In Sweden, a thorough examination of police case files from 1982 to 2022 reveals a concerning pattern in the handling of suspected female genital mutilation (FGM) cases—a phenomenon characterized by lawful decisions that nonetheless result in structural injustice. The archive studied encompasses 230 cases, offering a detailed view into how suspicions of FGM have been managed by various authorities, including social services, police, and the judiciary. Intriguingly, the vast majority of these investigations have either found no evidence of illegal FGM or could not substantiate claims sufficiently to proceed to prosecution.
A distinctive feature of the Swedish approach to suspected FGM cases is the reliance on genital examinations as a central investigative tool. Out of 179 cases where investigations progressed, 101 girls underwent medical genital examinations. Despite this invasive procedure, 76 such examinations revealed intact genitalia, effectively closing those cases. Where examinations indicated signs of FGM, criminal proceedings were rarely pursued, primarily because the acts were determined to have occurred before migration to Sweden or due to a lack of connection between the alleged perpetrators and Swedish jurisdiction. This legal framework sharply limits prosecution eligibility, reflecting a significant boundary between law enforcement and the lived realities of affected girls and families.
The professional landscape addressing suspected FGM in Sweden operates within well-defined legislative and organizational structures. Professionals working in healthcare, social services, education, and law enforcement are legally mandated to report any suspicions of child maltreatment, including FGM, to social authorities. The social services, in turn, uniformly pass suspected cases to the police, initiating investigations headed by specialized prosecutors focused on honour-related crimes—the category under which FGM is classified domestically. Inter-agency collaboration is institutionalized through coordinated networks and multidisciplinary meetings, sometimes convened in child-friendly facilities known as Barnahus, designed to minimize trauma during interviews and examinations.
A striking element in Sweden’s method is the legal stipulation permitting genital examinations without parental consent. This measure hinges on the appointment of a special representative for the child by a court, enabling the bypassing of parental authority when necessary. While this legal provision aims to protect the child’s interests and uphold investigative mandates, it introduces profound ethical tensions surrounding bodily autonomy and consent. Notably, in numerous cases documented, girls were examined despite explicit resistance, with only a minority demonstrating clear, informed consent. The ‘appropriate adult’ supporting the child during such examinations is often a trusted teacher or preschool staff member, yet many examinations occur without any documented presence of supportive adults, raising further concerns about the child’s well-being during these invasive procedures.
Medical assessments themselves present another layer of complexity and contention. There is no universal consensus within the medical community regarding the specific expertise required for genital examinations in suspected FGM cases. The wide range of specialists involved—from pediatricians to gynecologists and forensic physicians—leads to inconsistent diagnostic conclusions. Instances of repeated examinations for the same child because of initial uncertainty have been documented, compounding psychological distress. One case highlighted involved a young girl subjected to seven separate genital inspections over several years following an unrelated injury, reflecting how ethnic profiling and entrenched suspicion can intensify state surveillance and intervention, sometimes to the child’s detriment.
The inherent difficulty of definitively diagnosing FGM through genital examination compounds investigative challenges. Non-acute or mild forms of FGM may not leave conspicuous physical evidence, and normal anatomical variants can be misinterpreted as signs of trauma. Courts tend to give precedence to expert testimony that confirms FGM, even amid conflicting medical opinions, a phenomenon that calls into question the fairness of legal proceedings and the safeguarding of children’s rights. In fact, only three cases of confirmed FGM have reached Swedish criminal courts since 1982, all involving procedures performed outside Sweden before migration, emphasizing the limitations of domestic legislation in addressing such transnational human rights issues.
Preschool teachers emerge as frequent initial reporters of suspected FGM, often triggered by observations during routine diaper changes. However, multiple investigations have found that these suspicions are regularly unfounded, with children exhibiting intact genital anatomy. The lack of anatomical knowledge among these professionals, despite their daily contact with children’s genitalia, underlines a gap in training and awareness. This situation reflects wider questions about the efficacy and proportionality of heightened surveillance and coercive examinations based on mandatory reporting obligations that leave little room for contextual discretion.
