Female genital mutilation (sometimes referred to as female circumcision) refers to procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The practice is illegal in the UK.

It has been estimated that over 20,000 girls under the age of 15 are at risk of female genital mutilation (FGM) in the UK each year, and that 66,000 women in the UK are living with the consequences of FGM. However, the true extent is unknown due to the 'hidden' nature of the crime.

The girls may be taken to their countries of origin so that FGM can be carried out during the summer holidays, allowing them time to 'heal' before they return to school. There are also worries that some girls may have FGM performed in the UK.

Forms of mutilation

FGM is usually carried out on young girls between infancy and age 15, most commonly before puberty starts.

The procedure is traditionally carried out by a woman with no medical training. Anaesthetics and antiseptic treatments are not generally used and the practice is usually carried out using knives, scissors, scalpels, pieces of glass or razor blades. Girls may have to be forcibly restrained.

There are four main types of FGM:

• Type 1 – clitoridectomy – removing part or all of the clitoris.
• Type 2 – excision – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips).
• Type 3 – infibulation – narrowing of the vaginal opening by creating a seal, formed by cutting and repositioning the labia.
• Other harmful procedures to the female genitals, which include pricking, piercing, cutting, scraping and burning the area.

Effects of FGM

There are no health benefits to FGM. Removing and damaging healthy and normal female genital tissue interferes with the natural functions of girls' and women's bodies.

Immediate effects

• severe pain
• shock 
• bleeding
• wound infections, including tetanus and gangrene, as well as blood-borne viruses such as HIV, hepatitis B and hepatitis C
• inability to urinate
• injury to vulval tissues surrounding the entrance to the vagina 
• damage to other organs nearby, such as the urethra (where urine passes) and the bowel 

FGM can sometimes cause death.

Long-term consequences

• chronic vaginal and pelvic infections
• abnormal periods
• difficulties passing urine and persistent urine infections
• kidney impairment and possible kidney failure
• damage to the reproductive system, including infertility
• cysts and the formation of scar tissue
• complications in pregnancy and newborn deaths 
• pain during sex and lack of pleasurable sensation
• psychological damage, including low libido, depression and anxiety (see below) 
• flashbacks during pregnancy and childbirth
• the need for later surgery to open the lower vagina for sexual intercourse and childbirth

Psychological and mental health problems

Case histories and personal accounts taken from women indicate that FGM is an extremely traumatic experience for girls and women, which stays with them for the rest of their lives.

Young women receiving psychological counselling in the UK report feelings of betrayal by parents, regret and anger.

The legal situation

FGM is illegal in the UK. It is also illegal to arrange for a child to be taken abroad for FGM. If caught, offenders face a large fine and a prison sentence of up to 14 years.

What you can do

If you are worried about someone who is at risk of FGM or has had FGM, you must share this information with social care or the police. It is then their responsibility to investigate and protect any girls or women involved.

See the Useful links, right, for contact information.

Health professionals

If you are a health or social care professional who may come into contact with girls and women at risk of FGM, you can read the Multi-Agency Practice Guidelines on Female Genital Mutilation (HMG 2011) (PDF, 1.63Mb).

These guidelines contain detailed advice and guidance in relation to the protection of girls who may be at risk of FGM, as well as the care and treatment of women who have already undergone FGM.

Other useful resources are listed in the Useful links, right.

Surgical "reversal"

Surgery can be performed to open up the lower vagina. This is sometimes called "reversal", although it cannot restore sensitive tissue that has been removed.

Surgery may be necessary for women who are unable to have intercourse as the vagina is too narrow. In addition, some pregnant women who have had FGM will need to have their lower vagina opened up before labour to allow a safer birth.

FGM increases the risk of the vagina tearing during delivery, which causes damage and can lead to heavy bleeding. It can also increase the risk of the baby dying during, or just after birth.

Surgery is best performed before pregnancy, or at least within the second trimester of pregnancy (between about 12 and 36 weeks).

Some women may be reluctant to undergo reversal until labour starts, because this may be normal practice in their country of origin. The Royal College of Nursing 2006 guidelines (PDF, 1.03Mb) offer advice on this.

Surgery involves making a careful incision along the scar tissue that has closed up the entrance to the vagina, to expose the underlying vagina.

Adequate pain relief is essential – the procedure is usually performed under local anaesthetic in the outpatient clinic. However, a small number of women will need either a general or spinal anaesthetic (injection in the back), which would normally involve a one-day stay in hospital.

Where does FGM happen?

FGM is prevalent in Africa, the Middle East and Asia.

In the UK, FGM tends to occur in areas with larger populations of communities who practice FGM, such as first-generation immigrants, refugees and asylum seekers. These areas include London, Cardiff, Manchester, Sheffield, Northampton, Birmingham, Oxford, Crawley, Reading, Slough and Milton Keynes.

Why is it done?

FGM is carried out for cultural, religious and social reasons within families and communities.

For example, it is often considered a necessary part of raising a girl properly, and as a way to prepare her for adulthood and marriage. FGM is often motivated by the belief that it is beneficial for the girl or woman. Many communities believe it will reduce a woman's libido and discourage sexual activity before marriage.