Peer-reviewed article
Referrals for vulval appearance concerns to a specialist children and young person's female genital cutting/mutilation (FGC/M) clinic: a ten-year retrospective analysis.
Learner HI, Ali S, Deegan N, Hodes D ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined referrals to a specialist clinic in England and Wales for children with concerns about vulval appearance, to understand how many actually had undergone female genital cutting/mutilation (FGC/M). Of 42 children referred for appearance concerns, only one was confirmed to have FGC/M, while 34 had normal anatomy and six had common childhood conditions. Most referrals came from non-clinicians, suggesting gaps in anatomical knowledge. The findings indicate that current safeguarding guidance may lead to over-referral of children without FGC/M, and updated guidance is needed to better balance child protection with informed decision-making.
Key points
- Of 291 total referrals to the clinic, only 44.3% (129 children) were confirmed to have undergone FGC/M
- For the 42 appearance-related referrals, FGC/M was confirmed in only 2.4% (1 child); 81% had typical anatomy
- 61.9% of appearance-related referrals came from non-clinicians, suggesting knowledge gaps among referring professionals
- 33.3% of children referred for appearance concerns had a family history of FGC/M but no actual FGC/M themselves
- Common paediatric vulval conditions accounted for 14.3% of appearance-related referrals
Limitations
This is a retrospective analysis from a single specialist clinic in England and Wales, so findings may not represent other regions or healthcare systems. The study does not evaluate an intervention or provide information about outcomes for the children referred or follow-up after clinic visits.
Abstract
The diagnosis of female genital cutting/mutilation (FGC/M) in children is complex, as findings may be subtle or mimic normal vulval variation. England and Wales safeguarding guidance advises referral of any signs of FGC/M, regardless of the observer's background. We hypothesised that most children referred to a specialist clinic for concerns about vulval appearance would not have undergone FGC/M, reflecting gaps in anatomical knowledge and limitations of current guidance. A retrospective review of electronic medical records for all children (0-17years) seen from October 2014 to March 2025 was undertaken. The primary outcome was the proportion of appearance-related referrals. Secondary endpoints included confirmed finding of FGC/M, family history of FGC/M, vulval findings, and whose concerns triggered the referral. Among 291 referrals, 129/291 (44.3%) were confirmed to have undergone FGC/M. Forty-two cases (42/291 (14.4%)) were triggered for appearance concerns (median age 4 y IQR 2-11). FGC/M was verified in just one of these 42 children (1/42 (2.4%)). There was a family history of FGC/M in 14/42 (33.3%). Thirty-four (34/42 (81.0%)) had typical anatomy and six (6/42 (14.3%)) had common paediatric vulval conditions. Non-clinicians generated 26/42 referrals (61.9%). Updated guidance is needed to balance vigilance in safeguarding with a more nuanced, informed and child-centered approach.