The involvement of social services in these cases is marked by variability in approach and sensitivity. While the principle of acting in the child’s best interest guides decision-making, practical applications range from intrusive interventions to more restrained assessments. Some cases illustrate the potential benefits of early and informal examinations by social workers that preempt more invasive hospital-based procedures, signaling a possibility for less disruptive handling of suspicions. Nonetheless, cases where parents felt coerced into consenting to genital examinations reveal the ethical pitfalls and emotional strains inherent in the current system, where the balance between protective measures and respect for family autonomy is precarious.
Swedish courts demonstrate an ability, albeit infrequently exercised, to prosecute FGM without prior genital examinations. One notable trial involved sisters who admitted to having undergone FGM but refused medical examinations; their verbal testimonies and identifications of anatomical models formed the basis of legal consideration. Ultimately, the Court of Appeal acquitted the parents, illustrating the judiciary’s cautious stance in balancing evidentiary standards with the presumption of innocence and legal thresholds.
The practice of collecting consent for genital examinations reveals significant inconsistencies. While Swedish Patient Act emphasizes the importance of obtaining age-appropriate consent, many documented cases lack clear records of the child’s willingness to undergo such examinations. Of particular concern are instances where girls of sufficient maturity resisted but were compelled nonetheless, sometimes after receiving threatening assurances from their legal representatives or authorities. This points to a troubling dynamic where the child’s autonomy is subordinated to investigative priorities framed as in their best interest.
Support for girls during genital examinations is often insufficient, with only a minority of cases conducted in child-friendly environments like Barnahus. Many girls endure examinations in standard hospital settings without the presence of trusted adults, potentially exacerbating trauma. Documentation shows cases where no adult accompanied the child or records are ambiguous, undermining efforts to provide a supportive and minimally distressing experience during these deeply invasive procedures.
The ambiguity surrounding requisite medical expertise extends beyond the initial examination to influence interpretative reliability. Discrepancies between specialists, and even contradictory findings from the same practitioner over time, highlight the subjective elements underpinning medical conclusions in this context. Such variability can fuel prolonged investigations, repeated examinations, and unwarranted suspicion toward families, exacerbating the social and psychological toll on affected children. Furthermore, entrenched racialized assumptions among law enforcement and medical professionals contribute to persistent beliefs in undisclosed mild FGM cases despite a lack of evidentiary support.
Comparative international perspectives reveal that Swedish FGM-related court cases have yet to provoke debate over the quality of medical evidence, unlike cases elsewhere. For instance, Denmark’s handling of suspected FGM involved legal convictions based on forensic reports challenged by expert testimony and the girls’ denials. Similar controversies have unfolded in countries like the United Kingdom, Ireland, Australia, and the United States, where disagreements between medical experts have complicated judicial processes and raised concerns about fairness and children’s rights.
Ultimately, Sweden’s multifaceted approach to suspected FGM—marked by mandatory reporting, legally sanctioned genital examinations often without consent, and a legal framework limiting prosecution to acts committed within Swedish jurisdiction—creates a tension between protective intentions and the lived consequences for immigrant communities. The predominance of investigations yielding no evidence, juxtaposed with intrusive procedures and enduring suspicions, points to an urgent need for recalibration. Such recalibration must prioritize proportionality, minimize harm, improve professional training, and critically evaluate the ethical implications of practices that may, despite their legality, perpetrate structural injustice.
This comprehensive review challenges policymakers and professional bodies to reconcile the imperative of safeguarding children with the imperative to respect bodily integrity and avoid disproportionate state interventions. The evidence suggests that the current investigative paradigm, while well-meaning, risks undermining the trust and dignity of the very communities it aims to protect. Greater emphasis on culturally informed, multidisciplinary approaches and enhanced procedural safeguards could forge a path toward more just and effective responses to suspected FGM in Sweden.
Subject of Research: Female Genital Mutilation (FGM) investigations and genital examinations in Sweden, 1982–2022
Article Title: Genital examinations in cases of suspected ‘female genital mutilation’ in Sweden 1982–2022: lawful decisions resulting in structural injustice
Article References:
Johnsdotter, S., Wendel, L., Grönvall, K. et al. Genital examinations in cases of suspected ‘female genital mutilation’ in Sweden 1982–2022: lawful decisions resulting in structural injustice. Humanit Soc Sci Commun 12, 1191 (2025). https://doi.org/10.1057/s41599-025-05476-6
Image Credits: AI Generated
