Whilst it is reasonable to hypothesise that FGM may have adverse psychological consequences, the evidence base at present does not allow us to make a categorical statement. This is not to say that serious consequences do not exist, rather, that major constraints including those outlined below have meant that authoritative studies have not been (and may never be) feasible. Personal testimonies and case studies of course offer important and valuable insight. However they are generally not considered sufficient evidence because we do not know how representative they are of larger populations of girls and women.
Reliability, validity and parsimony
● Findings in FGM research in the UK may be biased towards individuals who are not committed to FGM, not
• FGM is illegal in the UK; those found involved in its practice could face a fine or prison sentence or
both. It is unlikely that individuals who have engaged in illegal practices would come forward to
participate in research;
• Researchers who are informed about the illegal practice of FGM by research participants are obliged
to report this to the authorities who may initiate child protection work where appropriate. All this
must be made clear to research participants before they give consent to participation;
• There may be situations whereby an individual wishes to but is disallowed to participate.
● Recruitment may be hampered further by contact difficulties, e.g. the lack of a stable address for potential
participants who are seeking asylum.
● The time lag between FGM (typically in childhood) and the manifestation of psychological or mental
health problems in adolescence or adulthood means that women are less likely to link any current difficulties
to FGM. It has been said that “Most of the consequences [of FGM] become evident only several years after
the operation; as a result the connection between cause and effects is not made by all of the women.”
(Source: Gallo, 1985)
● It could be claimed that other sources of adversity, such as difficulties relating to cultural transition, poverty,
social exclusion and other socio-economic factors, provide more salient explanations for mental health
difficulties than FGM per se. Indeed for some women, major struggles in the here and now may render
unimportant a childhood event that is only vaguely remembered.
● In studies where women do recall negative FGM experiences in childhood and offer an estimate of the
impact, these accounts are by definition retrospective and may not be reliable. Furthermore, the increased
public exposure of negative aspects of FGM, or a perception that the study is ‘looking for’ negative
psychological effects, could influence participants’ responses (so called demand characteristics).
● Language barriers may necessitate the engagement of interpreters, who may belong to the same
community. This raises ethical issues for confidentiality. Recruitment of English-speaking participants on the
other hand may yield findings that are less generalisable.
● Any effort to encourage participation, which may involve disclosure about third parties, could run into ethical
problems, especially for individuals who are socially vulnerable.
Given these and also resource considerations, the paucity of psychological research in FGM in the UK (and worldwide) is not surprising. Epidemiological studies demonstrating a strong and specific link between impaired mental health and FGM are currently absent. The relative unavailability of psychological reports makes it difficult to comment with confidence on the interaction patterns between mental health and age of FGM, type of FGM, physical consequences of FGM, family support, socio-economic status, and so on.
Nevertheless, the fact that many community workers and groups have been assisting women, girls and families affected by FGM suggests that assistance is needed in some instances. Psychologists have a duty to explore whether they can make a useful contribution to clients and colleagues. On the basis of the experience of the National Clinical Group and the evidence available, the most likely sets of psychological consequences for which psychologists may offer effective assistance include the following, which may inter-relate for some individuals:
• Traumatic stress.
• Sexual difficulties.
• Relationship discord within couples or families.