Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM) is a procedure where the external female genitalia female genital organs are deliberately cut, injured or changed and there is no medical reason for this. It is a serious and violent crime which causes severe physical and psychological damage, and there may be immediate and/or long-term health consequences, including pain and infection, mental health problems, difficulties in childbirth and/or death.

FGM is a deeply rooted practice and a global issue, widely carried out in Africa and parts of the Middle East and Asia. It serves as a complex form of social control of women's sexual and reproductive rights.

The age at which FGM is carried out varies enormously according to the community. The procedure may be carried out on new-born girls,  during childhood, adolescence or just before marriage or during a woman's first pregnancy. This could be within the family home, community or in hospitals. There is no  religious justification for FGM. UNICEF (2023) estimates that over 200 million girls and women worldwide have undergone FGM and there are believed to be 70,000 girls at risk of FGM in the UK. These are girls born to women where FGM is present already within the family and have inherited the risk.

FGM has been classified by the World Health Organisation (WHO) into four types:

• Type 1 - Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) 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 (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; and
• 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.

Under the Female Genital Mutilation Act (2003), FGM is a criminal offence - it is child abuse and is violence against women and girls and should be treated as such. It is secretive and organised crime.

Depending on the degree of mutilation, FGM can have a number of short-term health implications:

• Severe pain and shock;
• Wound infections;
• Urine retention;
• Injury to adjacent tissues;
• haemorrhaging;
• Genital swelling;
• Death. 1 in 10 girls die from FGM.

Long-term implications can include:

• Genital scarring;
• Genital cysts and keloid scar formation;
• Recurrent urinary tract infections and difficulties in passing urine;
• Possible increased risk of blood infections such as hepatitis B and HIV;
• Pain during sex, lack of pleasurable sensation and impaired sexual function;
• Psychological concerns such as anxiety, flashbacks and post traumatic stress disorder;
• Difficulties with menstruation (periods);
• Complications in pregnancy or childbirth (including prolonged labour, bleeding or tears during childbirth, increased risk of caesarean section); and
• Increased risk of stillbirth and death of child during or just after birth.

In addition to these health consequences there are considerable psycho-sexual, psychological and social consequences of FGM.

FGM is a complex issue, and individuals and families who support it give a variety of justifications and motivations for this. FGM is a crime, a form of child abuse, and no explanation or motive can justify it. The justifications given may be based  on ignorance and fear for example, it:

• Brings status and respect to the girl;
• Preserves a girl's virginity/chastity;
• Is part of being a woman;
• Is a rite of passage;
• Gives a girl social acceptance, especially for marriage;
• Upholds the family "honour";
• Cleanses and purifies the girl;
• Gives the girl and her family a sense of belonging to the community;
• Fulfils a religious requirement believed to exist;
• Perpetuates a custom/tradition;
• Helps girls and women to be clean and hygienic;
• Is aesthetically desirable;
• Makes childbirth safer for the infant; and
• Rids the family of bad luck or evil spirits.

FGM is a traditional practice often carried out by a family who believe it is beneficial and is in a girl or woman's best interests. This may limit a girl's motivation to come forward to raise concerns or talk openly about FGM – reinforcing the need for all professionals to be aware of the issues and risks of FGM and the need to ask questions about FGM when they have concerns. In addition, women and girls who have undergone FGM may not fully understand what FGM is, what the consequences are, or that they themselves have had FGM.

FGM is a complex and sensitive issue that requires professionals to approach the subject carefully. Good communication is essential when talking to individuals who have had FGM, may be at risk of FGM, or who are affected by the practice. When speaking to families, the care of women and girls affected by FGM should be the primary concern, treating them as individuals, listening and respecting their dignity. Culture is not an excuse or defence for FGM. An accredited female interpreter may be required. Any interpreter should ideally be appropriately trained in relation to FGM, and should not be a family member, nor someone known to the individual or who has influence in the individual's community.

Professionals should not be afraid to ask about FGM, using appropriate and sensitive language. Avoiding this conversation enables the perpetration of FGM. Perpetrators may have threatened their victims to keep silent and instilled fear, allowing them to continue committing this crime undetected. Professionals should obtain the voice of the child through professional curiosity and not rely on the child to initiate a disclosure. It is not the responsibility of a child victim to report. It is our collective responsibility to identify and safeguard victims and bring offenders to justice.

In England, Wales and Northern Ireland, criminal and civil legislation on FGM is contained in the Female Genital Mutilation Act 2003 ('the 2003 Act').

