences before and may not associate their health problems with having had FGM. Discussion may trigger flashbacks and distress. Nurses can ask the following questions:

Do you, your partner or your parents come from a community where FGM/cutting or circumcision is practised? Do you know what that is? Have you been cut? Do consider using other terms or phrases.

The questions should be asked to the patient directly, or in patients under 18, to their parent or legal guardian. Nurses should be prepared to take action on their findings and, where appropriate, initiate child safeguarding procedures and/or referral for further care. If a woman does not speak English then the use of an accredited interpreting service is needed.


Legislation in Scotland was amended under the Prohibition of FGM Act 2005

Little research has been carried out into the psychological problems caused by FGM. Women may present with symptoms such as distress, nightmares, flashbacks and depression. Talking about FGM in an informed way will help women to discuss these difficulties so that nurses can provide appropriate onward referral to support services.

Training on FGM

Your organisation should make sure that you have appropriate training in safeguarding and supporting the health needs of those who have had FGM. Health Education England has six e-Learning sessions on all aspects of FGM. These include an introduction to FGM, which covers the implications for health, and a mental health module which looks at how FGM affects psychological health and how to refer for further support. Your local Safeguarding Children Board may provide FGM training in your area.

The RCN (2016) recently published guidance on FGM and safeguarding for professionals working in travel and sexual health.

Final thoughts

FGM is child abuse and illegal in the UK. It often leaves those affected with lifelong physical and mental health difficulties. Nurses working in community settings can make a significant difference by talking to women about FGM and asking about their health. This allows women to discuss their experiences and leads to improved healthcare and sense of well-being.

Talking helps to protect those at risk and can help prevent the practice in future, through raising awareness. If FGM was eradicated tomorrow there would be at least two generations of girls and women still requiring healthcare and psychological support.


Further information

About the author

Jennifer Bourne is project manager, FGM Prevention Programme, Department of Health, London

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