Referrals for vulval appearance concerns to a specialist children and young person’s female genital cutting/mutilation (FGC/M) clinic: a ten-year retrospective analysis

The diagnosis of female genital cutting/mutilation (FGC/M) in children is complex, as findings may be subtle or mimic normal vulval variation. England and Wales safeguarding guidance advises referral of any signs of FGC/M, regardless of the observer's background. We hypothesised that most children referred to a specialist clinic for concerns about vulval appearance would not have undergone FGC/M, reflecting gaps in anatomical knowledge and limitations of current guidance. A retrospective review of electronic medical records for all children (0-17years) seen from October 2014 to March 2025 was undertaken. The primary outcome was the proportion of appearance-related referrals. Secondary endpoints included confirmed finding of FGC/M, family history of FGC/M, vulval findings, and whose concerns triggered the referral. Among 291 referrals, 129/291 (44.3%) were confirmed to have undergone FGC/M. Forty-two cases (42/291 (14.4%)) were triggered for appearance concerns (median age 4 y IQR 2-11). FGC/M was verified in just one of these 42 children (1/42 (2.4%)). There was a family history of FGC/M in 14/42 (33.3%). Thirty-four (34/42 (81.0%)) had typical anatomy and six (6/42 (14.3%)) had common paediatric vulval conditions. Non-clinicians generated 26/42 referrals (61.9%). Updated guidance is needed to balance vigilance in safeguarding with a more nuanced, informed and child-centered approach.