There are procedures (usually referred to as clitoral or labial reconstruction or reconstruction surgery) which attempt to ‘reinstate’ or ‘restore’ a woman’s genitalia to how it was before she suffered FGM. There are many clinics globally who offer these treatments often integrated with psychosexual therapy, largely across Europe (in Germany, France, Switzerland, Sweden, Netherlands, Belgium, Italy and Spain) and Africa (Burkina Faso, Kenya and Egypt) and parts of U.S.A., and there is emerging evidence of some of the benefits to women who receive this treatment.
Through the NHS, women can access vulva reconstruction surgery for conditions such as lichen sclerosis or post cancer surgical reconstruction; men can access gender reassignment surgery to become women; & labiaplasty (labial reduction surgery) is available for women diagnosed with mental health problems. Furthermore, designer vagina / cosmetic surgery is available in the private sector.
However, the NHS currently do NOT offer reconstruction surgery. The NHS does offer a procedure called ‘de-infibulation’ for women who have had FGM Type 3 (or pharaonic circumcision). This surgery opens the scar tissue that covers the urine hole and vaginal opening. It can help with some of the physical symptoms of FGM, such as allowing a woman to pass urine normally, have sex more comfortably, have a vaginal delivery at birth and to have a cervical smear examination. This is sometimes called a “reversal” but actually, this does not put back what has been removed during FGM.
There is increasing evidence that some women from FGM-affected communities want access to reconstruction surgery and are travelling abroad to obtain surgery or are accessing reconstruction in the private sector, where care is unregulated and costly.
We believe this is a social injustice, is an example of a health inequality and discriminates against FGM survivors.
The ACERS-UK project
Advocating Access to Clitoral reconstruction and Emotional support within a Research framework
A new project is underway, the end goal of which is to establish a National Centre of Excellence providing FGM reconstruction surgery and psychosexual therapy as a treatment option for FGM survivors. The plan is for reconstruction surgery to be integrated within a holistic care package offering psychosexual and trauma therapy alongside other treatment options and support. The co-designed service will be delivered by a multidisciplinary team with Patient and Public Involvement and Engagement (PPIE) at its core. Surgery may then be the final option after careful psychosexual assessment, education and offer of treatment alternatives. This will be carried out as part of a clinical trial to ensure that robust safeguards are in place and that we contribute to the development of new evidence in this important area of healthcare research.
We believe that although not all women will want or benefit from reconstruction surgery, women should be able to make an informed decision to access this if they wish and we believe that the NHS should be funding research in this area, so that in the future we can offer this type of surgery to FGM survivors.
Zero Tolerance to FGM Day – 6th February 2024
We held a national stakeholder event to celebrate Zero Tolerance to FGM day and to discuss:-Do YOU want reconstruction surgery to be made available to survivors of Female Genital Mutilation in the UK?
Who is involved?
The project team includes specialist FGM midwives, urologists, urogynaecologists, gynaecologist, plastic surgeon, GP, FGM academics and specialist FGM counsellors, FGM survivors/women with lived experience, health advocates, and representatives from charities who support women with FGM. All members have significant experiences caring for women with FGM and have worked in this area for many years.
All project members are giving their time freely to support this work.
We are grateful to The Urology Foundation for providing funding to support Phase 1 of this project.
Phase 1 – update April 2024
- Web page
- Scoping review
- Patient and Public Consultation
- Attended a FGM reconstruction masterclass in Geneva
- Launch parliamentary petition
- Collaborating with other leading FGM charities including FORWARDUK, The Dahlia Project (Manor Gardens), Sister Circle, Midaye, IKWRO, INTEGRATEUK, Oxford against Cutting, NESTAC and the Vavengers
- We have partnered with Oxford Surgical Trails Unit to develop our future research funding proposal
- Visit to a clinic in France run by Dr Foldes
- We presented at our Zero Tolerance to FGM day national stakeholder event; Juliet Albert presented our work to the British Journal of Midwifery Conference in April 2023 and we plan to present to the Global Surgery Umbrella collective in May 2024.
Everyone involved is a keen and committed #EndFGM advocate and we believe that the ultimate goal remains the complete eradication of FGM globally. The provision of the best treatment possible for FGM survivors is part of the #EndFGM campaign.
Progress
As of 2023, the project is in relatively early stages.
When there are project updates, we will update this page.
For more information, please email juliet.albert@nhs.net
Project Steering Group Members
- Juliet Albert – Specialist FGM/C midwife, The Sunflower Clinics, Imperial College Healthcare NHS Trust (Co-Lead)
- Professor Sohier Elneil – Consultant Uro-Gynaecology and FGM/C expert, University College London Hospitals NHS Foundation Trust (Co-Lead)
- Aurora Almadori – Plastic Surgeon, Royal Free Hospital
- Catriona Stalder – Gynaecologist, Imperial College Healthcare NHS Trust
- Tina Rashid – Urologist and Gender reassignment/feminizing surgeon, St George’s Hospital Foundation NHS Trust
- Roland Morley Urologist and Gender reassignment/feminizing surgeon – Imperial Healthcare NHS Trust and St George’s Hospital Foundation NHS Trust
- ‘KM’, Anonymous FGM/C survivor
- Suhad Adam FGM/C Health Advocate – The Sunflower Clinic, ICHNT
- Christie Coho Specialist FGM/C psychotherapist
- Huda Mohamed FGM/C Midwife – Whittington Hospital
- Alison Byrne FGM/C Midwife – University Hospitals Birmingham and Sandwell & West Birmingham Hospital Trust
- Vicky Bowler, GP – Bristol Rose clinic
- Professor Catrin Evans, academic FGM/C expert, University of Nottingham
- Stefania Palmieri – Uro-gynaecologist, UCLH
- Naana Otoo oyortey – FORWARD
- Toks Okeniyi – FORWARD
- N’Dey Gassama – founder of Holistic Support Ltd
- Astrid Fairclough – Churchill Fellow/Policy Advisor
- Dalia Saidan, Consultant Uro-gynaecologist, Croydon University Hospital
- Rachel Phillips – Imperial Clinical Trials Unit
- Hekate Papadaki – Manor Gardens
- Honorary member – Dr Jasmine Abdulcadir (HUG clinic, Switzerland)
- Njomeza Kartallozi – Manor Gardens
- Natasha Anderson-Foster – Psychosexual therapist
- Amal Hassan – Sister Circle
- Janet Fyle – Royal College of Midwives, FGM Policy Advisor
- Lola Adeleke – Media Executive, Film maker, Advocate
