01Principles and purposeThe professional or clinical skill and the decisions it supports.
FGM comprises non-medical injury or alteration of female genital organs and is recognised in UK law as abuse when performed on a child. People may use different community terms. Ask sensitively and use the patient’s preferred words while being clear when legal documentation requires FGM terminology. Do not assume religion, ethnicity, country of origin or family belief proves that FGM occurred or will occur.
Immediate complications include severe pain, bleeding, shock, infection, urinary retention and injury to nearby structures. Later effects vary with the procedure and individual: recurrent urinary symptoms, menstrual difficulty, scar pain, cysts, dyspareunia, reduced sexual wellbeing, anxiety, post-traumatic symptoms and obstetric obstruction may occur. Some people have few symptoms. Avoid implying that examination findings determine the person’s identity, sexuality or psychological response.
The England and Wales mandatory-reporting duty has a narrow trigger. A regulated health or social-care professional who, during professional work, receives a direct disclosure from a girl under 18 that FGM has been carried out, or visually identifies signs appearing to show it, must make the police report personally. The duty does not require a special examination to look for FGM and does not apply in the same way to suspicion, risk, or a parent’s disclosure.
Wider safeguarding remains active outside that trigger. A girl thought to be at risk, or information from a third party, should be discussed promptly with the safeguarding lead and referred through the applicable children’s pathway. Scotland and Northern Ireland have different legislation and procedures. Adult survivors are assessed individually; there is no automatic police or adult-social-care referral solely because FGM is identified, although children connected to the adult may need safeguarding consideration.
Examination should occur only for clinical need, with informed consent, privacy and a trained chaperone. Describe anatomy accurately without guessing a WHO type beyond competence. Avoid repeat examinations by coordinating specialists. Offer National FGM Support Clinics where eligible in England, specialist paediatric services for under-18s, and corresponding nation or local services elsewhere.
Care responds to the person’s concern. Treat infection, pain, urinary and menstrual problems and provide psychosexual or trauma support when wanted. Type III scarring can narrow the introitus and cover the urethral opening; deinfibulation may improve urination, menstruation, sexual comfort, examination and childbirth. Discuss timing before pregnancy or antenatally, and never reinfibulate after birth.
Key points
- Use neutral language the patient understands, ask whether they use terms such as cutting or circumcision, and avoid repeated unnecessary examinations.
- FGM has no health benefit and can cause immediate bleeding, infection and urinary injury plus long-term scar, pain, sexual, menstrual, obstetric and psychological complications.
- In England and Wales, regulated health and social-care professionals and teachers must personally report known FGM in an under-18 directly disclosed by the girl or visually identified in professional work.
- Risk alone, third-party disclosure and adult identification follow safeguarding or individual risk pathways rather than that exact mandatory-reporting trigger.
- Reporting and safeguarding law differs in Scotland and Northern Ireland; never present the England and Wales direct police duty as UK-wide.
- Offer symptom-led care, specialist FGM support, mental-health help, sexual-health care and maternity planning; deinfibulation can relieve obstruction from type III scarring.
- Assess whether sisters, daughters or other children may be at risk while preserving adult autonomy and explaining confidentiality before sharing where possible.
02Situations and prioritiesThe context, relevant information and actions that matter most.
Direct disclosure by a girl or visual identification during professional work activates the England and Wales regulated-professional police duty.
Travel plans, family pressure or a sibling history may indicate child risk requiring safeguarding even though the known-case reporting trigger is absent.
A narrowed opening from fused scar tissue can contribute to slow urination, retained menstrual flow, penetration difficulty and labour obstruction.
Identification in an adult leads to needs and risk assessment, not automatic police referral solely on the basis of FGM.
Bleeding, fever, severe pain, shock or urinary obstruction after recent cutting requires emergency clinical and safeguarding response.
When an adult survivor has daughters or younger relatives, explore risk without assuming the adult supports the practice.
03Assessment and interpretationHow to gather information, assess the situation and recognise uncertainty.
Consider the information, its meaning and its limitations before deciding what follows.
- 01
Private culturally sensitive history - Why
- Establish symptoms, terminology, procedure history, maternity needs and risk to the patient or connected children.
