Atlas›Domain XVI · Historical, discredited & harmful›Guide 099
Guide XVI-099

Female genital cutting

A 26 · L 66 · M 822 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: female genital cutting as described in the WHO fact sheet on female genital mutilation (31 January 2025) and the WHO 2016 guidelines on the management of health complications for the health picture; the Home Office Multi-agency statutory guidance on female genital mutilation (England and Wales, updated 30 July 2020) for safeguarding and reporting; the US Department of Justice account of 18 U.S.C. 116 as amended by the STOP FGM Act 2020 for US law.

Female genital mutilation (FGM), also called female genital cutting (FGC), "cutting", "circumcision" or "initiation", is a harmful practice, not a therapy. WHO calls it a violation of the human rights of girls and women and of children's rights, and "an extreme form of discrimination" [source: WHO fact sheet 2025]. The UK statutory guidance says "female circumcision" is a misleading term and notes that some women prefer "survivor" to "victim" [source: Home Office statutory guidance]. Terminology is itself a clinical choice: "FGM" is the legal and policy term; many clinicians use "cutting" or the client's own word in the room [synthesis].

WHO classifies the practice into four types, named here only as Type 1, Type 2, Type 3 and Type 4 [source: WHO fact sheet 2025; Home Office statutory guidance]. This guide gives no description of what any type involves.

This guide is the psychotherapist's own work: understanding the practice and its social logic, recognising girls at risk and women living with its consequences, meeting legal safeguarding and reporting duties, referring to specialist health care, and offering trauma-informed, culturally humble psychological care. The change the psychotherapist works towards is twofold: protection (no girl in the client's orbit is cut) and recovery (a woman who was cut can live with less distress, more agency and access to the care she is entitled to) [synthesis]. Cross-reference: the Domain XV rites-of-passage guides refer readers to this guide.

2. Framework

The practice in outline. WHO estimates that more than 230 million girls and women alive today have undergone FGM, in 30 countries in Africa, the Middle East and Asia, and that more than 4 million girls are at risk each year. It is mostly carried out on young girls between infancy and age 15, and occasionally on adult women [source: WHO fact sheet 2025]. WHO reports greater involvement of health workers in several settings ("medicalization"), partly because families believe it is safer, and strongly urges health workers not to perform it [source: WHO fact sheet 2025]. The reasons communities give include social convention and pressure to conform, preparation for marriage and control of sexuality, and perceived religious support, although WHO notes that no religious text prescribes it [source: WHO fact sheet 2025]. In England and Wales a 2015 study cited by the Home Office estimated about 103,000 women aged 15 to 49 and 24,000 aged 50 and over living with its consequences, about 60,000 girls aged 0 to 14 born to mothers who had undergone it, and about 10,000 migrant girls under 15 likely to have undergone it; the guidance says no local authority area is likely to be entirely free of FGM [source: Home Office statutory guidance]. The traditional practitioners who carry it out in many communities are described in other WHO material [uncertain: not verified].

Phases of the psychotherapist's work [synthesis, built on the cited guidance]:

  • Phase A: Recognition and enquiry. Goal: notice risk indicators or a history of cutting, and ask safely. Format: within ordinary assessment, with an accredited female interpreter where needed. Move on when: you know whether a child is at risk or known to have been cut, or an adult has disclosed.
  • Phase B: Safety, safeguarding and legal duties. Goal: protect any girl under 18 (risk referral; mandatory report of known cases where the duty applies; FGM Protection Order consideration). Format: consultation with the named or designated safeguarding lead; written records. Move on when: the referral or report is made and acknowledged, or a documented decision is made that no referral is needed and monitoring is in place [source: Home Office statutory guidance].
  • Phase C: Assessment and referral for health needs. Goal: assess anxiety, depression, post-traumatic stress, sexual and relationship difficulties, and refer for physical, obstetric and sexual-health care (e.g. NHS FGM support clinics). Move on when: referrals are made and the client consents to a psychological focus [source: WHO 2016 guidelines news release; NHS England 2019].
  • Phase D: Psychological treatment and repair. Goal: treat depression and anxiety with cognitive behavioural therapy and psychological support, as WHO recommends, and address trauma, identity, body image, loyalty to family and community, and grief [source: WHO 2016 guidelines news release]. Session number and length follow the client's needs and the setting; plan collaboratively [synthesis].
  • Phase E: Protection of the next generation, advocacy and follow-up. Goal: support the client to protect daughters and relatives, to engage with community organisations and, if she chooses, with advocacy. Close when goals are met and safeguarding plans are stable; re-open when risk events recur (planned travel, birth of a daughter) [synthesis; source for monitoring across childhood: Home Office statutory guidance].

