Abdulcadir J, Rodriguez MI, Say L Research gaps in the care of women with female genital mutilation: an analysis. BJOG.. 2015; 122:(3)294-303

Albert J, Wells M The Acton Model: support for women with female genital mutilation. Br J Midwifery.. 2020; 28:(10)697-708

Berg RC, Denison E Does female genital mutilation/cutting (FGM/C) affect women's sexual functioning? A systematic review of the sexual consequences of FGM/C. Sex Res Soc Policy.. 2012; 9:(1)41-56

Brown K, Beecham D, Barrett H The applicability of behaviour change in intervention programmes targeted at ending female genital mutilation in the EU: integrating social cognitive and community level approaches. Obstet Gynecol Int.. 2013; 2013:1-12

Dixon S, Agha K, Ali F Female genital mutilation in the UK- where are we, where do we go next? Involving communities in setting the research agenda. Res Involve Engage.. 2018; 4:(1)

Elneil S Female sexual dysfunction in female genital mutilation. Trop Doct.. 2016; 46:(1)2-11

Essén B, Johnsdotter S Female genital mutilation in the West: traditional circumcision versus genital cosmetic surgery. Acta Obstet Gynecol Scand.. 2004; 83:(7)611-613

Evans C, Tweheyo R, McGarry J Improving care for women and girls who have undergone female genital mutilation/cutting: qualitative systematic reviews. Health Serv Deliv Res.. 2019; 7:(31)1-216

Evans C, Tweheyo R, McGarry J Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting. BMJ Open.. 2019; 9:(5)

Gordon H, Comerasamy H, Morris NH Female genital mutilation: experience in a West London clinic. J Obstet Gynaecol.. 2007; 27:(4)416-419

Hanlon J, Hex N Economic analysis of NHS FGM support clinics.York: York Health Economics Consortium; 2021

Estimating the costs of female genital mutilation services to the NHS. 2016. https//

Karlsen S, Howard J, Carver N, Mogilnicka M, Pantazis C Available evidence suggests that prevalence and risk of female genital cutting/mutilation in the UK is much lower than widely presumed - policies based on exaggerated estimates are harmful to girls and women from affected communities. Int J Impot Res.. 2023; 35:212-215

MacFarlane AJ, Dorkenoo E PP20 Estimating the numbers of women and girls with female genital mutilation in england and wales. J Epidemiol Community Health.. 2015; 69:(Suppl 1)A61.1-A61

Mathers N, Rymer J Mandatory reporting of female genital mutilation by healthcare professionals. Br J Gen Pract.. 2015; 65:(635)282-283

Momoh C, Ladhani S, Lochrie DP, Rymer J Female genital mutilation: analysis of the first twelve months of a southeast London specialist clinic. BJOG.. 2001; 108:(2)186-191

NHS England. National female genital mutilation support clinics national launch. 2019b. https//

Okonofua FE, Larsen U, Oronsaye F, Snow RC, Slanger TE The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria. BJOG.. 2002; 109:(10)1089-1096

O'Connell H, Sanjeevan K, Hutson JM Anatomy of the clitoris. J Urol. 2005; 174:(4 Part 1)1189-1195

Paliwal P, Ali S, Bradshaw S, Hughes A, Jolly K Management of type III female genital mutilation in Birmingham, UK: a retrospective audit. Midwifery.. 2014; 30:(3)282-288

Rittenberg E Trauma-informed care— reflections of a primary care doctor in the week of the Kavanaugh Hearing. N Engl J Med.. 2018; 379:(22)2094-2095

Sosa G The African Well Women Clinic at the Whittington Hospital NHS Trust. MIDIRS Midwifery Digest.. 2004; 14:(2)255-260

UNICEF. Female genital mutilation/cutting: a global concern. 2016. https//

UNICEF. Female genital mutilation country profiles. 2020. https//

New York: UNICEF; 2020

UNICEF. On international day of zero tolerance for female genital mutilation, UNICEF warns COVID-19 threatens to reverse decades of progress. 2022. https//

World Health Organization. Female genital mutilation key facts. 2021. https//

World Health Organization. Prevalence of female genital mutilation. 2020. https//

Ziyada MM, Johansen REB Barriers and facilitators to the access to specialized female genital cutting healthcare services: Experiences of Somali and Sudanese women in Norway. Erbil N, editor. PLoS One.. 2021; 16:(9)

Analysis of a specialist service for non-pregnant women with female genital mutilation: 2008–2019

02 November 2023
Volume 31 · Issue 11



Female genital mutilation affects an estimated 200 million women and girls worldwide. This article examines a midwife-led service that integrates health advocates and counsellors into a model of holistic woman-centred care and was the blueprint for new national clinics opened in 2019.


This retrospective case note review examined referral patterns, clinical findings and interventions over 11 years at a UK specialist clinic for non-pregnant women with female genital mutilation.


More than 2000 consultations were conducted. Two thirds of women had type 3 mutilation. Most were Somali (73.4%) with 18 other ethnic backgrounds represented. Women presented with dysuria, dyspareunia/apareunia, dysmenorrhea, recurrent infections, post-traumatic stress disorder, nightmares, flashbacks and psychosexual issues. Interventions included deinfibulation under local anaesthetic (many as same day walk-in cases), clinical reports for asylum applications and trauma counselling. One in 10 attendees were healthcare professionals/carers. Nearly 5% were refugees/asylum seekers. There were 12 safeguarding referrals, three cases of mandatory reporting duty and two protection orders. Intersectional violence was frequently reported among women of West African origin.


Significant numbers of non-pregnant women require specialist help. Innovative means to publicise clinics and routine enquiry during gynaecological consultations and GP registration, could ensure earlier signposting to services. Deinfibulation can be safely performed by an expert midwife in a community or outpatient setting.

Female genital mutilation is defined as ‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’ (World Health Organization (WHO), 2021). An estimated 200 million women and girls worldwide (UNICEF, 2016) have experienced the physical, psychological, and social sequelae of female genital mutilation, with associated healthcare costs of 1.4 billion US dollars per year (WHO, 2021). In 2011, it was calculated that 137000 women and girls with female genital mutilation resided in England and Wales, (MacFarlane and Dorkenoo, 2015) costing the NHS approximately £100 million annually (Hex et al, 2016).

Female genital mutilation is recognised as a form of gender-based violence and human rights violation rooted in gender inequality (WHO, 2021). It is a global public health concern, presenting an increasing challenge to countries with large diaspora. Despite prevention efforts, the pace of decline is uneven and UNICEF (2022) estimate that an additional 2 million girls could be at risk of female genital mutilation by 2030 as a result of social disruption caused by COVID-19. The practice, which has been illegal in the UK since 1985, is often justified by cultural or religious reasons underpinned by the desire to control female sexuality (Berg and Denison, 2012).

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