Written evidence from Juliet Albert, Specialist FGM Midwife, Imperial College Healthcare NHS Trust [FGM0002]

I am specialist Midwife and Trust lead for women with Female Genital Mutilation (FGM) at Imperial College Healthcare NHS Trust and run the Sunflower Clinics – for pregnant and non-pregnant FGM survivors. Our services see approximately 600 pregnant women annually and 100 non-pregnant women.

I have been campaigning to improve FGM services since 1998. In 2008, I set up the 1st community-based clinic dedicated solely to non-pregnant women, the Acton community well woman clinic. We have performed over 1000 deinfibulations under local anaesthetic and fast track women into hospital for deinfibulation under general anaesthetic.  Women can self-refer and there are no geographical boundaries.

I was seconded as FGM project manager for the Department of Health’s FGM Prevention Programme from 2015 to 2017;

I worked for Barnardo’s National FGM Centre from 2017 -2019 and trained the NSPCC FGM helpline.

I currently co-chair the national FGM health network – an independent network of FGM experts that meet quarterly.

I founded and currently lead ACERS_UK – a female-led voluntary collective advocating for research and access to FGM reconstruction surgery in the UK

I am in my final year (write=up stage) of an NIHR funded Doctoral Clinical Academic Fellowship (PhD at Nottingham university) exploring UK FGM specialist service provision

PhD findings (unpublished) – Overview of UK FGM specialist service provision

• Identified 28 FGM specialist services across UK
• Survey of service leads
• Interviewed 8 service leads
• Interviewed 29 women who had attended an FGM specialist service appointment (women recruited from ten specialist FGM clinics located across the UK. 16 women recruited from five London clinics, 3 from Scotland, 4 from Bristol, 2 from Birmingham, 2 from Cardiff and 2 from Oxford). Women from different ethnic backgrounds, ages, language ability, level of education, pregnant and non-pregnant were interviewed to reflect the diversity of real-life specialist service attendees. Majority of participants were of Somali origin, (n=12) but other countries of birth included Gambia (n=2), Eritrea (n = 3), Egypt (n = 1), Sudan (n=3), Kenya (n=3), Saudi Arabia (n = 1), Nigeria (n = 1), Sierra Leone (n = 1), Iraq (n=1), Ethiopia (n=1). Ages ranged from 21 years to 64 years; 55% (16/29), were pregnant. Age when FGM took place ranged from infancy to 16 years old. Majority had Type 2 and Type 3 FGM. Eighteen interviews were conducted in English; four with an Arabic-speaking interpreter; five with a Somali-speaking interpreter; one Kurdish and one Amharic interview.

Worldwide an estimated 230 million women and girls have FGM (5% of global female population) (1). More than 140,000 FGM survivors living in the UK, predominantly from racially minoritised under-served communities (2). FGM survivors are frequently asylum seekers or first-generation immigrants mostly originating from Africa, the Middle East, and parts of Asia. Some were born in the UK and taken abroad to be cut, but most women were cut prior to arriving in the UK. Between 2015 and 2023, NHS Digital identified 85,575 FGM-related healthcare attendances in England.(3)

Health problems caused by FGM cost the NHS approximately £100 million annually, approximately 65% from psychological and psychosexual problems and 33% attributed to long term health consequences (4).

What are most frequent health complications we see in clinics?

Types 1 & 2 - Long-term consequences include urinary tract and genital infections, difficulty passing urine and menstrual blood, sexual health problems including decreased desire and pleasure, painful sexual intercourse, decreased lubrication, reduced frequency or absence of orgasm, excessive scar formation, childbirth complications, and psychological challenges, including post-traumatic stress disorder, anxiety and depression and body dysmorphia (5).

Type 3 - urinary tract and genital infections, difficulty passing urine and menstrual blood, painful sexual intercourse or unable to have sexual penetration.

Childbirth complications – obstruction of fetal head resulting in fetal death / asphyxiation / complex tearing – particularly women from East Africa - Sudan, Somalia, Eritrea, Ethiopia, Kenya

Deinfibulation  = opening surgery for women with Type 3 (who are closed)

Many women also present with cysts and abscesses at the site where the clitoral glans (external tip of the clitoris) has been removed.

Psychological impacts - anxiety, depression, PTSD, touch and needle phobia, flashbacks, sexual dysfunction. Body image concerns (not feeling whole, normal, complete)

More than 30% of women have suffered other intersectional violence such as rape, forced early marriage, domestic violence, juju/witchcraft, torture and fleeing from war.