The Act:

1. Makes it illegal to practice FGM in the UK;
2. Makes it 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;
3. Makes it illegal to aid, abet, counsel or procure the carrying out of FGM abroad;
4. Has a penalty of up to 14 years in prison and/or, a fine.

As amended by the Serious Crime Act 2015, the Female Genital Mutilation Act 2003 also includes:

1. An offence of failing to protect a girl from the risk of FGM - A person is liable if they are "responsible" for a girl at the time when an offence is committed. This covers both someone who has "parental responsibility" for the girl and has "frequent contact" with her, as well as any adult who has assumed responsibility for caring for the girl in the "manner of a parent". This could be for example family members, with whom she was staying during the school holidays;
2. Female Genital Mutilation Protection Orders ("FGMPO"). An FGMPO is a civil order which may be made for the purposes of protecting a girl against the commission of an FGM offence or protecting a girl against whom an FGM offence has taken place. Breaching an order carries a penalty of up to 5 years in prison. The terms of the order can be flexible and the court can include whatever terms it considers necessary and appropriate to protect the girl or woman including to protect a girl from being taken abroad, to order the surrender of passports; to enable the girl to obtain medical support.
3. Allowing for the lifelong anonymity of victims of FGM – prohibiting the publication of any information that could lead to the identification of the victim. Publication covers all aspects of media including social media;
4. Extra-territorial jurisdiction over offences of FGM committed abroad by UK nationals and those habitually (as well as permanently) resident in the UK;
5. Mandatory reporting which requires specified professionals to report known cases of FGM in under 18s to the police.

(Please note: in Scotland, FGM is illegal under the Prohibition of Female Genital Mutilation (Scotland) Act 2005).

See also: Making an Application for an FGM Protection Order (FGMPO) - Flowchart.

All professionals have a safeguarding duty to report FGM, however, some professionals have an additional mandatory duty.  Regulated health and social care professionals and teachers in England and Wales have a mandatory duty to report to the Police 'known' cases of FGM in under 18s which they identify in the course of their professional work.   Reports should be made using the non-emergency 101 telephone number.

'Known' cases are those where either a girl informs the person that an act of FGM – however described – has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was necessary for the girl's physical or mental health or for purposes connected with labour or birth.

Reports under the duty must be made as soon as possible after a case is discovered and within 24 hours.  Cases of failure to comply with the duty will be dealt with in accordance with the existing disciplinary performance procedures in place for each profession.

For more information on the Mandatory Reporting Duty, please see:

Information for Professionals Subject the Duty and their Employers, Including on How to Make a Report

Information for Health Care Professionals in England

FGM is child abuse and should be treated as such. Professionals should intervene to safeguard girls who may be at risk of FGM or who have been affected by it.

Safeguarding children partners should actively seek and support ways to reduce the prevalence of FGM in practising communities within the UK. Services aimed at preventing FGM should be developed in consultation with expert voluntary sector organisations and FGM survivors. Practitioners should be trained to recognise and respond to concerns and endeavours should be made to raise awareness across the community. 

Training should be available to enable professionals to discharge their safeguarding duties with regard to FGM, as for any other form of abuse. Training on FGM should include the following:

• An overview of FGM (what it is, when, where, how it is performed, who by);
• The UK law on FGM and child protection; It is Violence Against Women and Girls.
• The physical and psychological consequences of FGM;
• What to do when FGM is suspected or has been performed; and
• The role of different professionals and the importance of multi-agency working.

See also - E-learning for all professionals (including teachers, police, border force staff, and health visitors), developed by the Home Office, is available at Virtual College, Female Genital Mutilation: Recognising and Preventing FGM.

Health Education England offer e-learning, free to access by health and social care professionals.

Female Genital Mutilation Information Sharing (FGM- IS)

Female Genital Mutilation - Information Sharing is a national IT system that supports the early intervention and ongoing safeguarding of girls, under the age of 18, who have a family history of Female Genital Mutilation (FGM).

FGM-IS is a service that supports the sharing of FGM information, and allows authorised healthcare professionals and administrative staff throughout England to view information about girls with a family history of FGM, regardless of care setting.

A national alert instigated by NHS Digital enables health professionals to add a ‘standard’ alert to a child’s summary care record (SCR) if it is highlighted they are at risk of FGM. The FGM-IS tab sits alongside the CP-IS (child protection information sharing) tab on the patient information page of their summary care record.

