World Health Organization · 2025 edition · 104 pages
Evidence-based recommendations for health workers on preventing FGM and managing complications, including training, deinfibulation, and mental health support.
- Issuer
- World Health Organization
- Edition
- 2025 edition
- Audience
- Health workers, health programme managers, policy-makers, professional associations, training institutions, NGOs, UN partners, private sector entities involved in FGM-related services
- Evidence
- GRADE-rated systematic reviews (10 PICO questions, 4 PerSPECTiF questions); recommendations rated strong or conditional based on certainty of evidence, benefits/harms, values/preferences, equity, feasibility, and resource implications
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This guideline provides eight evidence-based recommendations and three best practice statements for the health sector on preventing female genital mutilation (FGM) and managing its complications. Over 230 million women and girls worldwide live with FGM, which has no health benefits and causes immediate and long-term physical, sexual, and psychological harm. The practice violates human rights principles and constitutes violence against women and girls.
The recommendations address health worker training and capacity-building; educational interventions for affected communities; deinfibulation for women with Type III FGM (infibulation); mental health interventions for anxiety, depression, and PTSD; and sexual health interventions including counselling and, for selected women, clitoral reconstruction surgery. Best practice statements call for laws protecting women and girls, professional codes of conduct prohibiting medicalization of FGM, and counselling before deinfibulation.
The guideline emphasizes that FGM medicalization—performance by health workers—is never acceptable and violates medical ethics. All recommendations are framed by three principles: women with FGM deserve quality care; all stakeholders should work toward prevention; and medicalization perpetuates harm and must be opposed.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Health workers should receive training on FGM prevention and management of complications, with access to job aids, clinical guides, and IEC materials (strong recommendation, moderate- to very-low-certainty evidence)
- Women, girls, men and boys in FGM-practising communities should receive group or one-on-one health education on FGM risks and prevention (strong recommendation, very-low-certainty evidence)
- Deinfibulation is recommended for women and girls with Type III FGM to improve health outcomes and facilitate childbirth (conditional recommendation, low-certainty evidence)
- Either antepartum or intrapartum deinfibulation can be considered for pregnant women with Type III FGM; timing depends on woman's preference, access to facilities, health worker skill, and place of delivery (conditional recommendation, very-low-certainty evidence)
- Women with Type III FGM should receive counselling before deinfibulation, with partners/family included only at the woman's request (best practice statement)
- Women and girls with FGM experiencing anxiety, depression, or PTSD should receive mental health interventions adapted from WHO mhGAP guidelines (strong recommendation, low-certainty evidence)
- Sexual health counselling is suggested for women with FGM experiencing sexual dysfunction (conditional recommendation, very-low-certainty evidence)
- Clitoral reconstruction surgery is suggested for selected women with FGM as part of multidisciplinary care including sexual health counselling (conditional recommendation, very-low-certainty evidence)
Summary of recommendations and best practice statements
Table extracted from the guideline
| Topic | Recommendation/Statement | Strength |
|---|---|---|
| Health worker training | Health workers should be trained in FGM prevention and complication management | Strong |
| Capacity-building resources | Health workers should access IEC materials, job aids, clinical guides, handbooks | Strong |
| Laws and policies | Laws protecting women/girls from FGM should be developed and enforced | Best practice |
| Professional codes | Codes of conduct enforcing zero tolerance to FGM should be developed | Best practice |
| Community education | Women, girls, men and boys should receive educational interventions on FGM | Strong |
| Deinfibulation | Deinfibulation is recommended for women and girls with Type III FGM | Conditional |
| Timing of deinfibulation | Either antepartum or intrapartum deinfibulation can be considered | Conditional |
| Deinfibulation counselling | Women should receive counselling before deinfibulation | Best practice |
| Mental health | Women/girls with anxiety, depression, PTSD should receive adapted mhGAP interventions | Strong |
| Sexual health counselling | Sexual health counselling suggested for women with sexual dysfunction | Conditional |
| Clitoral reconstruction | Clitoral reconstruction surgery suggested for selected women | Conditional |
Source: World Health Organization, Guideline on the prevention of female genital mutilation and clinical management of complications. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- Expanded scope from 2016 version to include prevention interventions in addition to clinical management
- New recommendation on health worker training for FGM prevention and care (previously not included)
- New recommendation on access to capacity-building resources including IEC materials and job aids
- New recommendation on educational interventions for women, girls, men and boys in practising communities
- Expanded mental health recommendation beyond cognitive behavioural therapy to include all mhGAP interventions
- New recommendation on sexual health counselling for sexual dysfunction
- New recommendation on clitoral reconstruction surgery for selected women
- Added best practice statements on laws/policies, professional codes of conduct, and counselling before deinfibulation