“A lot of shame and stigma. A lot of divorce in societies that practice circumcision and marital infidelity as women suffer pain during intercourse and feel that they don’t look whole or normal.“

What support do health services provide and how well equipped are they to provide care (particularly for non-pregnant women)?

•          28 specialist clinics across the UK. Services are focused upon maternity care for pregnant women. 75% Midwife-led; 25% Doctor-led. All Female-led; some diaspora-led.

•          Geographical variability (e.g. No clinic in N. Ireland; 1 in Wales; 1 in Scotland; 13 in London;) Women sometimes having to travel long distances to access services

•          15 clinics for non-pregnant women (but 5 of these see < 2 non-pregnant women per year). Services often “cobbled together” = Not properly commissioned.

•          2 services are dedicated solely for adult non-pregnant women (Bristol Rose clinic & Leeds community clinic). Clinics see women across the life course from 18 to mid-60’s. Menopausal women. Service provision for teenagers is lacking. Paediatric care also variable as expertise limited.

In 2019 NHS England set up 5 new community-based clinics for non-pregnant women (based in high prevalence areas – Croydon community clinic, Birmingham Summerfield community, Leeds community clinic, Brent community clinic, Waaha clinic in Waltham Forest). modelled upon the Acton clinic. Tri-partite model (midwife/doctor service lead + health advocate + trauma counsellor) Accepting self-referrals,  no geographical boundaries, female-led, fast-track, walk-in, - ACCESSIBLE

2021 NHSE withdrew funding for IBC’s to take over commissioning of services.

Since then, Waaha clinic closed. Brent clinic forced to move into the hospital setting. Birmingham clinic under threat of closure for a year of uncertainty – just been informed that has funding now until 2027.

•          Provision of multidisciplinary care:-

•          Variable standards of care across UK - Some examples of centres of excellence with a specialist multidisciplinary team (Service lead + trauma counsellor + health advocates/interpreters) e.g. Sunflower clinic, Croydon clinic, Birmingham Summerfield community clinic, Oxford Rose clinic, Bristol Rose GP clinic, Leeds community clinic.

•          1/3 of midwife-led services is midwife working alone

•          5 services have co-located trauma counsellor & 13 have a direct referral pathway to trauma counselling

•          Only 3 services in UK have psychosexual therapist (Oxford, Manchester and Mile End)

•          10 services (35%) with NO counselling support

•          Every woman should be offered FGM diagnosis + safeguarding assessments + FGM health consequences information. Some provide:- vulval & clitoral anatomy & physiology education; sexual relationships discussion, human rights, law in UK, Failure to Protect explanation, medical reports for asylum applications

•          Treatment options – trauma counselling; psychosexual counselling; deinfibulation; cyst removal; reconstruction surgery (not available in UK)

•          Most offer fast track deinfibulation (opening surgery) for Type 3 FGM – but some glaring disparities. In Sheffield pregnant women cannot access deinfibulation during pregnancy and have to wait until labour. In Edinburgh, Bristol and Cardiff women who want deinfibulation under general anaesthetic are referred from specialist service into general gynaecological surgery and have long wait on a general gynae waiting list.

•          1/3 of services offer cervical screening

•          FGM survivors are not one homogenous group – women with all different Types of FGM and from all different ethnic backgrounds. Need person-centred care. Women are from minoritized populations, and many with English as a 2nd language.

• More than half of women attending specialist services have English as a second language and 1/8 have none or minimal English; Language line and google translate are not good enough. Digital technology – women regularly changing mobile phone because can’t afford a contract. Use of WhatsApp, texting, zoom is useful.

What training should there be for healthcare professionals?

• FGM training is still NOT Mandatory for all health care professionals

• We need an FGM champion in every maternity hospital (AND in primary care – GP surgeries, GUM clinics, sexual health clinics

• Trauma and psychosexual Counsellors need to be trained in FGM

We need 3 levels of training for health staff: -

(1)    Admin & clerical & porters need basic training . E learning for health - but must be mandatory!

(2)    All patient facing healthcare professionals need mandatory FGM training

(3)    Expert FGM training for gynaecologist/obstetricians, Gum clinic staff, sexual health, midwives, health visitors

How well does NHS adapt to local needs?

