What are the Signs of FGM?

Female Genital Mutilation (FGM) is a procedure that involves altering or removing female genitalia. Female Genital Mutilation is done for non-medical reasons and the procedure is often carried out by someone with no medical training.

The genitalia are cut or removed using instruments such as a knife, scissors, a scalpel, glass, or a razor blade. Girls usually undergo this procedure without anaesthetic or antiseptic and they will often not be given any aftercare. Often, girls are not given any choice and are forced to undergo FGM against their will. In this situation, the girl is likely to be forcibly restrained.

FGM is usually carried out between birth and 15 years of age. Girls will usually undergo this procedure before puberty. Also known as female circumcision, FGM violates human rights and is illegal in the UK. All countries of the UK categorise FGM as child abuse and it carries heavy prison sentences.

It is a serious offence in the UK to:

• Perform FGM.
• Take a child abroad for an FGM procedure.
• Help anyone perform FGM in the UK.
• Help anyone perform FGM outside the UK if the victim is a UK national or resident.
• Help a female perform FGM on herself.
• Fail to protect a girl from FGM.

Anyone who is found guilty of failing to protect a girl from FGM can be sentenced to up to seven years in prison. Anyone found guilty of performing FGM can be sentenced to up to 14 years in prison.

FGM is extremely painful and can have some serious immediate side effects, such as:

• Extreme pain.
• Blood loss, cysts and abscesses.
• Shock.
• Swelling of the genital tissue.
• Problems with healing.
• Repeated infections that can cause long-term damage.
• Problems urinating or the development of incontinence issues.
• Organ damage.
• Death.

Some girls lose their life as a result of FGM. They could die during the procedure itself, or as a result of complications, such as blood loss or infection. For more information about Female Genital Mutilation, consult the NSPCC.

Signs Female Genital Mutilation might occur

Being aware of the signs that FGM could be about to occur, or being aware of the risk factors, can help others prevent this illegal procedure from taking place.

Girls who originate from communities where FGM is common, such as some African countries, are at higher risk of having the procedure done to them, especially if they still have extended family living in these communities. If a girl’s mother or sister has undergone FGM, the likelihood of them having the procedure is also significantly higher.

As FGM is done during childhood, the victims may not realise what is about to happen to them. If they are aware that they are about to undergo FGM, they may not want to speak out, out of fear of betraying their family or getting their parents in trouble with the law.

Other girls may not have a trusted adult they can talk about the procedure with. For more information about why girls may keep quiet about female genital mutilation, consult our knowledge base.

If adults ensure they are aware of the risk factors and the signs that FGM might happen, girls can be protected.

Signs that FGM might be about to happen include:

• A ceremony is arranged where the girl will transition to womanhood and be prepared for marriage.
• The girl is going on a holiday to a country with high FGM prevalence, for an extended period of time.
• The girl has long, unexplained periods of absence from school.
• A relative or someone with a history of performing FGM procedures is visiting from abroad.
• The girl begins to show changes in her emotional behaviour, such as showing anxiety or stress, or she becomes withdrawn.
• The girl runs away, or plans to run away, from home.
• The girl begins to show reluctance to go home or a reluctance to go abroad.
• The girl’s mother or sisters underwent FGM at a similar age.

If you are concerned that someone is at risk of FGM, there are several ways you can seek help and advice:

• Call 999 – If someone is in immediate danger of having an FGM procedure, call the police to receive immediate help.
• Contact the NSPCC – If you are concerned that someone is at risk, or you would like help or advice, contact the NSPCC helpline on 0800 028 3550. You could also email them at fgmhelp@nspcc.org.uk.
• Contact the social services team at your local authority – Most local authorities in the UK will have a designated social services team for victims or potential victims of FGM. Children’s social services work 24 hours a day, so if the risk of FGM is imminent, they can act immediately. If it does not require quick intervention, social services can speak to relevant professionals and family members. In some cases, the family is not aware that FGM is illegal in the UK, so social services can provide them with support and resources to prevent the procedure from happening to their child.
• Follow safeguarding procedures – If you are a professional that works in an organisation such as a school, sports club, religious setting or healthcare setting, there will be a safeguarding procedure you must follow. This will involve informing the Safeguarding Lead immediately if you feel a girl is at risk of FGM. For more information about safeguarding, consult our knowledge base.

Signs that FGM might have taken place

After FGM has taken place, adults might notice significant changes in the victim’s behaviour or mental state. Victims may have been told not to tell anyone what happened and may have received pressure from their family or community to behave normally.

However, the victim will likely be experiencing emotional distress. They may show changes in their emotional behaviour or withdraw and isolate themselves from their friends. It is also likely that the victim is feeling pain and struggling with the physical implications of the procedure.

Physical signs that FGM has taken place can differ, depending on what type of FGM procedure they have undergone. Behavioural and emotional signs may differ, depending on the girl’s thoughts and feelings about the procedure.

Signs of FGM may include, but are not limited to:

• Difficulty walking, standing or sitting.
• Difficulty performing their usual daily tasks.
• Spending longer than normal in the bathroom.
• Complaining of pain but not going into more detail.
• Refusing to go to a doctor or speak to a medical professional.
• Long periods of absences from school or repeated absences.
• Refusing or unable to take part in physical activities.
• Showing changes in behaviour or their emotional state, such as appearing anxious, tearful, depressed, stressed or withdrawn.
• Struggling to concentrate in class.
• Asking for help but not being explicit about the problem.
• Making indirect disclosures to friends or other trusted individuals, for example saying that something has happened to them, but they are not able to give more information.
• Showing physical symptoms such as bleeding, discharge, infections and pain.
• Having unusual menstrual issues or frequent menstrual problems.

