Britain still has no routine NHS pathway for women who want to explore reconstructive surgery after female genital mutilation. That is no longer a marginal complaint. It is a recognised policy gap. The Women and Equalities Committee said many survivors seek reconstructive surgery to reduce pain, sexual dysfunction and body dysmorphia, criticised the Government for citing a lack of evidence while failing to invest in the research needed, and recommended priority funding, with NHS provision if effectiveness is shown.
FGM policy in Britain has been strongest at the point of condemnation and weakest at the point of repair.
That is the contradiction at the centre of this issue. Britain rightly treats FGM as child abuse and a grave violation of rights. But condemnation is not the same as care. A serious system must also deal honestly with the women already living with pain, scarring, sexual difficulty, trauma and distress.
This is no longer a speculative debate. The Government’s formal response accepted that reconstructive surgery is an important area of research and said the NIHR was developing a call with FGM specialists and scientific experts. NIHR then opened a two-stage funding opportunity on 4 November 2025 and closed outline applications on 18 March 2026. Its research question is direct: what is the clinical and cost-effectiveness of reconstruction surgery in FGM/C survivors?
That matters because Parliament also found that survivor services remain inconsistent and amount to a postcode lottery. It said services often do not provide appropriate counselling and called for funded multidisciplinary services, clear referral pathways and specialist counselling support. This is not only a research story. It is a service failure story too.
The NHS does already provide care for women affected by FGM. The Government says Integrated Care Boards and NHS Trusts commission support clinics offering physical treatment, counselling and onward referral, with at least 24 clinics across England, and that the NHS also provides clinical intervention, including deinfibulation, for medical complications associated with FGM.
But deinfibulation is not reconstruction. RCOG defines deinfibulation as a minor surgical procedure to divide the scar tissue sealing the vaginal opening in Type III FGM and states plainly that it does not replace genital tissue or restore normal genital anatomy and function. That distinction is central. Too much public discussion blurs different procedures and then pretends the policy problem has already been solved. It has not.
This is not an argument for surgery at any cost. Not every survivor will want reconstruction. Not every survivor will benefit from it. The strongest current international guidance is careful. The WHO’s 2025 guideline says clitoral reconstruction surgery is suggested for selected women living with FGM, but only as a conditional recommendation based on very-low-certainty evidence. It also suggests sexual health counselling for women living with FGM who are experiencing sexual dysfunction.
WHO is also clear about the limits. It warns that endorsing reconstruction without conclusive evidence of benefit could raise expectations that cannot be met for many women, and it strongly endorses sexual health counselling as a precursor to or alongside surgery. That is exactly why Britain needs a serious pathway: not pressure, not false hope, but honest information, careful assessment, counselling and informed choice.
The UK’s caution has a history. RCOG’s Green-top Guideline says clitoral reconstruction should not be performed because current evidence suggests unacceptable complication rates without conclusive evidence of benefit. However, the position can no longer end there. The state itself is now funding the question. NIHR’s specification asks applicants to assess outcomes including quality of life, mental health, sexual function, pain, acceptability, body image, urogenital morbidity and cost-effectiveness. Once the state accepts the research question, the issue stops being theoretical.
NIHR’s own rationale states that reconstructive surgery is currently unavailable in the UK because of the lack of randomised controlled trial evidence, and that some British women have travelled abroad to access it. It also notes that the NHS already performs genital reconstruction for other purposes, suggesting the technical expertise exists. That does not prove the case for immediate routine provision. It does, however, expose how weak it now sounds to say the subject is simply too difficult to touch.
What should happen next is straightforward. Britain should stop hiding behind the evidence gap while only just beginning to fund the work needed to narrow it. Survivors should be told clearly what is available, what is not, and why. Current support services should be strengthened now. Counselling and referral pathways should not depend on geography or luck. And reconstruction should be treated as a proper policy question rather than an awkward afterthought.
Britain has rightly condemned FGM for years. It now needs to show the same seriousness at the point of survivor care. Until there is a credible NHS pathway grounded in evidence, counselling, consent and dignity, the country cannot honestly claim that this part of the job is done.
Aneeta Prem MBE is a UK safeguarding campaigner, founder of Freedom Charity and author of Cut Flowers. She writes on forced marriage, female genital mutilation, child protection and public policy affecting women and girls, with a longstanding focus on how law, safeguarding and public services respond to women already living with harm. 19 march 2026 London
Aneeta.com: We need FGM Reconstruction Surgery for UK Survivors
Freedom Charity: FGM reconstruction surgery UK
Women and Equalities Committee report: Female genital mutilation
Government response: Female genital mutilation
NIHR: Reconstruction surgery for FGM/C survivors
NHS: Female genital mutilation (FGM)
WHO guideline PDF: prevention of FGM and clinical management of complications
RCOG Green-top Guideline No. 53 PDF
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Female genital mutilation reconstruction UK, NHS pathway for FGM survivors, clitoral reconstruction UK, FGM survivor care UK, Women and Equalities Committee FGM reconstruction
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