There are FGM risk assessments for safeguarding pregnant women / a woman who has recently had a baby and children to help support decision making.

Virginity testing and hymenoplasty can be precursors to child or forced marriage and other forms of family and/or community coercive behaviours, including physical and emotional control. The practices are degrading and intrusive. They can lead to extreme psychological trauma in the victim, and can provoke conditions including anxiety, depression and post-traumatic stress disorder. The practices have been linked to suicide and can be physically harmful.

Women and girls may themselves present to agencies requesting the procedures in an attempt to protect themselves from further harm and abuse, including shaming, disownment, physical abuse and possible honour-killings. Family and/or community members who are unaware of the change in law may also try to contact agencies seeking the procedures for their daughters and female relatives.

See Virginity Testing and Hymenoplasty: Multi-agency Guidance (DHSC) for good practice guidance and indicators that a woman or girl is at risk of or has been subjected to a virginity test and/or hymenoplasty.

It is important to find out if the woman or girl is in immediate danger. In an emergency, the police should be contacted without delay. If it is not an emergency but there is a concern that the individual is at risk, the organisation’s safeguarding procedures and any professional duties should be followed. This may involve a referral to social care services and/or the police should be made.

Virginity testing and hymenoplasty are forms of so called ‘honour-based’ abuse and violence against women and girls. Like forced marriage and female genital mutilation (FGM), the victims of these abuses are at risk of being subjected to further harm, whether that be psychological or physical. The same sensitivity and precautions apply as for other types of so called ‘honour’ based abuse.

Organisations should not involve families and community members in cases involving virginity testing and hymenoplasty, including trying to mediate with family or using a community member as an interpreter. Engaging with families and community members may increase risk of harm to the victim. The victim may be punished for seeking help and arrangements for procedures may be expedited.

The Health and Care Act 2022 has made it illegal to carry out, offer or aid and abet virginity testing or hymenoplasty in any part of the UK. It is also illegal for UK nationals and residents to do these things outside the UK.

In England and Wales and Northern Ireland, the offences will each carry a maximum penalty of a 5-year custodial sentence and/or an unlimited fine. There is a risk that women and girls may be taken abroad and subjected to virginity testing and hymenoplasty (as is often seen with so called ‘honour-based’ abuse offences, such as female genital mutilation or forced marriage). The offences, therefore, carry extra-territorial jurisdiction. This means that UK nationals and residents who carry out a virginity test or hymenoplasty outside the UK also commit an offence in the UK.

Breast flattening which is the painful and harmful practice of bringing a girl's breasts into contact with hard or heated objects (which may vary in nature but may include stones, belts, pestles and heated implements) to suppress or reverse the growth of breasts by destroying the tissue.

Breast flattening is often performed at first signs of puberty, usually by female family members professing to make a teenage girl look less womanly to avoid sexual interest, prevent pregnancy and rape, deter from sexual relationships outside marriage and dishonouring the family/community. Due to the type of instruments, force and lack of aftercare, there are significant physical and psychological consequences and risks related to this practice.

Breast flattening is a form of child abuse. See the CPS legal guidance on So-Called Honour-Based Abuse.

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Multi-Agency Statutory Guidance on Female Genital Mutilation (GOV.UK)

Female Genital Mutilation Resource Pack (Home Office) - including links to local organisations

FGM Protection Orders: Factsheet

AFRUCA (Child Protection of African Children)

Forward (Foundation for Women's Health Research and Development)

NHS - FGM (including information on where to get support)

FGM Protection Orders: Factsheet

Mandatory Reporting of Female Genital Mutilation – procedural information

Safeguarding Women and Girls at Risk of FGM – Guidance for Professionals (DHSC) – includes Pathway and Risk Assessment tools

Female Genital Mutilation CPS Guidelines

 Virginity Testing and Hymenoplasty: Multi-agency Guidance (DHSC)

National Support Agencies

Good Practice Guidance

FGM Assessment Tool for Social Workers (National FGM Centre). It has two elements; Best Practice Guidance and an Online FGM Assessment Tool to help guide the assessment of cases where FGM is a concern.

NSPCC FGM helpline: 0800 028 3550

Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2015

Useful Websites

National FGM Centre provides a range of guidance for all agencies including schools, health and social care

AFRUCA (Child Protection of African Children)

Forward (Foundation for Women's Health Research and Development)

NHS - FGM (including information on where to get support)