- Interpretation and limitations
- Country or community background modifies inquiry but cannot diagnose FGM or establish imminent risk.
- 02
External genital examination with consent - Why
- Assess scarring, obstruction, cysts, infection and anatomy when the result will change care.
- Interpretation and limitations
- Do not perform an examination solely to trigger reporting; document objective findings and seek specialist classification advice when uncertain.
- 03
Urinary and infection assessment - Why
- Investigate dysuria, retention, recurrent infection, discharge, fever or scar inflammation.
- Interpretation and limitations
- Treat the identified condition while considering whether anatomical obstruction contributes to recurrence.
- 04
Pregnancy and maternity assessment - Why
- Plan examination, cervical access, deinfibulation, labour and safeguarding before birth.
- Interpretation and limitations
- Anatomy and symptoms guide timing; type III scarring should be addressed through specialist antenatal planning.
- 05
Safeguarding and legal-trigger assessment - Why
- Distinguish direct disclosure, visual identification, suspicion, third-party information, age and UK nation.
- Interpretation and limitations
- These facts decide which mandatory report or safeguarding route applies; document the advice and action taken.
04Worked approachesCases with ordered reasoning, an action and a check of the outcome.
01Worked caseSeparate reporting duty from wider safeguardingA mother tells an English GP that her 14-year-old daughter underwent FGM abroad, but the GP has not seen or spoken with the girl.+
- 1Recognise that the parent’s third-party disclosure does not itself activate the regulated professional’s personal known-case police-report duty.
- 2Treat the information as a serious child-protection concern and contact the designated safeguarding lead immediately.
- 3Follow the England children’s social-care and police safeguarding pathway without arranging an unnecessary genital examination merely to create a reporting trigger.
- 4Record the source of information, advice, referrals and safety plan, then ensure the girl reaches appropriate specialist care.
02Known-case dutyMake the direct report in England or WalesA girl under 18 directly discloses FGM to a regulated professional, or it is visually identified during ordinary professional care.+
- 1Address urgent health and safety needs and explain the duty in age-appropriate language when safe to do so.
- 2Make the police report personally according to current procedural guidance and involve the safeguarding lead.
- 3Continue the wider children’s safeguarding and specialist healthcare pathway; the police report does not replace either.
03Adult careOffer specialist symptom and maternity supportAn adult survivor seeks help with urinary symptoms, pain, sexual wellbeing or pregnancy planning.+
- 1Ask about symptoms and goals privately and assess whether any child or the adult is currently at risk.
- 2Offer clinically indicated examination and refer for FGM-specialist, gynaecological, psychosexual, urological or maternity care.
- 3Explain that adult identification alone does not cause an automatic police referral, while discussing any necessary safeguarding disclosure.
05Feedback, follow-up and evidenceReview outcomes, seek feedback and identify what to improve.
- Confirm that acute complications and each identified symptom have a named clinical follow-up route.
- Record whether information was direct disclosure, visual identification, suspicion or third-party report.
- Document age, UK nation, professional role, safeguarding advice and the precise report or referral made.
- Review pregnancy and deinfibulation planning early enough to avoid crisis decisions during labour.
- Offer psychological and sexual-health follow-up without assuming every survivor wants the same intervention.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
One duty has narrow facts
Age under 18, England or Wales, regulated professional status and direct disclosure or visual identification all matter.
Safeguarding is broader
Absence of the mandatory-report trigger never means that credible child risk can be ignored.
Do not examine for law
The reporting guidance does not require a genital examination solely to establish whether the duty applies.
Adult autonomy remains central
An adult survivor’s care and police involvement are individual decisions unless another lawful safeguarding basis requires disclosure.
07Common pitfallsFrequent interpretation and management errors.
- 01
Calling a parent’s disclosure the same as a direct disclosure by the girl.
- 02
Applying the England and Wales police-reporting duty throughout all UK nations.
- 03
Examining a child solely to create a mandatory-report trigger.
- 04
Automatically reporting every adult survivor to police.
- 05
Assuming ethnicity or travel alone proves current risk.
- 06
Leaving type III FGM maternity planning until labour.