• Non-pregnant women need better services (across the life course)– improved since 10 years ago but still v patchy. (Laura Jones publication called it a “postcode lottery”.(6)
• No service in Northern Ireland. One woman who I interviewed had been to see her GP in Northern Ireland suffering with flashbacks and dyspareunia (pain during sexual intercourse) and was told that there was a waiting time of 3 years to see a gynaecologist. Flew to London to be seen in FGM clinic.

• Some local services not offering deinfibulation under local anaesthetic or fast track access to deinfibulation. Women waiting months to be seen

• Services usually dependent upon passionate clinicians or sympathetic commissioners. A partial evaluation was commissioned and carried out in 2022 but not published and findings not shared. (7) Positive experience of women receiving specialist care in the new community clinics. Only need 29 new service users annually to be cost-effective (8)

• No national body ensuring accountability & ensuring that ICBs fulfil their obligation to support FGM survivors.

• FGM specialist commissioning guidance meant to be updated- NOT DONE (9, 10)

• There was an NHSE-led national health group attended by FGM experts or interested parties including: -  service leads, counsellors, health advocates, safeguarding leads & other interested health professionals , physios, GPs , etc. This was disbanded in 2022 and now there is no accountability or national leadership to ensure that ICBs share best practice and fulfil their responsibilities.

• I now co-chair a national health network but it is voluntary & has no power.

• NHSE leads a national multidisciplinary meeting every 6 months led by Gwen Kennedy (Director of Nursing Leadership & Quality, Regional Lead for Safeguarding London, NHS England & NHS Improvement) but this is for police. social care, education and safeguarding leads to meet, NOT solely for healthcare professionals.

• FGM has been swallowed up into general harmful practices work & risks being forgotten.

Do we want women’s health hubs?

• Not all ICBs have the population that requires a stand-alone service for non-pregnant women – hence the need for women’s health hubs – safe female only spaces with an FGM champion and with interpreters and expert counsellors available.

• \\identifying FGM is a perfect opportunity to uncover other health problems including infertility, incontinence, domestic violence etc. We know that these are under-served communities who are less likely to attend for cervical smears.

• 60% of FGM clinics are based in maternity setting. Non-pregnant FGM survivors don’t want to attend FGM clinics based in maternity services – there is real stigma and shame and risk of being identified as being pregnant which is unacceptable if unmarried etc.

All interviewed women want safe female-led spaces with health advocates and expert trauma and psychosexual counsellors

Do women encounter barriers when seeking gynaecological care or sexual and reproductive healthcare (e.g. smear test avoidance)

• Women are fearful of attending healthcare services because of the fear of police and social services involvement (see Karlsen work (11-13) - we need FGM specialist training, otherwise professionals overemphasize safeguarding and once women have a bad experience they never return. Mandatory reporting is contentious - Would it be better for mandatory reporting to social services rather than to police? Cases were handled badly when mandatory reporting was first introduced

• Often women don’t have knowledge of screening interventions e.g. smear tests or breast screening or why it’s important to have them. They hear community gossip that these are painful, so they don’t attend.

• Women don’t want to visit GPs as long waiting list, male GP, and fear of social services.

• Safeguarding is an issue if it is not conducted sensitively. Women want to safeguard their children but are frightened of police involvement and often feel criminalised. This stops women from attending specialist services. We need to ensure hcps are properly trained so that they focus on the woman’s health & well-being & provide health consequences education rather than talking about the law and nothing else.

• 99.9% of FGM survivors would not dream of doing FGM to their daughters.

• Women often don’t know specialist services exists. We should advertise these services on mainstream television, radio, and social media.
   

Does the NHS surcharge affect recent immigrants access to services?

Women often don’t know specialist services exist

Yes, women are already scared they will have to pay for deinfibulation

What is the evidence surrounding reconstruction surgery – should the NHS offer this?

This is about informed choice and how we support women’s mental and physical health

• Women say they don’t feel whole? They suffer with genital pain, lack of sexual pleasure and body image concerns

• In my PhD findings, 76% of service leads said women increasingly request clitoral reconstruction surgery in specialist appointments (1-2 women every week in London clinics and in Birmingham, Bristol, Manchester).

• More than 90 women in one year across the UK requesting reconstruction surgery (2023).

• 5 service leads had met women who had travelled abroad to access surgery in other countries.

• All FGM specialist service leads unanimously agreed that reconstruction surgery should be available in UK

Reconstructive surgery is a pioneering treatment to restore original genital appearance by revealing any remaining clitoral tissue and rebuilding the clitoral glans and clitoral hood.

