female genital mutulation (FGM)

Last edited 04/2019

• Female genital cutting or mutilation (FGM) sometimes called female circumcision is a practice which is thought to have existed for thousands of years (1)
  • is most commonly practised in countries in northern sub-Saharan Africa; in the Sahel region, in the horn of Africa and Egypt, but it is also found outside Africa e.g. amongst women and families migrating to European countries and the US from these locations
    
    
• it is estimated that world-wide between 100-140 million women are thought to have undergone FGM and 3 million girls annually are thought to be at risk
  • FGM varies from a more or less ritual and symbolic genital cutting, through to levels of severity which include removal of the clitoris; and/or removal of the labia minora; and/or infibulation (abrasion and stitching together) of the labia majora after which a small hole is left through which urination and sexual activity can occur
    
    • this last form requires reopening (and re-closure) for childbirth
      
      
  • what is infibulation?
    • refers to the removal of the clitoris, partial or total removal of the labia minora and stitching together of the labia majora (1)
      
      
  • what is de-infibulation (defibulation)?
    • infibulation creates a physical barrier to sexual intercourse and childbirth
      • an infibulated woman therefore has to undergo gradual dilation of the vaginal opening before sexual intercourse can take place. Often, infibulated women are cut open (the process of defibulation) on the first night of marriage (by the husband, or a circumciser), in order to enable the husband to be intimate with his wife
      • at childbirth, many women also have to be cut again, because the vaginal opening is too small to allow for the passage of a baby. Attempts at forcible penetration may cause rupture of scars and sometimes perineal tears, dyspareunia, and vaginismus. Excessive penile force during first intercourse can cause severe bleeding, shock and infection
        
        
  • what is re-infibulation?
    • in some communities, the raw edges of the wound are sutured again after childbirth, recreating a small vaginal opening. This is referred to as re-infibulation
      
      
• FGM is carried out on girls at different ages ranging from babies and toddlers to teenagers. It is frequently carried out in unsterile conditions by traditional practitioners. This is both the result of its traditional form and its illegality in many places means that it is conducted in such conditions
  
  
• Complications can include immediate urinary and genital tract infection, pain and haemorrhage, complications in childbirth and social, psychological and sexual complications
  
  • the public health burdens of FGM include both consequences for women or daughter mortality and ongoing morbidity concerns through their life span.

FGM, a dangerous and potentially life-threatening procedure to which women and girls in many countries are subjected has been viewed as a Human Rights violation in many countries.

Detailed description of the different types of FGM:

Type 1 - Clitoridectomy :

Excision of the prepuce, with or without excision of part or all of the clitoris

Type 2 - Excision:

partial or total removal of the clitoris and labia minor, with or without excision of the labia majora (the labia are the "lips" that surround the vagina)

Type 3 - Infibulation:

narrowing of the vaginal opening through the creation of a covering seal

The seal is formed by cutting and repositioning the inner, or outer, labia with or without removal of the clitoris. Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation)

Infibulation is strongly linked to virginity and chastity, and used to safeguard girls from sex outside marriage and from having sexual feelings. In some cultures it is considered necessary at marriage for the husband and his family to see her "closed" and, in some instances, both mothers will take the girl to be cut open enough to be able to have sex

Type 4 - Unclassified: which includes:

pricking, piercing or incising of the clitoris and/or labia for cultural/non-therapeutic reasons; stretching of the clitoris and/or labia; cauterisation by burning of the clitoris and surrounding tissue; scraping of the tissue surrounding the vaginal orifice (angurya cuts) or cutting the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it; and any other procedure that falls under the definition of female genital mutilation given above

The UK Law

FGM is against the law in the UK and has been a criminal offence since 1985. It is a serious crime that carries a penalty of 14 years in prison. It is an offence to make arrangements for FGM to be undertaken within the UK or to take, or plan to take a child out of the UK for the purpose of FGM.

What to do if you are concerned or have been made aware FGM has occurred ?

It is a mandatory duty for a regulated healthcare professional to report any concerns they have about a female under 18 years and record when FGM is disclosed or identified as part of NHS healthcare. As FGM is illegal this should be reported to the Police via the 101 non-emergency number.

Reference:

• UNFPA (United Nations Population Fund) Promoting Gender Equality. Frequently Asked Questions on Female genital Mutilation/Cutting. http://www.unfpa.org/gender/practices2.htm
• NHS England (2017). Safeguarding in Adults - NHS England North Designated Professionals for Safeguarding Adults.