FGM Summary

What is FGM

  • Removal of female genital organs for non-therapeutic reasons
  • Recognized as child abuse and gender violence
  • Illegal in the UK for those under 18

UK Law

  • FGM Act 2003 - illegal to perform FGM or take children abroad for FGM
  • Serious Crime Act 2015 - mandatory reporting for under 18s
  • Up to 14 years imprisonment for offenders

HCP Responsibilities

  • Mandatory reporting for under 18s
  • Failure to report risks registration loss
  • No requirement to ask every female

Health Effects

  • Severe pain and infections
  • Sexual, urinary and reproductive problems
  • Mental health issues and risk of death

Action Steps

  • Record discovery in health records
  • Report to police for under 18s
  • Implement safeguarding procedures
  • Offer support to adults

Female Genital Mutilation (FGM)

Medical guidelines for identification, reporting, and management of FGM cases

What is Female Genital Mutilation (FGM)?

Female genital mutilation (FGM), which is also known as female genital cutting, involves any procedure that includes the removal of any part of the female genital organs for cultural or any other non-therapeutic reasons.

Prevalence

Approximately 2 million females worldwide undergo FGM each year. There are an estimated 137,000 females in England and Wales who have undergone FGM, including 10,000 girls under the age of 15 years.

Cultural Context

Some communities believe FGM enhances marriageability, improves hygiene, ensures virginity, reduces promiscuity, and preserves family honor.

UK Situation

FGM has become more prevalent within the UK due to immigration from countries where FGM is practiced. It is illegal in the UK for those under 18 and is recognized as child abuse and gender-based violence.

Types of FGM

Clinical Note

Identifying the specific type of FGM can be difficult, and is not required of ED staff. The important action is recognition and appropriate response.

Type Description
Type 1 Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris)
Type 2 Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora
Type 3 Infibulation: narrowing of the vaginal opening through the creation of a covering seal (formed by cutting and repositioning the labia), with or without removal of the clitoris
Type 4 Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area

Effects of FGM

No Health Benefits

There are no health benefits to FGM. It can cause serious harm with both immediate and long-term consequences.

Immediate Complications

  • Severe and/or constant pain
  • Infections (tetanus, HIV, hepatitis B and C)
  • Bleeding, cysts and abscesses
  • Death from blood loss or infections

Long-Term Physical Effects

  • Pain or difficulty having sex
  • Infertility
  • Difficulties urinating or incontinence
  • Organ damage
  • Problems during pregnancy and childbirth

Psychological Impact

  • Depression, anxiety and PTSD
  • Flashbacks and nightmares
  • Self-harm and suicidal thoughts
  • Sexual dysfunction and relationship problems

UK Law on FGM

UK law has progressively strengthened protections against FGM, with serious penalties for those who perform, facilitate, or fail to report these practices.

1985 Prohibition of Female Circumcision Act

Made it an offence to excise, infibulate or otherwise mutilate the whole or any part of the labia majora or clitoris of another person, or to aid or abet such acts.

2003 Female Genital Mutilation Act

Updated the law to make it illegal to take girls abroad for the purpose of FGM (so-called "vacation cutting"). Increased maximum penalty to 14 years imprisonment.

2015 Serious Crime Act (Section 74)

Added mandatory reporting duty for health and social care professionals and teachers in England and Wales to report known cases of FGM in under-18s to the police.

Professional Consequences

Healthcare professionals who fail to report a case risk losing their registration and potentially their career. It is essential that all HCPs know their responsibilities.

Key Recommendations for Healthcare Professionals

Targeted Assessment - There is no requirement to ask every female if she has undergone FGM, only those from high-risk areas or backgrounds.
Documentation - If FGM is discovered or disclosed, it must be recorded in the patient's health records by the HCP who makes the discovery.
Adults Over 18 - Females over 18 who have undergone FGM do not need referral to social services or police but should be offered support and follow-up. Assess risk to other females in their family.
Children Under 18 - Any child with symptoms, disclosure, or suspected risk of FGM must be reported to police with implementation of safeguarding procedures.
Information Sharing - Concerns about children must be shared with social care, GP, and health visitor as part of safeguarding actions.
Professional Development - Frontline staff should be empowered to recognize and manage FGM cases through education and awareness training.

Support Resources

Several organizations provide support for FGM survivors, including the NSPCC FGM helpline, FORWARD, and the Dahlia Project. Healthcare professionals should be familiar with local and national support services.