3. Guiding principles

  • The child's safety and welfare is paramount. FGM "cannot be left to personal choice"; protection of a girl overrides family preference [source: Home Office statutory guidance].
  • Cultural humility does not weaken protection. The guidance states that fears of being branded "racist" or "discriminatory" should not weaken the protection professionals provide: respect the culture, never the harm [source: Home Office statutory guidance].
  • No assumptions about communities. Do not assume every woman or girl from a practising community supports the practice or is at risk; assess each person [source: Home Office statutory guidance].
  • Ask, one question at a time. Leave time, stay non-judgmental: disclosure may be the first time a woman has spoken of it [source: Home Office statutory guidance].
  • Independent female interpreters. Use an accredited interpreter, often female, never a family member or someone known to the client [source: Home Office statutory guidance].
  • Adults decide for themselves; children are protected. An adult woman is not automatically referred to police or social services; cases are assessed individually, with attention to any risk to others such as daughters [source: Home Office statutory guidance].
  • Do not assume another professional will act. Share safeguarding information with the right agency yourself [source: Home Office statutory guidance].
  • Trauma-informed, never re-traumatising. The therapist never examines a client's body, never asks for anatomical detail, and asks only what is needed to protect and to treat [synthesis].
  • Health workers never perform or endorse it. WHO opposes medicalization; any request to a clinician to carry out, "reduce" or "medically supervise" the practice is refused and treated as a safeguarding matter [source: WHO fact sheet 2025; WHO 2016 guidelines news release].
  • Language follows the client. Use her word for it in the room and the legal term in reports [synthesis].
  • Survivors' anonymity is protected by law. In the UK victims have lifelong anonymity; never identify survivors in teaching, writing or supervision outside need-to-know [source: Home Office statutory guidance].
  • Hold ambivalence without collusion. Clients may love the relatives who arranged it; validate the attachment while being clear about the harm [synthesis].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis]. None of them involves carrying out, describing or assisting the practice.

4.1 Historical, cultural and legal literacy

  • Purpose / when: Before working with any client from a community where cutting is practised, and when a client raises it. Knowing prevalence, ages, reasons given and law lets you ask competently and avoid both alarm and naivety.
  • Steps: (1) Know the WHO figures, the age range (infancy to 15) and the four type names without needing anatomical detail [source: WHO fact sheet 2025]. (2) Know the reasons communities give: social convention, marriageability, control of sexuality, perceived religious duty [source: WHO fact sheet 2025]. (3) Know the law where you practise (see 4.7, 4.8, 4.17). (4) Know local referral routes: safeguarding lead, children's social care, police, specialist clinics [synthesis].
  • Example language (illustrative): "Some families from the region your parents come from have a tradition of cutting girls. I ask everyone about it in the same way, so I can make sure you and any children get the right care."
  • Watch for: Overgeneralising to a whole community (the guidance warns against it); signs that the client is testing whether you will judge her family. Working when the client experiences the question as routine and respectful rather than targeted.

4.2 Recognising that a girl may be at risk

  • Purpose / when: In family, child and perinatal work, whenever risk indicators appear.
  • Steps: (1) Hold in mind the indicators the statutory guidance lists: the strongest is a family history of FGM; others include a mother who has undergone it, a family planning a long trip abroad (especially to a country where it is practised), a girl mentioning a "special procedure" or celebration, and a girl being withdrawn from PSHE lessons. The list is not exhaustive [source: Home Office statutory guidance]. (2) Note what you heard, verbatim, with date. (3) Consult your safeguarding lead the same day. (4) If travel is imminent, treat it as urgent (see 4.8).
  • Example language (illustrative): "You mentioned your daughter is going to visit her grandmother for the whole summer and that there will be a celebration for her. Can you tell me more about the celebration?"
  • Watch for: The guidance notes that a mother's history alone may not require a social-care referral but does call for monitoring across childhood, because cutting can occur at any age. Working when your concern becomes a documented, shared risk assessment rather than a private worry.