At present reconstruction surgery does not exist within the UK but is available in many countries in Europe (Spain, France, Germany, Italy, Belgium, Switzerland, Sweden, Netherlands), Africa (Kenya, Burkina Faso, Egypt), and parts of USA. Reconstruction has been available in Europe since 1998 and, in France alone, more than 6,000 women have had reconstruction surgery. Some UK women have even travelled abroad to have this.

In the NHS, genital reconstruction is currently offered for gender reassignment / feminising surgery and vulval cancer survivors. We have the technical expertise already. This is about equity – why cannot FGM survivors’ access this? This is a necessity. It is not cosmetic.

Several studies have evaluated safety and clinical effectiveness (14-20)and there is increasing evidence that FGM reconstruction can treat genital pain, improve sexual pleasure, and help with body image concerns which in the long term may improve marital/sexual relationships, quality of life and reduce psychological problems.

Furthermore, several UK academic publications have reported that women want information and services relating to reconstructive surgery (21-24).

In 2016 the World Health Organisation (WHO) stated: -

“Evidence indicates that reconstructive clitoral surgery can improve chronic clitoral pain as well as dyspareunia among women who have had clitoral tissue damaged due to FGM. However, there is little evidence regarding the safety and effectiveness of this surgical procedure in improving women’s sexual health”.

They concluded “strongly encourage further research”.

The Royal College of Obstetricians and Gynaecologist (RCOG), 2023 stated: “The RCOG is supportive of further research into the role of reconstructive surgery for women affected by FGM.” (25)

In response to the statement that there isn’t enough evidence to support reconstruction surgery:
(1) What is enough evidence? This surgery has been in existence since 1998. Lots of other countries provide reconstruction surgery and have produced evidence proving that it often has benefits and complications are rare ; we have the technical know how - as we are doing reconstruction surgery already for vulval cancer patients and male to female gender reassignment
(2) If a man’s penis was cut in half (and this is the equivalent to the top of a woman’s clitoris being cut out, as it is during FGM) - and surgery was available to reconstruct it - I don’t suppose the men would appreciate being told to wait for more evidence!

(3)The only way to contribute to this research is by providing a service and researching it!

(4)The RCOG Vice President does not speak for all consultant obstetricians and gynaecologists.

In 2021 I set up ACERS-UK (Advocating for Access to Reconstruction Surgery and Emotional Support for FGM survivors).

We are a female-led voluntary collective of FGM experts, including FGM survivors, charity workers, and healthcare professionals. Our aim is to set up a national centre of excellence offering FGM reconstruction surgery integrated with psychosexual assessment and therapy for FGM survivors and to conduct a co-designed clinical trial so that we contribute towards the evidence base through stakeholder consultation, evidence publication, and parliamentary advocacy. We are supported by several FGM charities/NGO’s including FORWARDUK, Manor Gardens, IKWRO, Sister Circle, Oxford against Cutting, Midaye, Barnardo’s National FGM Centre and the Vavengers.

We published a Scoping review of the evidence around reconstruction surgery in 2024 in British Journal of Obstetricians and Gynaecologists (BJOG). We found “7,274 women underwent some form of reconstruction. Post- surgery improvement was reported in 94% of the cases. The complication rate was 3%” and concluded “reconstructive surgery improves quality of life, satisfaction with vulval appearance and sexual function in survivors of FGM. However, the level of evidence is low and more research is urgently needed.”(26)

We have partnered with Oxford Surgical Trials Unit and have applied for an National institute of Health Research (NIHR) Research for Patient Benefit (RfPB) grant proposing a feasibility study examining:

“Is it feasible to recruit and randomise women with Female Genital Mutilation (FGM) to a clinical trial comparing Best Conservative Care (BCC) with BCC plus clitoral reconstruction surgery?”

Best Conservative Care = 10 sessions of trauma therapy followed by 10 sessions of psychosexual therapy. (Therapy sessions include assessment and education with specialaist FGM health advocates acting as interpreters to translate as required).

There is evidence that when some women receive trauma and psychosexual therapy, they then no long want reconstruction surgery. This is why we have designed a study where all women will receive Best Conservative Care and where surgery is the last resort (called our ladder of intervention).(27)

Our stage 1 application was submitted on March 5th, 2025. We find out in July 2025 whether we have progressed to the second stage. We will hear in November 2025 whether the clinical trial will be funded.

Although the NIHR is a public funded body there is no guarantee that this funding application will be successful.