From the guideline
Verbatim
“Medicalization of FGM refers to situations in which FGM is practised by any category of health worker, whether in a public or a private clinic, at home or elsewhere. It also includes the procedure of reinfibulation at any point in time in a woman's life.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As a WHO consultant on health and migration, I recognize that while FGM is not traditionally practised in Georgia, our health system must be prepared to provide competent, stigma-free care to affected women and girls from refugee and migrant communities, particularly given Georgia's role as both a host and transit country. The recommendation I would emphasize most to Georgian clinicians is the strong recommendation for health worker training on FGM identification and management, which can be integrated into our existing universal health coverage programme and primary care network at relatively low cost. The key implementation challenge for Georgia will be building specialized surgical capacity for deinfibulation and clitoral reconstruction, which currently exists only in our tertiary centres; we should focus initially on training obstetrician-gynaecologists in deinfibulation as part of comprehensive maternal health services, while ensuring all primary care providers can identify FGM and make appropriate referrals. The guideline's emphasis on preventing medicalization is critical—Georgian medical professional associations should proactively establish clear ethical standards now, before any demand emerges, and our medical curricula should include FGM as part of culturally competent care for diverse populations.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
While Georgia does not have high FGM prevalence among its ethnic Georgian population, the country hosts refugee and migrant populations from FGM-practising regions and serves as a transit route for migration to Europe. Georgian health workers may encounter women and girls with FGM in clinical practice, particularly in urban centres and border regions. National health programmes should ensure that maternal and reproductive health services include protocols for identifying and managing FGM complications, that health workers receive training on culturally sensitive care without stigmatization, and that referral pathways exist for specialized surgical, mental health, and sexual health services. Integration into existing universal health coverage programmes and the primary care network would be most efficient. Professional medical associations should develop clear ethical guidelines prohibiting any form of FGM medicalization while ensuring quality care for affected women.
Questions this guideline answers
Quick answers
What is the difference between deinfibulation and reinfibulation?
Deinfibulation is a surgical procedure to reopen the vaginal introitus in women with Type III FGM by cutting the midline scar tissue, which improves health and facilitates childbirth. Reinfibulation is re-suturing the vaginal opening after deinfibulation, which WHO strongly opposes as it constitutes FGM medicalization and causes further harm with no health benefits.
Should deinfibulation be done during pregnancy or during labour?
Either timing can be considered based on the woman's preference, access to health facilities, health worker skill level, and expected place of delivery. Antepartum deinfibulation allows healing time before childbirth and may be preferred where home births are common or facilities are distant. Intrapartum deinfibulation is acceptable with experienced providers. The decision should involve the woman and consider local context.
Can clitoral reconstruction surgery restore sexual function?
Evidence from 13 observational studies (very-low-certainty) suggests clitoral reconstruction may reduce vulvar/clitoral pain, improve body image and self-esteem, and improve some aspects of sexual function including ability to experience orgasm. However, results vary by technique, surgeon skill, and individual factors. It should only be offered in multidisciplinary care settings including sexual health counselling, and women should understand that outcomes are not guaranteed.
What mental health interventions should be offered to women with FGM?
Women and girls with FGM who have symptoms of anxiety, depression, or PTSD should be offered mental health interventions adapted to their needs and consistent with WHO's mhGAP guideline. In settings with limited mental health specialists, trained and supervised non-specialist health workers or community health workers can deliver psychological interventions and manage care, including prescriptions and referrals where needed.
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Other guidelines on this topic
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2025 edition
- Replaces
- Guidelines on the management of health complications from female genital mutilation, 2016
- Status
- Current
- Published
- 2025-04-28
- Languages
- English; Arabic and French translations planned
- Scope
- Prevention of FGM and clinical management of complications in women and girls who have undergone or are at risk of any type of FGM
- Audience
- Health workers, health programme managers, policy-makers, professional associations, training institutions, NGOs, UN partners, private sector entities involved in FGM-related services
- Pages
- 104
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-010728-1
- Evidence
- GRADE-rated systematic reviews (10 PICO questions, 4 PerSPECTiF questions); recommendations rated strong or conditional based on certainty of evidence, benefits/harms, values/preferences, equity, feasibility, and resource implications
- Next review
- Not specified
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
WHO guideline on the prevention of female genital mutilation and clinical management of complications. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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