title: Female genital mutilation in children presenting to a London safeguarding clinic: a case series.
abstract: OBJECTIVE
  To describe the presentation and management of children referred with suspected female genital mutilation (FGM) to a UK safeguarding clinic.
  
  
  METHODS
  Case series of all children under 18 years of age referred with suspected FGM between June 2006 and May 2014.
  
  
  METHODS
  These include indication for referral, demographic data, circumstances of FGM, medical symptoms, type of FGM, investigations and short-term outcome.
  
  
  RESULTS
  Of the 47 girls referred, 27 (57%) had confirmed FGM. According to the WHO classification of genital findings, FGM type 1 was found in 2 girls, type 2 in 8 girls and type 4 in 11 girls. No type 3 FGM was seen. The circumstances of FGM were known in 17 cases, of which 12 (71%) were performed by a health professional or in a medical setting (medicalisation). Ten cases were potentially illegal, yet despite police involvement there have been no prosecutions.
  
  
  CONCLUSIONS
  This study is an important snapshot of FGM within the UK paediatric population. The most frequent genital finding was type 4 FGM with no tissue damage or minimal scarring. FGM was performed at a young age, with 15% reported under the age of 1 year. The study also demonstrated significant medicalisation of FGM, which matches recent trends in international data. Type 4 FGM performed in infancy is easily missed on examination and so vigilance in assessing children with suspected FGM is essential.
authors.affiliation: University College Hospital, London, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hodes
authors.affiliation: University College Hospital, London, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Armitage
authors.affiliation: Department of Paediatrics, The Whittington Hospital, London, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Robinson
authors.affiliation: University College Hospital, London, UK.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Creighton
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D019093:Circumcision, Female / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008131:London / Q000453:epidemiology; D012189:Retrospective Studies; D016387:Women's Health
keywords: Child Abuse; Children's Rights; Paediatric Practice; Race and Health