Research into reconstructive surgeries post female circumcision/FGM needed

Now that the decade plus propaganda hype in regard to ‘an FGM epidemic’ in the UK has died down, it’s interesting to note that a new female circumcision/FGM reconstruction surgery service for women who’ve undergone FGM is being suggested.

In the past this was a controversial topic. Claims made in The Lancet in 2012 that clitoral surgery after FGM can reduce pain and restore pleasure were critiqued for not being anatomically possible and not supported by current evidence of the effects of clitoral surgery.

Although the prevalence of FGM in the UK is unknown, it was estimated in 2014 that 137 000 women have undergone FGM here. NHS England advised in 2015 that the NHS would not routinely commission specialised surgery to restore clitoral sensation following FGM due to the limited evidence base available. So reconstructive surgeries which could include procedures like clitoral or labial reconstruction which attempt to ‘reinstate’ or ‘restore’ a woman’s genitalia to approximate how it was before undergoing circumcision, have never been commissioned.

However, the Royal College of Midwives (RCM) believe that although not all women will want or benefit from this type of surgery, they should be able to make an informed decision about accessing such a service, should they wish to. I agree.

FGM types seen by NHS over nine years

Between April 2015 and March 2024, 37,525 women and girls who had undergone FGM were seen at NHS services in England where it was relevant to their attendance. NHS Digital reported that 56 per cent of known cases seen with FGM included; 

• Type 1: Removal of clitoris / prepuce
• Type 2: Removal of clitoris and labia minora
• Type 3: Narrowing of vaginal orifice (includes individuals whose original FGM type 3 has been deinfibulated or reinfibulated)
• Type 4: All other harmful procedures to the female genitalia, i.e. pricking, piercing, incising, scraping and cauterisation

It’s possible that a proportion of these attendees might be interested in exploring the possibility of reconstructive options.

Indeed the RCM reports a growing demand for them from people living in the UK. This specialist midwife reported getting requests for these surgeries in 2015. Some women are even travelling abroad to obtain surgery or to access reconstruction in the private sector. But the RCM say this care is unregulated and costly.

Adult genital piercings continue to be reported as FGM so distort the picture

It remains important to note however that when three key pieces of information is reported by NHS staff about FGM patients; FGM Type 1-4 with known subtype; known age; and country undertaken;

• 630 women and girls (5.3 per cent) had FGM in the UK
• 90.6 per cent had genital piercing as an adult
• 9.4 per cent had FGM that was not a genital piercing or that took place when they were a child.

These women are unlikely to need the proposed service but I wonder whether they know that they’ve undergone ‘FGM’? Supposedly.

Scoping Review

To help begin to identify a need for and effectiveness of the service Reconstructive surgery for women with female genital mutilation: A scoping review was undertaken. It  was the first of its kind and was published in June 2024 in the British Journal of Obstetrics and Gynaecology.

Forty studies were included and their strengths and limitations identified. The review outcome showed that reconstructive surgery improves quality of life, satisfaction with vulval appearance and sexual function in women who’ve undergone FGM. 

However, the level of evidence was low, the need for more research was identified and further testing in a clinical trial was warranted. 

The RCM believe that the NHS should be funding research in this area. I agree. and think it would be money well spent considering the focus on and funding for FGM related propaganda to date.

In 2014, NHS England launched a £1.4m FGM prevention programme. But it is difficult to establish how effective the work has been, how much has been spent since them or on what. Was it even evaluated? In 2018, the estimated annual cost of care for women and girls with FGM in England and Wales was £100m. Much has no doubt been spent since then. Surely some could now be diverted to research into the need for reconstructive surgical services instead?

Postscript

ACERS-UK (Advocating access to clitoral reconstruction surgery and emotional support for FGM survivors within a research framework) hosted a national stakeholder event in February 2024. The quesion under discussion was “Do YOU think that FGM survivors in the UK should have access to reconstructive surgery and psychosexual therapy?”. Presentations can be accessed here.