4.3 Recognising signs that cutting may already have happened (child)

  • Purpose / when: In work with children and adolescents, or when a parent describes a change in a girl.
  • Steps: (1) Know the non-exhaustive signs the guidance lists: difficulty walking, sitting or standing; frequent urinary, menstrual or stomach problems; prolonged absence from school; emotional change or withdrawal [source: Home Office statutory guidance]. (2) Do not question the child about her body or examine her; the psychotherapist's role is to listen and pass concern on [synthesis]. (3) If she discloses, you have a "known case" (4.7); if not, follow local safeguarding procedures.
  • Example language (illustrative): "You've seemed sad and in pain since you came back from your trip. Has anything happened that has hurt you or frightened you?"
  • Watch for: Leading questions; the girl being silenced by an accompanying adult. Working when the girl has a safe adult and a referral is in train.

4.4 Sensitive enquiry and disclosure with an adult woman

  • Purpose / when: Assessment of adult women from practising communities; perinatal, sexual-health-related, trauma or relationship presentations.
  • Steps: (1) Ask privately, without partner or relatives present. (2) Use the guidance's approach: one question at a time, time to answer, non-judgmental tone [source: Home Office statutory guidance]. (3) Use her word. (4) Do not ask what was done; ask about her experience, health effects and needs [synthesis]. (5) Recognise that this may be the first time she has spoken of it [source: Home Office statutory guidance]. (6) Explain confidentiality and its limits, especially concerning daughters (4.10).
  • Example language (illustrative): "Some women I see were cut as girls. Is that part of your story? You can tell me as much or as little as you want."
  • Watch for: Shame, dissociation, sudden silence, fear that you will call the police on her family. Working when she can name what happened in her own terms and choose next steps.

4.5 Working with interpreters

  • Purpose / when: Whenever the client's first language is not yours.
  • Steps: (1) Book an accredited interpreter; a female interpreter may be required; never a family member or anyone known to the client [source: Home Office statutory guidance]. (2) Brief the interpreter beforehand on the topic and on confidentiality; check they are not from the client's close community network [synthesis]. (3) Speak to the client, not the interpreter. (4) Debrief the interpreter afterwards; the topic can be distressing for them too [synthesis].
  • Example language (illustrative): "Before we start: the interpreter has no link to your family, and she keeps everything confidential, just as I do."
  • Watch for: The interpreter adding advice, softening words or showing disapproval; the client checking the interpreter's reaction. Working when the client speaks freely and corrects mistranslations.

4.6 Trauma-informed psychological assessment

  • Purpose / when: After disclosure, to identify the mental-health consequences WHO lists: depression, anxiety, post-traumatic stress disorder and low self-esteem [source: WHO fact sheet 2025]; the UK guidance adds flashbacks [source: Home Office statutory guidance].
  • Steps: (1) Screen for depression, anxiety and post-traumatic symptoms with validated measures available in her language (describe, do not reproduce, licensed items) [synthesis]. (2) Assess triggers likely in her life: medical examinations, childbirth, sexual contact, the cutting season or a daughter's approaching age [synthesis]. (3) Assess suicide risk (4.15). (4) Use the DSM-5-TR Cultural Formulation Interview to understand meanings of the practice, family and religion for her [synthesis]. (5) Agree a formulation in her words.
  • Example language (illustrative): "Many women carry memories of that day in their bodies: in pain, in fear before a doctor's visit, in nightmares. Which of these, if any, fits for you?"
  • Watch for: Over-attributing all distress to cutting, or ignoring it; somatic presentations. Working when she recognises her symptoms as understandable responses and agrees treatment goals.

4.7 Mandatory reporting of known cases (England and Wales)

  • Purpose / when: When a girl under 18 tells you she has undergone FGM, or (for professionals who would observe it, such as health workers) physical signs are observed, in England and Wales.
  • Steps: (1) Know the duty: section 5B of the FGM Act 2003, inserted by the Serious Crime Act 2015, requires regulated health and social care professionals and teachers to report known cases of FGM in under-18s to the police [source: Home Office statutory guidance; GPhC 2024]. (2) It covers known cases (disclosed or observed), not suspected or at-risk cases, and not women aged 18 or over; those follow local safeguarding procedures [source: GPhC 2024]. (3) Report as soon as possible: best practice by the close of the next working day, and at most within one month [source: Home Office statutory guidance]. (4) The report is personal: it cannot be delegated [source: GPhC 2024]. (5) Report to the police; call emergency services if the girl is in immediate danger [synthesis]. (6) Also make a safeguarding referral and inform your safeguarding lead. (7) Record what was said, when, and the report reference. (8) Failures are dealt with through professional regulators [source: Home Office statutory guidance]. (9) Whether a particular psychotherapist is within the duty depends on whether their profession is a statutorily regulated one (e.g. practitioner psychologists) [uncertain: check the Home Office procedural information]; anyone not covered still follows local safeguarding procedures [synthesis].
  • Example language (illustrative): "Thank you for telling me. Because you are under 18, the law asks me to tell the police, and I'm going to make sure people help keep you and your sisters safe. I'll tell you what happens next."
  • Watch for: Pressure from the girl or family not to report; the duty is legal and not overridden by confidentiality, which the Home Office states it does not breach [source: GPhC 2024 citing Home Office guidance]. Working when the report is made, logged and followed by a safeguarding plan.

