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Seven days in medicine: 20-26 July 2016

BMJ 2016; 354 doi: (Published 28 July 2016) Cite this as: BMJ 2016;354:i4148

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UK doctors performing labial reduction on minors need clarity about the law on FGM

The UK Female Genital Mutilation (FGM) Act 2003 states that “A person is guilty of an offence if he excises, infibulates or otherwise mutilates the whole or any part of a girl’s labia majora, labia minora or clitoris”. However, “no offence is committed by an approved person who performs a surgical operation on a girl which is necessary for her physical or mental health” although “… it is immaterial whether she or any other person believes that the operation is required as a matter of custom or ritual.”

Thus, doctors do not decide the legitimacy of such surgery, which is a matter for the Courts. It is moot whether cosmetic genital surgery on minors in the UK might also come under the remit of the Act. Following publication of a case series detailing several labial reductions in girls under 16 in the UK (1), I wrote a letter about the failure to address the legality to the Journal of Adolescent and Pediatric Gynecology in 2013. The article was drawn to the attention of the police who investigated but did not pursue a criminal case as they found no evidence that the procedures referred to had contravened the Act. Gynaecologists operating on children's labia need clarity about the law, especially since the failed 2015 prosecution of a UK obstetrician. The febrile atmosphere in which misinformed debates about FGM take place do not aid understanding. The letter was accepted in 2014, but has still not been published despite repeated representations.


Jothilakshmi PK, Salvi NR, Hayden BE, Bose-Haider B. Labial reduction in adolescent population-a case series study. J Pediatr Adolesc Gynecol. 2009 Feb;22(1):53-5

Competing interests: I was paid for expert advice in the defence of R v Dharmasena 2015

19 August 2016
Susan Bewley
Professor of Women's Health
Kings College London