How to Spot the Signs of Female Genital Mutilation (FGM)

Recognising When FGM is About to Take Place

Understand the other words people may have for FGM. Different cultures call FGM different things. When people are planning FGM, they are unlikely to use that word, and may instead use a word in their own language. The National FGM Centre has a document of the most common traditional terms for FGM in each county by language, which can be found here. Some of the most common words for FGM include Sunna, gudniin, halalays, tahur, megrez and khitan. The terminology used will depend on the person's culture and language.

Notice if a family member is coming from abroad. While this on its own isn't anything to worry about, if someone is more at risk, this could happen. Older women are the most likely to carry out FGM.

Watch out for any holidays abroad, especially to see family or friends in countries with high FGM rates. The holidays are normally quite long. Again, this does not directly point to anything, but take note of other signs. These holidays can take place at any time of year, but the summer months are most common. This is because child victims typically have time off from school during the summer, so they will have more time to travel and recover. The potential victim may be asked to keep this holiday abroad a secret.

Be aware of any ceremonies, especially those celebrating "becoming a woman" or "being prepared for marriage". While there may be an innocent explanation for it, if you are unsure you can ask what the purpose of it is.

Recognise sudden change in behaviour. This could be down to a number of reasons, but it could be possible that they are preparing for FGM. If they seem more withdrawn than usual, something could be the matter. They may be more reluctant to join in activities, or may struggle to keep up in school. They may also appear aggressive, anxious, clingy or obsessive. These can also be signs of mental illness, such as depression, so, if possible, try to see if there is an underlying cause.

Don't ignore any requests for help. If the person knows what's going to happen, they might ask for help but not elaborate. If they know they are going on holiday or seeing a specific family member, but don't want to or try to avoid it, this could be a sign that something is not right. Very often they will not get into specifics due to fear or embarrassment. If someone is at risk of FGM, they may express a desire to, try to, or plan to run away from home. Younger people may be less aware of what the procedure is, and may view it as a normal thing. They may be (but aren't always) more open about it, even if they don't explicitly say what will happen. They may mention that they are not allowed to say what's going on. Take this as a major red flag.

Recognising Physical Signs

Notice if they are spending more time than usual in the bathroom or are experiencing incontinence. FGM can cause problems with peeing or holding in pee. This can lead to people spending a longer time than usual in the bathroom or going to the bathroom more frequently. An FGM victim may also have worse periods than usual, or have irregular periods.

See if they express discomfort sitting down, standing or walking. The pain from FGM can affect these things. They may be more cautious or stiff. They may also try to hide the fact that they are in pain. They might also complain about a pain between the legs, without saying why. Experiencing pain like this is also common in many rape victims. They may be excused from physical education lessons without a doctor's letter if they have recently undergone FGM.

Take note if they say they are experiencing infection, bleeding, cysts of abscess. These are all common side effects of FGM. To hide some of these symptoms, they may opt to wear looser clothes than they normally would. UTIs and STDs are especially common after FGM.

Recognising Behavioural Signs

See if they are refusing to go to doctor appointments, especially with a gynaecologist. This could be because they don't want the doctor to know what happened. They may make excuses or directly say that they don't want to go. They may also lie and say that they went when they didn't. They may also worry about the doctor asking questions about their health.

Be alert for signs of PTSD. PTSD is very common among victims of FGM. Signs of PTSD include flashbacks, nightmares, sleeping problems, lack of concentration, avoiding particular people or places, panic attacks, angry outbursts, and physical symptoms such as headaches and dizziness. If someone was cut as a baby or toddler, they might not remember it, so may not be as emotionally affected.

Observe if they display other signs of mental illness. Not only can FGM cause PTSD, it can also cause a wider variety of other mental disorders, such as anxiety, depression and eating disorders. If you suspect someone may be suicidal, get help immediately. Read Prevent a Suicide to know how to best help. Those who have gone through FGM are also more likely to self harm.

Look out for withdrawal of sex. Not wanting sex can be caused by a number of factors, but having FGM can be one of them. This is because sex after FGM is usually very painful. They also might want to hide the fact that they underwent FGM. You can approach your partner and ask them if there is a particular reason why they don't want to have sex recently. Ask it in a respectful way and make it clear that they don't have to have sex, or explain why they don't want to. Never force your partner to have sex with you. They do not have to justify not having sex.

Understanding Risk Factors

Take note if any other female or AFAB people in the family have had female genital mutilation, especially their mother or sisters. This is the biggest sign that someone may be at risk. You should also consider what happened when the family members were cut. Were they at home or abroad? How old were they? You may ask family members directly, but be sensitive as they are unlikely to want to talk about it or may have been sworn to secrecy.

Be aware of the age groups most at risk. While FGM can happen at any age, it is most common in those under the age of 15. It is also more common at certain points in someone's life. Common times include just as they are born, in adolescence (especially at the time of their first period), when they get pregnant or before marriage.

Watch out for "cutting season". This is when school holidays take place, especially the summer holidays. This is because a child can go abroad and back in that time and will have more time to recover from the FGM. FGM can also take place during term time. Having a long, unexplained absence from school could be a warning sign. After the absence, they may seem different, for example, quieter or more withdrawn.

Note any other risk factors. While no single risk factor can tell you if someone has been through FGM, or is going to, certain things make it more likely: Being from a poor background Not being fully integrated in their country's culture (if they moved there) Not being educated on the risks of FGM A child being taken out of PSHE (or equivalent) classes in school Their family already has some safeguarding issues identified by social work

Taking Action

Contact the police. You can find the number for your country's emergency services here if you don't know it, but in most places, calling 999 or 911 will redirect you to your local police. If you can't bring yourself to contact the police yourself, getting someone else to do it is another option. There are currently 84 countries with specific legislation outlawing FGM, but even in countries with no specific law, action will still usually be taken.

Get medical help. FGM poses serious health risks, with the most severe being death. If you or someone you know has been the victim of FGM, it is important to seek medical help as soon as possible to reduce the risks. Seeing a doctor is confidential and they won't make you take further action, such as telling the police, unless you want to.If someone is experiencing shock, heavy bleeding or you suspect may have septicaemia, you should always call for an ambulance. It is especially important to let medical services know if you are pregnant or are planning on getting pregnant. There are medical treatments, such as deinfibulation which can help protect against some of the risks after you have been victim of FGM. There is no treatment which can reverse FGM, however.

Tell someone in a position of authority. If you suspect something might be going on, but aren't completely sure, or you are unable to contact the police for any reason, tell someone else who can help. Telling a teacher is always a good option as they are required to help. Keep in mind that people like teachers are, in most cases, obligated to go to the police about this issue in order to best keep people safe.

Call a helpline. There are many different types of helplines available to victims of FGM. Some play a more active role, while others are just there to give advice. You can search online to find local ones. In the UK, you can call the NSPCC helpline at 0800 028 3550, or email them at [email protected] for help. In Canada or the USA, you can call the tip line at 1 866 347 2423, or email [email protected] for resources. Helplines may have waiting times and may not always have direct links to the police or ambulance. In an emergency, call the emergency services.

Find a support clinic. In some areas, clinics are available that provide specialist support for FGM victims. Look online for clinics near you. Help clinic will not judge you, and offer a wider range of services including physical examinations, general advice, access to FGM Health Advocates, counselling and referral to a specialist if needed. While rape and sexual assault clinics may not be specialised in FGM, they are another option and generally have more availability. FGM is considered sexual assault, so some clinics can help with that.