4.8 Safeguarding referral for a girl at risk

  • Purpose / when: When risk indicators (4.2) are present for a girl under 18.
  • Steps: (1) Discuss with your named or designated safeguarding lead [source: Home Office statutory guidance]. (2) Carry out or contribute to a risk assessment based on the girl's individual needs, not a fixed routine; in England, the Department of Health's 2017 risk-assessment guidance applies [source: Home Office statutory guidance]. (3) Refer to children's social care; where risk is imminent or serious, make an urgent referral or contact the police [source: Home Office statutory guidance]. (4) Make sure the family understands that FGM is illegal, its health consequences, what you are doing and that information will be shared [source: Home Office statutory guidance]. (5) Do not assume another professional has already referred [source: Home Office statutory guidance].
  • Example language (illustrative): "I need to be honest with you: cutting a girl is against the law here and causes lasting harm. Because of what you've told me about the trip, I am going to share this with the children's services team so we can plan together how to keep her safe."
  • Watch for: Sudden cancellation of sessions, travel brought forward, the family leaving services. Working when a multi-agency plan exists and the girl's travel and welfare are monitored.

4.9 FGM Protection Orders: informing and supporting

  • Purpose / when: When a girl or woman is at risk, or has been cut and needs protection (UK).
  • Steps: (1) Know what they are: civil court orders introduced by section 73 of the Serious Crime Act 2015, which inserted section 5A and Schedule 2 into the FGM Act 2003 (England and Wales; Northern Ireland), in force from 17 July 2015 [source: legislation.gov.uk s.73]. (2) Who can apply: the person at risk (adult or child), a local authority, or anyone else with the court's permission, such as police, a teacher, a charity or a relative [source: FGMPO fact sheet]. (3) What they can contain: tailored conditions, such as surrender of passports to prevent travel abroad and requirements that no one arranges FGM for the protected person [source: FGMPO fact sheet]. (4) Breach is a criminal offence with a maximum of five years' imprisonment, or can be dealt with as contempt of court [source: FGMPO fact sheet; Home Office statutory guidance]. (5) Where risk is immediate, the local authority should consider an FGMPO and/or an Emergency Protection Order [source: Home Office statutory guidance]. (6) Your role: tell the client the route exists, support her to seek legal advice (legal aid guidance is published), provide factual written records if asked [synthesis]. Scotland has its own FGM Protection Orders under a 2020 Act of the Scottish Parliament [uncertain: not verified in detail].
  • Example language (illustrative): "There is a court order that can stop anyone taking your niece abroad to be cut. You can apply yourself, or the council can. Would you like help finding a solicitor?"
  • Watch for: The client's fear of family rupture or retaliation; the need for a safety plan alongside the order. Working when the client knows her options and has legal contact.

4.10 Confidentiality and an adult survivor

  • Purpose / when: When an adult woman discloses that she was cut as a child.
  • Steps: (1) Explain that the mandatory duty does not cover women aged 18 or over [source: GPhC 2024]; adults are not automatically referred to police or adult social care; cases are assessed individually [source: Home Office statutory guidance]. (2) Respect her confidentiality if she does not want action taken [source: GPhC 2024]. (3) Assess risk to others, especially daughters, younger sisters and nieces [source: Home Office statutory guidance]. (4) If she wishes to report a crime, support her; tell her that UK law gives victims lifelong anonymity and that immigration status should not delay police inquiries into offences against her or her children [source: Home Office statutory guidance].
  • Example language (illustrative): "What you've told me stays between us unless I believe a girl is at risk now. Do you have daughters, or younger girls in the family, who might be?"
  • Watch for: Her fear of statutory agencies, which the guidance says professionals must be "extremely sensitive" to [source: Home Office statutory guidance]. Working when she trusts you enough to continue and any risk to children is assessed.