Failure to offer reconstructive surgery to FGM survivors is unethical, is an example of a gender and health inequality, and discriminates against FGM survivors.

•         Although not all women with FGM will want or benefit from reconstruction surgery, women should be informed of the benefits and risks of surgery and should be able to make an informed choice to access this if they wish.

•         The UK should be contributing to this area of research, developing new surgical techniques, and keeping abreast with the rest of Europe.

•         There are risks associated with women accessing surgery abroad or seeking unregulated reconstruction surgery in the UK private sector.

Other members of ACERS_UK: -

Janet Barter - President of the Faculty of Sexual and Reproductive Health leads Mile End FGM clinic

Dalia Saidan – Consultant Uro-gynaecologist leads Croydon Calabash FGM community clinic

Aurora Almadori – Consultant plastic surgeon, Royal Free Hospital

Huda Mohamed - FGM specialist midwife, Whittington Hospital

Alison Byrne – Specialist FGM midwife Birmingham Summerfield community clinic

Brenda Kelly – Consultant Obstetrician/Gynaecologist – Oxford Rose FGM clinic

Tina Rashid – Consultant Feminizing/Gender reassignment surgeon, Urologist- Chelsea & Westminster

Professor Vik Khullar –Consultant Uro-gynaecologist, Imperial College Healthcare NHS Trust

A reconstruction service is not expensive, this is day-case surgery that takes approximately one hour, is not life threatening and we already have the expertise!

Plan:

If the clinical trial is successful, we will apply for funding for a bigger definitive trial. This will involve setting up two national centres of excellent offering reconstruction surgery – one in London, one in Birmingham/Manchester

Care pathway includes 10 trauma plus 10 psychosexual assessment, education and therapy sessions (with specilaist health advocate interpreters to translate as required).

There is currently no tariff for FGM reconstruction surgery

We used this generic tariff to cost a serivce - Higher Tariff:  MA04C (Intermediate Open Lower Genital Tract Procedures with CC Score 3+)

£2,585 * 1.176907 = £3,042.30 for recosntruction surgery for 1 person.

This includes the cost of theatre space, anaesethetist, surgeon, operating department assistant, day case surgery bed, theatre equpment etc.

We costed 10 traumasessions  plus 10 psychosexual sessions @  £3,372.30 per person

Therefore for 50 patients = £6,414.60 per person x 50

= Total cost £320,730 potentially over one year.

How well does NHS support FGM survivors during maternity care and childbirth – (i.e. funding resources and knowledge)?

• Extremely variable – some pregnant women still unable to access deinfibulation in pregnancy and being told to wait until labour

• Many maternity hospitals still don’t have an FGM specialists (only 25 specialists out of a total of 215 hospital Trusts)

• Women need access to interpreters and counsellors during pregnancy – because they may suffer from flashbacks during pregnancy; more likely to have severe perineal tears including anal sphincter injury, clitoral tears; higher blood loss, longer stay in hospital; often other intersectional violence; asylum seekers/refugees

• Women having to teach counsellors about FGM! – enhanced clinical training – you can’t send FGM survivors to perinatal mental health services without making sure the counsellors have had FGM training. (e.g. examples of counsellors crying)

• Person-centred, trauma informed, culturally sensitive, non-judgemental care is critical

Recommendations

• Fund research into reconstruction surgery now!

• FGM champion in every hospital and compulsory questioning about FGM in relevant healthcare appointments e.g. GP surgery registration, GUM clinics, sexual health clinics, gynaecology appointments

• Standardized services – we need consistency

• In areas of low prevalence, we need women’s health hubs – so women feel safe – with direct access to gynaecologist; interpreters; counsellors. (Counsellors need the continuity of the same interpreter every session)
• Advertise service - clinics need comms support

• Community organisations need funding to support women

• A national centralised body to ensure accountability for healthcare provision across regions

• FGM is a pivotal means of reaching extremely vulnerable women. We need HOLISTIC services – help with asylum applications, signposting to English classes and local charities; help with housing etc. This can be provided by specialist FGM health advocates working closely with community organisations
• Overemphasis on safeguarding in UK – Mandatory Reporting Duty to police needs to be evaluated – what is the impact on access of girls under 18 to specialist support services due to fear of their parents being reported; women want safeguarding - but they want it to be sensitive, non-judgemental, focused upon women’s well beings and health rather than treating them like potential criminals.

• Some pregnant women clinics still make blanket referall of all women with FGM to social care !!!

