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female genital mutilation important uk healthcare challenge health benefits female genital mutilation associated lifelong physical psychological sexual impacts annual cost nhs care survivors 100m deinfibulation may improve health wellbeing women consensus optimal timing surgery type 3 survivors uk care provision reportedly suboptimal aimed explore views survivors men healthcare professionals timing deinfibulation surgery nhs service provision qualitative study informed sound silence framework framework useful researching sensitive issues healthcare needs marginalised populations total 101 interviews 44 survivors 13 men 44 healthcare professionals conducted supplemented two workshops affected communities participants n 10 one workshop stakeholders participants n 30 data analysed using hybrid framework method clear consensus groups optimal timing deinfibulation however within groups survivors expressed preference deinfibulation pre pregnancy healthcare professionals preferred antenatal deinfibulation caveat survivors choice consensus among men agreement deinfibulation take place hospital setting undertaken suitable healthcare professional decisionmaking around deinfibulation complex deficiencies professionals awareness knowledge understanding resulted impacts provision appropriate care although examples good practice positive care interactions general service provision opaque remains suboptimal deficiencies notable mental health deinfibulation reportedly helps mitigate impacts female genital mutilation interactions survivors healthcare professionals disproportionately framed around law way services planned provided often silences perspectives preferences survivors families minority interviews conducted language english recruitment survivors predominantly maternity settings meant voices may heard sample men relatively small limiting interpretation general service provision remains suboptimal silence perspectives preferences survivors deinfibulation services need widely advertised information highlight procedure carried hospital suitable healthcare professionals range time points offered facilitate choice future services developed survivors ensure clinically culturally appropriate guidelines updated better reflect needs survivors ensure consistency service provision research needed 1 map female genital mutilation service provision 2 develop test effective education address deficits awareness knowledge affected communities healthcare professionals 3 develop monitor evaluate clinically culturally competent female genital mutilation services current controlled trials isrctn14710507 project funded national institute health care research nihr health technology assessment programme published full health technology assessment vol 27 3 see nihr journals library website project information