4.11 Psychoeducation about health, law and rights

  • Purpose / when: Once she is ready, to link symptoms she may never have connected with cutting.
  • Steps: (1) Share, as WHO states them, the immediate and long-term consequences: urinary, menstrual, sexual, obstetric and psychological [source: WHO fact sheet 2025]. (2) Explain that many of these are treatable and specialist services exist (4.12). (3) Explain the law and her rights where she lives. (4) Offer written material in her language from official or survivor organisations [synthesis].
  • Example language (illustrative): "The pain you've had with your periods and your fear of doctors can be connected to what happened. That's not your fault, and there are clinics that help with exactly this."
  • Watch for: Overwhelm, grief, anger at relatives, or defensiveness on behalf of her family. Working when she uses the information to make her own choices about care.

4.12 Referral for physical, obstetric and sexual-health care

  • Purpose / when: Whenever physical, menstrual, urinary, sexual or pregnancy-related problems are reported.
  • Steps: (1) In England, offer NHS FGM support clinics: community "one stop shop" services for women over 18 offering specialist doctors, midwives and nurses, trained counsellors, FGM health advocates, tailored care plans, specialist procedures for complications and community education, launched in 2019 in eight centres [source: NHS England 2019]. (2) In pregnancy, refer to maternity services with specialist FGM midwifery [synthesis]. (3) Elsewhere, refer to gynaecology or sexual-health services; WHO 2016 guidelines cover obstetric, urological and sexual-health management [source: WHO 2016 guidelines news release]. (4) Coordinate with consent; you do not examine or describe her body [synthesis].
  • Example language (illustrative): "There's a clinic run by women who understand cutting, with a counsellor and a health advocate. Would you like me to help you get an appointment?"
  • Watch for: Fear of examinations; shame about being seen; practical barriers (childcare, transport, interpreter). Working when she attends and reports feeling respected.

4.13 Psychological treatment: CBT and psychological support

  • Purpose / when: For depression, anxiety disorders and post-traumatic stress related to cutting.
  • Steps: (1) Offer cognitive behavioural therapy and psychological support, which WHO 2016 guidelines recommend for women with FGM experiencing depression or anxiety disorders [source: WHO 2016 guidelines news release]. (2) For post-traumatic stress, use an established trauma-focused therapy for which you are trained, following national guidelines [synthesis]. (3) Adapt to culture: work with her explanatory model, use metaphors from her context, include faith if she wishes [synthesis]. (4) Pace exposure to memories carefully, with grounding, consent at each step and the right to stop [synthesis]. (5) Build anticipatory coping plans for medical procedures and childbirth [synthesis].
  • Example language (illustrative): "We can work on the fear that rises before a medical appointment: what you notice, what you tell yourself, and what helps you stay steady."
  • Watch for: Dissociation, intrusive memories after sessions, avoidance of the topic. Working when symptom measures fall and she reports more freedom in daily life.

4.14 Sexual and relationship health

  • Purpose / when: When she reports pain, fear or loss of pleasure in sexual life, or relationship strain.
  • Steps: (1) Ask permission before discussing sexuality at all [synthesis]. (2) Refer for sexual counselling, which WHO 2016 guidelines recommend to prevent or treat female sexual dysfunction [source: WHO 2016 guidelines news release]. (3) With consent, offer couple work focused on communication, consent and safety [synthesis]. (4) Screen for intimate-partner violence and coercion [synthesis].
  • Example language (illustrative): "Some women find that cutting affects closeness with a partner. If that's true for you, we can talk about it, or I can refer you to a specialist counsellor. It's your choice."
  • Watch for: Shame, a partner who minimises her pain, coercion. Working when she can set limits and seek help on her terms.

4.15 Suicide-risk assessment and crisis resources

  • Purpose / when: In any assessment showing depression, hopelessness, post-traumatic stress, or family rupture after disclosure or reporting.
  • Steps: (1) Ask directly about suicidal thoughts, plans and intent using standard risk-assessment practice; no discussion of method beyond safety planning [synthesis]. (2) Build a safety plan with reasons for living, supports and limits on access to means. (3) Give crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland); emergency services if in immediate danger.
  • Example language (illustrative): "Sometimes when people carry this much, they think about not wanting to be alive. Have you had thoughts like that?"
  • Watch for: Risk spikes after family conflict over a report or a protection order. Working when she has a written safety plan and uses her supports.

