Paeds · child-safety-and-social-paediatrics
Female genital mutilation or cutting
Also known as FGM · Female genital cutting · Female circumcision · Infibulation · WHO Type I–IV FGM/C
A fellowship approach to recognising and managing female genital mutilation or cutting in children and adolescents: understanding the WHO Type I–IV classification and why every type performed on a minor is child abuse, identifying the at-risk girl through history and community risk, conducting a trauma-informed and culturally safe examination, managing the acute and lifelong complications from urinary retention to obstetric fistula, arranging deinfibulation and reconstructive care, and fulfilling the mandatory-reporting and safeguarding duties that fall on every paediatrician.
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Target exams
Red flags
- Any girl from a practising community with a planned trip overseas or a 'special ceremony' — screen proactively for imminent risk of cutting
- A parent requesting FGM, or a family member asking the clinician to perform it — this is a request to commit child abuse and triggers an immediate safeguarding response
- Acute urinary retention, severe genital pain, or bleeding in a girl from a high-prevalence community — consider recent cutting even if not disclosed
- A girl who has already been cut who is pregnant — plan antenatal deinfibulation and prepare for prolonged labour and postpartum haemorrhage
- A disclosure of cutting in a non-verbal or disabled child — the threshold to investigate is lower, not higher
- A sibling of a girl known to have been cut — screen every daughter in the family, because cutting is familial and recurrent
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Child safety and maltreatment
- Cultural competence and migrant health
- Current 2026 PREP curriculum — Learning Objective 2.3.1: Recognise and manage child abuse and neglect
- Current 2026 PREP curriculum — Learning Objective 2.3.2: Work effectively with child protection and interagency services
- Renewed curriculum for first-year trainees from 2027 — Learning goal 4: Safeguarding and child protection
- Clinical Applications — child protection and safeguarding
- Clinical Applications — cultural competence and health equity
- Long Cases
- Short Cases
- Communication stations
- 2. Professional skills and knowledge: Safeguarding
- 9. Child protection and safeguarding
- 10. Equity and inclusion
- 11. Adolescent health
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Safeguarding and child protection
- Global child health
- History
- Communication
- Clinical
- Development
- General Pediatrics Content Outline — Domain 8: Child Abuse and Neglect
- General Pediatrics EPA 8: Evaluate suspected child maltreatment
- Adolescent Medicine and Gynecology
- Patient Care 1: History and Physical Examination
- Patient Care 5: Patient Management
- Systems-Based Practice 2: Advocate for patients and populations
- Professionalism 1: Professional Behavior and Ethical Principles
- Advocate
- Professional
- Collaborator
- Pediatrics: Foundations EPA — Assessing suspected child maltreatment
Overview & Definition
A four-year-old girl is brought to your clinic with dysuria and recurrent urinary tract infections. Her family recently migrated from a country in the Horn of Africa. On examination you find that her external genitalia show scarring and a narrowed vaginal opening consistent with Type III infibulation. The mother is present, watchful, and speaks limited English. Your first responsibility in this moment is not to judge the mother, who may herself be a survivor of cutting. Your responsibility is to recognise what you are seeing, safeguard the child, investigate for complications, and begin the safeguarding and reporting duties that follow. [8] [1]
Female genital mutilation or cutting comprises 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. The World Health Organization, UNICEF, and UNFPA jointly define it as a violation of the human rights of girls and women, reflecting deep-rooted inequality between the sexes and constituting an extreme form of discrimination. When performed on a child — as the majority of cases are — it is child abuse under every paediatric safeguarding framework in the world. [8]
The term "mutilation" versus "cutting" deserves a moment. The WHO and UN agencies adopted "FGM" to signal the gravity of the practice, while many community-engagement programmes use "female genital cutting" or "FGC" to reduce stigma and keep dialogue open with practising communities. Both terms describe the same act. What matters clinically is that the practice has no health benefit, causes immediate and lifelong harm, and is never justified by culture, religion, or consent of the family. [8]
References10ShowHide
- [1]Lurie JM, Weidman A, Huynh S, et al. Painful gynecologic and obstetric complications of female genital mutilation/cutting: A systematic review and meta-analysis. PLoS Medicine, 2020.PMID 32231359
- [2]Bonavina G, Kaltoud R, Ruffolo AF, et al. Female Genital Mutilation and Cutting and Obstetric Outcomes. Obstetrics & Gynecology, 2022.PMID 35849461
- [3]Abdalla SM, Galea S Is female genital mutilation/cutting associated with adverse mental health consequences? A systematic review of the evidence. BMJ Global Health, 2019.PMID 31406589
- [4]Bello S, Ogugbue M, Chibuzor M, et al. Counselling for deinfibulation among women with type III female genital mutilation: A systematic review. International Journal of Gynaecology and Obstetrics, 2017.PMID 28164284
- [5]Nzinga AM, De Andrade Castanheira S, Hermann J, et al. Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis. Journal of Sexual Medicine, 2021.PMID 33618990
- [6]Ayenew AA, Mol BW, Bradford B, et al. Prevalence of female genital mutilation and associated factors among women and girls in Africa: a systematic review and meta-analysis. Systematic Reviews, 2024.PMID 38217004
- [7]Restaino S, Pellecchia G, Driul L, et al. Reconstructive surgery after Female Genital Mutilation: a multidisciplinary approach. Acta Bio-Medica, 2022.PMID 35765892
- [8]Xu Z, Chen X, Yu J, et al. Female Genital Mutilation/Cutting: A Systematic Review of Global Patterns, Sociocultural Drivers, and Health Consequences. Journal of Pediatric and Adolescent Gynecology, 2026.PMID 41038307
- [9]Ehiri JE Health systems approaches and other multisectoral efforts for primary prevention of female genital mutilation and clinical management of its complications. International Journal of Gynaecology and Obstetrics, 2026.PMID 41582678
- [10]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.PMID 23747293