• FGM Information Sharing system - technology allows hospital Trust to add a flag for girls identified as at potential risk of FGM if there is a family history BUT no supporting information to help professionals understand how this information is shared, when or where, and what they should do. Several Trusts don’t use it.

• Midwives running clinics for non-pregnant women – needs to be recognised formally. Service specification needs to be consistent and updated and Information resources standardized

• Training for staff in deinfibulation under local anaesthetic

•          UK national prevlance statistics were collated in 2014 and have not been updated.

References

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2.              Macfarlane A, Dorkenoo E. Prevalence of female genital mutilation in England and Wales: National and local estimates: City University London in association with Equality Now; 2015.

3.              Digital NE. Female Genital Mutilation, Annual Report - April 2022 to March 2023 (experimental statistics report) 2024 [Available from: https://digital.nhs.uk/data-and-information/publications/statistical/female-genital-mutilation/april-2022-to-march-2023.

4.              Hex N, Hanlon J, Wright D. Estimating the costs of Female Genital Mutilation services to the NHS. University of York and King’s Fund; 2016. p. 30-.

5.              WHO. Care of women and girls living with female genital mutilation: a clinical handbook. 2018.

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12.              Karlsen S, Carver N, Mogilnicka M, Pantazis C. ‘Putting salt on the wound’: a qualitative study of the impact of FGM-safeguarding in healthcare settings on people with a British Somali heritage living in Bristol, UK. BMJ open. 2020;10(6):e035039.

13.              Ali S, Karlsen S, Learner H, Carver N, Pantazis C, Earp BD, et al. UK policy response to female genital mutilation needs urgent rethink. bmj. 2023;383:1-4.

14.              Foldès P, Cuzin B, Andro A. Reconstructive surgery after female genital mutilation: a prospective cohort study. The Lancet. 2012;380(9837):134-41.

15.              Foldés P, Louis-Sylvestre C. Results of surgical clitoral repair after ritual excision: 453 cases. Gynecologie, obstetrique & fertilite. 2006;34(12):1137-41.

16.              Abdulcadir J, Rodriguez MI, Say L. A systematic review of the evidence on clitoral reconstruction after female genital mutilation/cutting. International Journal of Gynecology & Obstetrics. 2015;129(2):93-7.

17.              Sharif Mohamed F, Wild V, Earp BD, Johnson-Agbakwu C, Abdulcadir J. Clitoral Reconstruction After Female Genital Mutilation/Cutting: A Review of Surgical Techniques and Ethical Debate. J Sex Med. 2020;17(3):531-42.

18.              Bah M, Abdulcadir J, Tataru C, Caillet M, Hatem-Gantzer G, Maraux B. Postoperative pain after clitoral reconstruction in women with female genital mutilation: An evaluation of practices. Journal of gynecology obstetrics and human reproduction. 2021;50(10):102230.

19.              Auricchio V, Garzon S, Pomini P, Laganà AS, Casarin J, Cromi A, et al. Clitoral reconstructive surgery after female genital mutilation: A systematic review. Sexual & Reproductive Healthcare. 2021;29:100619-.

20.              Berg R, Taraldsen S, Said M, Sørbye I, Vangen S. The effectiveness of surgical interventions for women with FGM/C: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2018;125(3):278-87.

21.              Albert J, Evans C, Wells M. Analysis of a specialist service for non-pregnant women with female genital mutilation: 2008–2019. British Journal of Midwifery. 2023;31(11):610-21.

22.              Edon A. NHS Female Genital Mutilation Care Provision, What About the Psychological, Psychosexual Support? ; 2016.

23.              Safari F. A qualitative study of women's lived experience after deinfibulation in the UK. Midwifery. 2013;29(2):154-8.

24.              Abdelshahid A, Smith K, Habane K. ‘Do No Harm’: Lived Experiences and Impacts of the UK’s FGM Safeguarding Policies and Procedures, Bristol study. 2021.

25.              RCOG. RCOG Green-top Guideline No. 53. 2015.

26.              Almadori A, Palmieri S, Coho C, Evans C, Elneil S, Albert J. Reconstructive surgery for women with female genital mutilation: A scoping review. BJOG: An International Journal of Obstetrics & Gynaecology. 2024;n/a(n/a).

27.              Caillet M, O’Neill S, Minsart A-F, Richard F. Addressing FGM with multidisciplinary care. The experience of the Belgian Reference Center CeMAViE. Current Sexual Health Reports. 2018;10:44-9.

March 2025