4.16 Identity, meaning, body image and loyalty

  • Purpose / when: When the work turns to what cutting means to her: belonging, womanhood, marriageability, faith, betrayal or love for those who arranged it.
  • Steps: (1) Explore the meanings she was given, using the Cultural Formulation Interview and its spirituality, religion and moral traditions module [synthesis]. (2) Note that WHO states no religious text prescribes the practice; offer this as information, not argument, and only if she raises religion [source: WHO fact sheet 2025]. (3) Help her hold both attachment and anger; grief for what was lost; pride in her survival [synthesis]. (4) Address body image and self-esteem, which WHO lists among psychological consequences [source: WHO fact sheet 2025]. (5) Where she frames this as a religious or spiritual problem, the DSM-5-TR "Religious or Spiritual Problem" can be recorded with code Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]; DSM-5-TR wording [uncertain: not verified].
  • Example language (illustrative): "You can love your grandmother and still be angry about what happened to you. Both can be true."
  • Watch for: Your own reactions (horror, rescue) leaking into the room; a client protecting you from her story. Working when she can tell her story with her own evaluation of it.

4.17 Working with mothers and families to protect daughters

  • Purpose / when: With a mother who was cut, or a family under pressure from relatives at home or abroad.
  • Steps: (1) Ask about intentions for daughters directly and non-judgmentally [synthesis]. (2) Share the law and health consequences; the UK makes failing to protect a girl under 16 an offence for those with parental responsibility or caring "in the manner of a parent" (maximum seven years), and offences extend to acts abroad by UK nationals and residents [source: Home Office statutory guidance]. (3) Rehearse how she will refuse pressure from relatives (her own words; the law as a shield) [synthesis]. (4) In England, the Home Office has published a "Statement opposing FGM" that families can carry when travelling [uncertain: not verified]. (5) Where risk remains, follow 4.8.
  • Example language (illustrative): "If your aunt raises it during the visit, what would you like to be able to say? Some mothers find it helps to say: the law here forbids it and I will not risk my daughter's health."
  • Watch for: Ambivalence, deference to elders, pressure from abroad. Working when she states a clear plan to protect her daughter and the safeguarding plan is in place.

4.18 US practice: federal law and child-protection reporting

  • Purpose / when: Practising in the United States.
  • Steps: (1) Know that 18 U.S.C. 116 (1996, expanded 2013) prohibits FGM on girls under 18 and taking a girl out of the US for it; the STOP FGM Act 2020, law from 5 January 2021, raised the maximum penalty to 10 years, broadened the punishable acts, tied jurisdiction to interstate or foreign commerce and added reporting duties for the Attorney General [source: DOJ HRSP newsletter 2021]. (2) The amendment followed United States v. Nagarwala, 350 F. Supp. 3d 613 (E.D. Mich. 2018), in which a federal district court held part of the earlier provision unconstitutional [source: DOJ HRSP newsletter 2021]. (3) State laws and state child-abuse reporting duties also apply [uncertain: varies by state]. (4) Reporting routes the DOJ lists: local child protection agency or 1-800-422-4453; FBI tips (1-800-CALL-FBI); HSI/ICE tips; reports can be anonymous [source: DOJ HRSP newsletter 2021].
  • Example language (illustrative): "In this country it is a federal crime to cut a girl or to take her abroad to be cut. If I learn a girl is at risk, I must contact child protection."
  • Watch for: Immigration fears deterring families from services. Working when reports follow state procedure and the family stays engaged.

4.19 When a health worker or institution is involved (medicalisation)

  • Purpose / when: When a client says a doctor, nurse or midwife offered, performed or "supervised" cutting, or a colleague suggests a "harm-reduction" version.
  • Steps: (1) State clearly that WHO opposes medicalization and urges health workers never to perform it, and that it contradicts "Do no harm" [source: WHO fact sheet 2025; WHO 2016 guidelines news release]. (2) Treat it as a safeguarding and criminal matter: inform your safeguarding lead, police and the relevant professional regulator [synthesis; UK legal basis: Home Office statutory guidance]. (3) Never discuss "safer" methods; never refer to such a provider. (4) Record and escalate in writing [synthesis]. (5) If the colleague is a psychologist, ethics complaints follow the APA Ethics Code (https://www.apa.org/ethics/code) and licensing-board routes [synthesis].
  • Example language (illustrative): "No health professional should ever do this, whatever the method. I'm required to pass on what you've told me."
  • Watch for: Families describing a medical setting as reassurance; WHO notes this belief drives medicalization [source: WHO fact sheet 2025]. Working when concerns are escalated and recorded.

