Introduction Female genital mutilation (FGM) is illegal. If a child has undergone FGM or is thought to be at risk, a referral should be made to social care or the police. FGM is defined by the World Health Organisation as procedures that include the partial or total removal of the external female genital organs for cultural or other non-therapeutic reasons. There are four main types of FGM – type 1 clitoridectomy, type 2 excision, type 3 infibulation and type 4 other harmful procedures including pricking, piercing, cutting, scraping and burning. There are an estimated 20,000 girls at risk of FGM in the UK.

Cosmetic genital surgery is not illegal, nor is circumcision or genital piercing in males.

Aim to discuss the controversies around cosmetic genital surgery and piercing and their relation to FGM.

Method and results a literature search was performed and findings will be discussed. The discussion will focus on FGM and cosmetic surgery as a spectrum of harmful practices. How does a woman reject one set of cultural behaviours, deemed to be inappropriate and inhumane, when the UK society she is integrating into is tolerant of cosmetic genital procedures?

The rationale will be put forward to reform legislation to ensure that girls are protected from all non-medical genital surgery (eg labiaplasty), with regulation of the piercing industry. Currently a genital piercing will not necessarily lead to a prosecution – is it in the public interest to prosecute such a case? Discussion will include the development of an education programme with a focus on FGM for all young people. The pros and cons of regular genital examination (as performed in some countries) will be explored.

Conclusion Girls must be protected from FGM, piercing and cosmetic surgery under the age of 18 years. We need to achieve a balance of protecting those who are most vulnerable while empowering them to make their own decisions about their bodies.