Female genital mutilation

Key messages for primary care practitioners

  • The WHO estimates that between 100 million and 140 million girls and women worldwide have been affected by female genital mutilation (FGM) [1].  The practice is particularly common in some African countries.
  • FGM has long term implications for physical, sexual, and psychological health, and girls and women who have been affected may need referral to specialist services.
  • It is illegal to practice FGM in the UK.
  • UK-born children may be at risk of FGM when they travel with their families to visit friends and relatives in countries where this practice is common. It is illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country. If you are concerned that a girl may be taken overseas for the purpose of FGM please call the Foreign and Commonwealth Office on 0207 008 1500 or email fgm@fco.gov.uk  

 

Background information

Types of FGM

Health risks associated with FGM

Treatment

Other useful resources

References

Background information

  • Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.
  • The WHO estimates that between 100 million and 140 million girls and women worldwide have been subjected to FGM [1].
  • In the UK it is estimated that over 100,000 women have undergone FGM and that some 25,000 girls are at risk [2].
  • FGM has been documented in 28 African countries, and in a few countries in Asia and the Middle East. 
  • The prevalence of FGM varies between countries and regions, and is largely based on ethnic group.  In some countries the prevalence reported is as high as 95% (Egypt, Somalia, Guinea) [1,2].
  • Communities that practise FGM describe a variety of social and religious reasons for the practice [2].
  • The procedure is generally carried out on girls under the age of 15 years, but the actual age is varied and can take place anytime between birth and labour with their first child.

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Types of FGM

The WHO/UNICEF/UNFPA Joint Statement [external link] classified female genital mutilation into four types: 

  • Type I: Partial or total removal of the clitoris and/or the prepuce (clitoridectomy). 
  • Type II: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). 
  • Type III: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation). 
  • Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization [1].

Countries with which UK residents are most likely to have links and that have the highest prevalences of FGM [3]:

 

Country ordered by UK census rank Estimated prevalence of FGM in girls and women 15-49 years (%)
Somalia 97.9
Egypt 95.8
Sierra Leone 94.0
Sudan, northern 90.0
Ethiopia 74.3
Eritrea 88.7
Gambia 78.3

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Health risks associated with FGM

FGM can have a number of short-term health implications [2]:

  1. severe pain and shock
  2. infection
  3. urinary retention
  4. injury to adjacent tissues
  5. haemorrhaging

Long-term implications can include:

  1. extensive damage of the external reproductive system
  2. uterine, vaginal and pelvic infections
  3. cysts and neuromas
  4. increased risk of vesico vaginal fistula
  5. complications in pregnancy and child birth
  6. psychological damage
  7. sexual dysfunction
  8. difficulties during menstruation

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Treatment [4]

Women and children who have had FGM may need access to a variety of specialist services such as:

  • counselling and psychiatric support through statutory or voluntary services because of psychological trauma, relationship or psycho-sexual difficulties
  • infertility
  • uro-gynaecological services including surgical reversal of infibulation (known as deinfibulation)
  • interpreter service with workers who appreciate the problems facing affected girls and women. It is very important that women do not find themselves relying on family members for interpretation when dealing with health care professionals. Children should never be used for interpreting purposes.

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Other useful resources

Foreign and Commonwealth Office information about FGM [external link] including information for health professionals

FGM national clinical group [external link]

The Foundation for Women's Health, Research and Development [external link] - FORWARD - is an international non-governmental organisation (NGO) that works to advance and protect the sexual and reproductive health and human rights of African girls and women.

Hospitals and clinics offering specialist FGM services in the UK [external link]

WHO FGM information and guidelines [external link]

BBC ethics guide: Female circumcision [external link]

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References

  1. World Health Organization. Female Genital Mutilation [external link]   
  2. Forward. Female Genital Mutilation [external link] 
  3. Eliminating Female Genital Mutilation, An interagency statement [external link] - OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO
  4. Female genital mutilation. An RCN educational resource for nursing and midwifery staff, 2006 [external link]

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