Where does FGM commonly take place?

The World Health Organisation (WHO) reports that more than 200 million girls and women who are alive today have undergone an FGM procedure. Furthermore, they state that every year 3 million girls are at risk of having the procedure done.

Below are some statistics about FGM in the UK:

• It is estimated that 60,000 girls in England aged 0-14 were born to mothers who had undergone FGM themselves. These girls are at higher risk of undergoing FGM themselves.
• FGM was identified in 1,630 girls and women between October and December 2020.
• It was estimated that 103,000 women with FGM aged 15-49 were living in England and Wales in 2011.
• London has the highest prevalence of women living with FGM.

Some communities have a much higher risk of FGM. This is because FGM is a deeply rooted social norm. Various socio-cultural factors increase the prevalence of FGM.

The reasons why FGM is practised in certain communities could include:

• To suppress female sexuality.
• To uphold the family honour.
• As a local tradition that is passed down through the generations.
• To ensure future marriage for the girl involved.
• To welcome the girl into womanhood.
• To follow religious beliefs.
• To preserve virginity and prevent immorality.
• To prevent deviant sexual behaviour and discourage infidelity.
• FGM may be seen as more hygienic and more aesthetically pleasing.

Many of the communities that perform FGM also have significant gender inequality. This means girls are not likely to have the freedom to make their own choice.

FGM is most commonly associated with certain communities and ethnic groups in Africa. The following countries, as reported by The World Health Organisation (WHO), have the highest prevalence of FGM.

The percentages represent the number of females aged 15-49 that have undergone FGM:

• Somalia – 98%.
• Guinea – 96%.
• Djibouti – 93%.
• Egypt – 91%.
• Mali – 89%.
• Eritrea – 89%.
• Sudan – 88%.
• Sierra Leona – 88%.
• Gambia – 76%.
• Ethiopia – 74%.
• Mauritania – 69%.
• Liberia – 66%.

FGM is also associated with some communities in Asian and Middle Eastern countries, including:

• India.
• Indonesia.
• Malaysia.
• Pakistan.
• Yemen.
• Oman.
• United Arab Emirates.

Girls whose families originate from communities where FGM is prevalent may be taken abroad to have the procedure done. Often, the victim may not be aware of the reason they are travelling abroad.

The risk of FGM is highest during the summer holidays, as this gives a longer time for recovery and has a lower risk of teachers, friends or other adults becoming aware that the procedure has taken place.

Forms of FGM that exist

There are four main types of FGM, although this may differ in different communities:

• Type 1 – Clitoridectomy – This involves removing part or all of the clitoris. This could include the clitoral gland and the clitoral hood.
• Type 2 – Excision – This involves removing part or all of the clitoris plus the inner labia (labia minora). This may also include the removal of the labia majora.
• Type 3 – Infibulation – This involves the narrowing of the vaginal opening. This is done by cutting and repositioning the labia to create a seal. The seal can also be created by stitching the vaginal opening. Type 3 FGM is sometimes completed together with Type 1 FGM.
• Type 4 – Any other harmful procedure done to the female genitalia for non-medical purposes, including cutting, piercing, scraping or burning.

The prevalence of each FGM type varies in different communities and cultures. The WHO estimates that 10% of cases are Type 3 FGM, which is the most severe form. Type 3 is mainly practised in North-East Africa. Types 1 and 2 are the most common globally, accounting for approximately 85% of FGM procedures worldwide.

Female Gential Mutilation can have serious, life-changing consequences, as well as the immediate complications that may occur from an FGM procedure.

There are some serious long-term consequences:

• Long-term urinary problems – This can include incontinence, painful urination, repeated urinary tract infections and difficulty urinating.
• Issues with menstruation – This can include severe pain when menstruating and difficulty passing menstrual blood.
• Vaginal problems – This can include repeated infections and pain or itching.
• Issues with sex – This may include pain during intercourse, decreased pleasure or satisfaction or the inability to have sex.
• Issues with childbirth – Women who have undergone an FGM procedure can experience serious issues during childbirth. Complications during childbirth can include haemorrhaging, inability to have a natural birth, stillbirth and early neonatal death.
• Emotional distress and mental health difficulties – Women who have undergone FGM may develop long-term mental health difficulties such as depression, anxiety or Post Traumatic Stress Disorder (PTSD).

How to support someone suffering from the effects of FGM

If someone you know has undergone FGM, it may be that they do not want to open up about what has happened to them.

This could be because they are scared or embarrassed, or that they are still dealing with the physical, mental and emotional consequences of Female Gential Mutilation. The best thing you can do to support them is to create a trusting environment where they know they can talk about what has happened to them.

It may also help them to speak to a professional, such as a doctor or a counsellor. These professionals can help the victim deal with the physical and psychological consequences of FGM.

If the victim does not want to open up, but you are concerned about their wellbeing, you may have to seek advice from a relevant professional. If a girl under the age of 18 has undergone FGM and an adult or professional is aware of the procedure or suspects that it may have happened, they must report it to the police.

There are a number of support services available to victims. All of these services specialise in supporting victims and preventing FGM from happening to others. For a full list of available services.