Female genital mutilation (FGM)

There are 4 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 (the lips that surround the vagina), with or without removal of the labia majora (the larger outer lips)
• type 3 (infibulation) – narrowing the vaginal opening by creating a seal, formed by cutting and repositioning the labia
• other harmful procedures to the female genitals, including pricking, piercing, cutting, scraping or burning the area

FGM is often performed by traditional circumcisers or cutters who do not have any medical training. But in some countries it may be done by a medical professional.

FGM can happen at different times in a girl or woman's life, including:

• when a baby is new-born
• during childhood or as a teenager
• just before marriage
• during pregnancy. 

Economic Reasons

• By ensuring a girl’s virginity, this may make men more willing to marry her and pay more money for her (her bridal price, which is money paid to her parents).
• Circumcisers also get paid for each circumcision performed and so this provides them with a good income (source of money).
• The FGM celebration also provides gifts and money to a girl and her family.
• In some communities traditional leaders and chiefs are paid to give permission for girls to be cut.

Social Reasons

• Increasing sexual pleasure for the male
• Family honour
• Community Leaders, religious leaders, circumcisers and some medical personnel can contribute to upholding the practice
• FGM is considered a cultural tradition, this upholds its continuation
• Copying traditions of neighbouring groups
• Men’s control of female reproductive functions
• Social pressure to conform to convention
• Sense of belonging or fear of social exclusion
• Necessary part of raising a girl “properly”, preparing for adulthood and marriage
• Proper sexual behaviour, hindered pre marital sex
• Cultural ideas of femininity and modesty – girls are “clean” and beautiful after removal of body parts that are considered “male” or “unclean”

It can cause serious harm, including:

• severe and/or constant pain
• infections, such as tetanus, HIV and hepatitis B and C
• pain or difficulty having sex
• period problems
• infertility
• bleeding, cysts and abscesses
• difficulties urinating or incontinence
• organ damage
• problems during pregnancy and childbirth, which can be life-threatening for the mother and baby
• mental health problems, such as depression, flashbacks and self-harm
• death from blood loss or infections 

Follow the Pan Cheshire Procedures for Adults and Children by clicking on this link

If an adult female is at risk of undergoing or had already undergone FGM, these incidents should be dealt with by the Public Protection Investigation Unit as a form of Domestic Violence and Abuse/Honour Based Violence incident.

Relevant risk assessments (such as the DASH domestic abuse and stalking risk indicator checklist - see SafeLives website) and safeguards should be put in place and referrals to partner agencies made as appropriate in order to ensure the victim receives all relevant support.

If the adult female is an Adult at risk, the adult safeguarding process should be initiated and an urgent Strategy Meeting arranged. Note however if the adult has Capacity and does not give consent the safeguarding process would not be taken forward unless there was a wider 'public interest' element to the case. Immediate protection may be secured through the Court of Protection or the High Court.

Part of the investigation should entail identification of any persons who seek to aide, abet or procure someone to commit FGM and with a view to identifying other victims

Contact Adult Social Care First Response Team on 01925 443322 or Outside of office hours ring us on 01925 444400

If you know someone in immediate danger

Contact the police if you think that a girl or young woman is in immediate danger of FGM. You should also contact the Foreign and Commonwealth Office if she’s already been taken abroad.

Foreign and Commonwealth Office

• telephone: 020 7008 1500
• from overseas: +44 (0)20 7008 1500

Adults who are vulnerable / At Risk need to be interviewed alone and a Capacity assessment completed. Capacity is a decision and time specific - the decisions to be assessed may include whether they can consent to travel abroad when there is a risk of their family arranging for them to undergo FGM.

If they are not able to make a decision or safeguard themselves, then a Best Interests decision should be made. When an adult lacks Capacity and needs to be safeguarded the local authority can apply to the Court of Protection to give them powers to protect an individual. Adults at Risk who are assessed as having Capacity but are at risk of coming to harm can be protected using the powers contained within the inherent jurisdiction of the high court. Other adults may be protected for example through non molestation orders.

The Strategy Meeting should reconvene as agreed to discuss the outcomes and recommendations from the initial investigations and assessment. The multi-agency group will need to agree next steps for support and level of need. At all times the primary focus is to prevent the female undergoing any form of FGM by working in partnership with parents, carers and the wider community to address risk factors. However where the assessment identifies a continuing risk of FGM then, the first priority is protection and the local authority should consider the need for:

• Legal action;
• Criminal prosecution;
• An Initial Child Protection Conference/Adult Safeguarding Conference.

For Adults, a Safeguarding Plan will be formulated and monitored in accordance with the Safeguarding Adult Procedures.

Talking to women and girls about FGM

When talking about FGM, professionals should:

• ensure that a female professional is available to speak to if the girl or woman would prefer this
• make no assumptions
• give the individual time to talk and be willing to listen
• create an opportunity for the individual to disclose, seeing the individual on their own in private
• be sensitive to the intimate nature of the subject
• be sensitive to the fact that the individual may be loyal to their parents
• be non-judgemental (pointing out the illegality and health risks of the practice, but not blaming the girl or woman)
• get accurate information about the urgency of the situation if the individual is at risk of being subjected to the procedure
• take detailed notes
• use simple language and ask straightforward questions; use terminology that the individual will understand, e.g. the individual is unlikely to view the procedure as ‘abusive’
• avoid loaded or offensive terminology such as ‘mutilation’
• use value-neutral terms understandable to the woman, such as: “Have you been closed?” Were you circumcised?” “Have you been cut down there?”
• give the message that the individual can come back to you if they wish;
• give a clear explanation that FGM is illegal and that the law can be used to help the family avoid FGM if/when they have daughters.
• be direct, as indirect questions can be confusing and may only serve to reveal any underlying embarrassment or discomfort that you or the patient may have. If any confusion remains, ask leading questions such as: 

• • “Do you experience any pains or difficulties during intercourse?”
  • “Do you have any problems passing urine?”
  • “How long does it take to pass urine?”
  • “Do you have any pelvic pain or menstrual difficulties?”
  • “Have you had any difficulties in childbirth?” 

FGM Protection Orders

Female Genital Mutilation Protection Orders (FGMPOs) offer a legal means to protect and safeguard victims and potential victims of FGM.

FGMPOs are granted by a court and are unique to each case. They contain conditions to protect a victim or potential victim from FGM. This could include surrendering a passport to prevent the person at risk from being taken abroad for FGM or requirements that no one arranges for FGM to be performed on the person being protected.

You can apply to get a protection order from the court if:

• you’re a victim of FGM
• you or someone you know is in danger of FGM

Download and fill in an application form (FGM001). Read the guidance to find out which courts you can apply to.

For further information about FGM Protection orders read the HM Government Fact sheet below.

FGM protection orders: factsheet 

The NHS have an informative website that includes information on: 

• Types of FGM
• Effects of FGM
• Getting Help and Support
• FGM and Sex
• FGM and Pregnancy
• FGM and Mental Health
• Treatment for FGM (deinfibulation)
• Why is FGM carried out?
• Where is FGM carried out?

FGM Support Clinics - Read about National FGM Support Clinics and where to find them.