Female genital mutilation (FGM) and the adolescent: 10 year case series from the first UK dedicated clinic for young people

Introduction The World Health Organisation (WHO) estimates 3 million girls each year are at risk of female genital mutilation (FGM). In England and Wales 70,000 girls are thought to be at risk, and in 2015 mandatory reporting... [ view full abstract ]

Introduction

The World Health Organisation (WHO) estimates 3 million girls each year are at risk of female genital mutilation (FGM). In England and Wales 70,000 girls are thought to be at risk, and in 2015 mandatory reporting for FGM became law. In response, a multidisciplinary clinic dedicated to the paediatric and adolescent age group was establised. The unique clinic includes a paediatrician, gynaecologist, psychotherapist, specialist nurse and play specialist.

Objectives

To report on the pattern and characteristics of adolescents referred, and the role of the clinic in supporting them.  

Methods 

The study cohort included adolescents aged 10 to 19 years with suspected or known FGM referred between 2006 and 2016. Data was collected on age, ethnic background, source of referral to the clinic, circumstances of FGM, medical symptoms resulting from FGM, clinical findings and the WHO classification of the type of FGM.

Results

There were increasing referrals during the 10-year period with 54 (42%) of the 130 being in the adolescent age range. Of the adolescent group, 33 (61%) patients both gave a history and had FGM confirmed on examination. 10 (19%) had no evidence of FGM with normal examination and 11 (20%) refused examination.  The most frequent type of FGM was type 2 (WHO classification) in 15 (46%). There appeared to be a generational change regarding the type of FGM observed in the adolescents compared to the child cohort. Confirmed cases had the procedure performed in a range of countries – the majority in Somalia, the remainder in other African nations, and one case in the UK. 

Conclusion

Increasing migration necessitates a raised awareness of FGM by health care providers, who should ensure they can recognise a young person at risk, be aware of the local resources for evaluation and support whilst understanding the safeguarding issues and cultural challenges.