4.20 Records, information sharing and avoiding re-traumatisation

  • Purpose / when: Every case.
  • Steps: (1) Record disclosures, risk factors and actions factually; in NHS England settings, FGM is recorded under the FGM Enhanced Dataset standard (including type, recorded by health professionals) and a risk indicator may be added to the FGM Information Sharing system [source: Home Office statutory guidance]. (2) Do not record or ask for anatomical detail yourself; that is for examining clinicians [synthesis]. (3) Share with the relevant local authority children's or adults' social care when someone is at risk [source: Home Office statutory guidance]. (4) Tell the client what is recorded and who sees it [synthesis].
  • Example language (illustrative): "I will write that you told me you were cut as a child and that you have no daughters. Nothing more detailed. Is that all right?"
  • Watch for: Repeated retelling across agencies; offer to coordinate. Working when she feels informed, not processed.

4.21 Community, men and partners

  • Purpose / when: When fathers, partners, brothers or community leaders are part of the client's world, or in community-facing roles.
  • Steps: (1) Recognise that WHO frames the practice as a social convention maintained by pressure to conform [source: WHO fact sheet 2025]; change often depends on men and elders as well as women [synthesis]. (2) With consent, include partners in psychoeducation and protection planning [synthesis]. (3) Connect clients with community-based organisations such as FORWARD, which describes itself as one of the longest-standing UK organisations tackling FGM, offering one-to-one support, signposting and training for professionals and community members [source: FORWARD UK programme page].
  • Example language (illustrative): "Would it help if your husband came to one session so we can talk together about keeping your daughters safe?"
  • Watch for: A partner who sides with relatives; coercive control. Working when the household speaks with one voice on protection.

4.22 Advocacy, survivor networks and the therapist's own stance

  • Purpose / when: Later in the work, and throughout as supervision.
  • Steps: (1) If the client wants to, support links with survivor and community organisations as they describe themselves (e.g. FORWARD; US-based groups such as Sahiyo [uncertain: not verified]) [synthesis]. (2) Support her right not to campaign; advocacy is her choice [synthesis]. (3) Take cases to supervision: notice disgust, rescue fantasies or cultural defensiveness in yourself [synthesis]. (4) If you share the client's community, consider whether a multiple relationship could impair objectivity or risk harm, as APA Ethics Code Standard 3.05 addresses [source: APA Ethics Code]. (5) Keep training current on local procedures [synthesis].
  • Example language (illustrative): "Some women find meaning in helping others; some want to put this behind them. Either is fine."
  • Watch for: Pushing a survivor into a public role; over-identification. Working when her choices, not yours, lead.

5. Handling problems

  • The client will not talk about it, or denies it despite indicators. Do not press for detail. Name that you ask everyone, leave the door open, and keep working on presenting problems. For a child, act on indicators through safeguarding procedures; a referral does not need her confirmation [synthesis; risk-based referral: Home Office statutory guidance].
  • Fear of police, social services or immigration consequences. Explain what will and will not happen; the guidance says professionals must be "extremely sensitive" to these fears and that immigration status should not hold up police inquiries into offences against her or her children [source: Home Office statutory guidance]. Offer to stay with her through contacts [synthesis].
  • The family insists cutting is their culture or religious duty. Avoid argument about culture. State the law and the health harm plainly, note that WHO says no religious text prescribes it, and keep the conversation on the child's welfare [source: WHO fact sheet 2025; synthesis]. Do not let fear of seeming discriminatory soften protection [source: Home Office statutory guidance].
  • Rupture after you report. Expect anger or withdrawal. Acknowledge it, restate why you acted and what remains confidential, and offer continued support; if she leaves, ensure safeguarding agencies know [synthesis]. Monitor suicide risk after family conflict (4.15).
  • Overwhelm or dissociation in session. Stop trauma work, ground her, return to stabilisation, give her control over pace; the right to stop applies throughout [synthesis].
  • Triggering medical events (examinations, pregnancy, childbirth). Plan ahead with her and, with consent, with the midwife or clinician; coordinate interpreter and chaperone preferences [synthesis].
  • Non-attendance. Check practical barriers (childcare, travel, interpreter, partner control). Persistent non-attendance where a girl is at risk is itself a safeguarding concern to discuss with your lead [synthesis].
  • The interpreter is from the client's community or reacts with judgment. Change interpreter; never continue with a family member [source: Home Office statutory guidance].
  • A colleague hesitates to act ("it's not our business", "she's not cut yet"). Remind them that no professional should assume another will share information and that the safety of the child is paramount; escalate to the safeguarding lead [source: Home Office statutory guidance].
  • A client asks you where to get a "safe" or "symbolic" procedure for a daughter. Refuse clearly, explain law and harm, treat as risk (4.8); WHO opposes all medicalization [source: WHO fact sheet 2025].
  • Your own reactions. Disgust, horror or a wish to rescue can silence clients; cultural over-identification can mute protection. Take both to supervision [synthesis].
  • Uncertainty about whether the mandatory duty applies to you. Check the Home Office procedural information and your regulator; in any doubt, follow local safeguarding procedures and consult your lead without delay [synthesis].

Harm account

What was actually done

Female genital cutting is a non-medical practice, classified by WHO as Types 1 to 4, carried out on girls, mostly between infancy and age 15 and occasionally on adult women, in 30 countries in Africa, the Middle East and Asia and in diaspora communities worldwide [source: WHO fact sheet 2025]. It is arranged by families and carried out by community practitioners and, in several settings increasingly, by health workers [source: WHO fact sheet 2025; community practitioners: uncertain: not verified]. It is justified as social convention, as preparation for marriage and control of sexuality, and as a religious duty, though no religious text prescribes it [source: WHO fact sheet 2025]. From the outside, it often appears as a girl being taken on a long trip abroad or to a family "celebration" or "special procedure", returning with pain, difficulty walking or sitting, absence from school and withdrawal [source: Home Office statutory guidance]. It is a crime in the UK and in the United States, including taking a girl abroad for it [source: Home Office statutory guidance; DOJ HRSP newsletter 2021].

How it caused harm

WHO lists immediate harms of severe pain, heavy bleeding, infection including tetanus, urinary problems, wound-healing problems, shock and death; long-term urinary, vaginal, menstrual and sexual problems; obstetric complications including difficult delivery, excessive bleeding, caesarean section and higher risk of newborn death; the need for later surgery for some women; and depression, anxiety, PTSD and low self-esteem [source: WHO fact sheet 2025]. The UK guidance adds increased risk of stillbirth and flashbacks [source: Home Office statutory guidance]. WHO estimates the cost of treating complications at US$1.4 billion a year [source: WHO fact sheet 2025]. WHO calls it a violation of human rights and of children's rights [source: WHO fact sheet 2025]; UK guidance holds that all types constitute significant harm for family-law purposes [source: Home Office statutory guidance].

Recognising it today

  • Girls at risk: a family history of FGM, a mother who has undergone it, a planned long trip to a practising country, mention of a "special procedure", withdrawal from PSHE [source: Home Office statutory guidance].
  • Girls who may have been cut: difficulty walking, sitting or standing; frequent urinary, menstrual or stomach problems; prolonged absence; emotional withdrawal [source: Home Office statutory guidance].
  • Adult survivors: chronic pain, menstrual and sexual difficulties, fear of examinations or childbirth, anxiety, depression, post-traumatic symptoms [source: WHO fact sheet 2025].
  • Medicalisation: any offer by a health worker to perform or "supervise" it [source: WHO fact sheet 2025].

What to do instead and how to help those harmed

  • Protection: safeguarding referral for girls at risk; in England and Wales, mandatory police report of known cases in under-18s by regulated professionals within the stated timescales; FGM Protection Orders; in the US, child-protection and federal reporting routes [source: Home Office statutory guidance; GPhC 2024; FGMPO fact sheet; DOJ HRSP newsletter 2021].
  • Health care: specialist services such as NHS FGM support clinics; obstetric, urological and sexual-health care per WHO 2016 guidelines [source: NHS England 2019; WHO 2016 guidelines news release].
  • Mental health: cognitive behavioural therapy and psychological support for depression and anxiety, and sexual counselling, as WHO recommends; trauma-informed, culturally humble care with independent interpreters [source: WHO 2016 guidelines news release; Home Office statutory guidance].
  • Community and survivor support: organisations such as FORWARD (one-to-one support, signposting, training) [source: FORWARD UK programme page].
  • Crisis: 988 (US); Samaritans 116 123 (UK and Ireland); emergency services for immediate danger.
  • Never: perform, assist, refer to, or advise on any form of the practice, including a "medical" or "symbolic" one [source: WHO fact sheet 2025].

Sources

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