Madina has no fond memories of her teenage years. She suffered all of them, and many more, in abject agony and shame.
She had barely entered adolescence when she was subjected to one of the most severe forms of female genital mutilation (FGM) - infibulation. It involves cutting parts of the vagina and repositioning exposed tissue to create a seal that narrows the opening of the female organ to the size of a tiny hole that just about allows for passing of urine and menstrual blood.
Madina was too young to understand what was happening to her. Like all other young girls in her ethnic Fulani community in Mali, she was required to go through this rite of passage before the onset of puberty. "All I know is that I had severe problems immediately after being cut. I remember going through a very agonising cycle of puberty. I remained covered in pain and humiliation," says Madina who is now in her 50s.
Infibulated girls often have their legs bound together for anything up to four weeks to allow for freshly fused tissue to heal into a barrier. For families it is a seal of guarantee that secures girls against any sexual encounter prior to marriage and protects the family honour.
"I cannot even explain the feeling of terror that runs through infibulated girls' minds thinking of marriage," says Madina. On the day of their wedding, brides undergo another painful surgery to reverse the procedure. This involves cutting open the connecting tissue created by infibulation to restore the vaginal opening to enable sexual intercourse with their husbands. "It is only after completing this procedure an excised bride is considered 'free'. She usually has her first sexual experience the very same night after cutting," says Madina.
Every year, hundreds of thousands of girls - mostly in Africa and the Middle East, are subjected to intentional mutilation of their genitalia for non-medical reasons on the basis of a variety of traditional beliefs and cultural practices. According to the World Health Organization about 140 million girls and women worldwide are currently living with the consequences of FGM. Of these, about 125 million are concentrated in Africa and the Middle East alone. As the practice continues, 30 million girls are still at risk of being cut in the next decade.
Girls enacting a traditional excision ceremony in Guinea. Plan / Mary Matheson
In most places where it is practised, FGM is considered an essential part of raising a girl and preparing her for womanhood and marriage. In countries such as Somalia, Guinea, Djibouti and Egypt more than 90 percent of all girls undergo genital mutilation. With a huge premium placed on virginity and marital fidelity, the pressure is intense to control sexual behaviour and prevent any "illicit" sexual acts. The degrading treatment is preserved and promoted as a cultural ideal of femininity and modesty. Girls are routinely told it makes them "clean" and "beautiful".
There are no health benefits associated with FGM. In the majority of cases 'cutting' is done by a traditional practitioner without any anaesthesia and little care for hygiene. Blades, knives or scissors are commonly used, and they are rarely sterilised. The cutting takes place wherever it is convenient - from out in the open to the bathroom floor.
Thousands suffer health complications and damage to their healthy and normal genital tissues as a result of FGM procedure. Immediate complications can include severe pain, shock, bleeding and infection whereas life-long consequences range from conditions interfering with natural bodily functions to infertility, childbirth complications and newborn deaths. Only last year 13-year-old Soheir al-Batea died in a clinic in Egypt when a local doctor performed a procedure to slice off her clitoris as instructed by her family.
From verbal threats and physical force - all sorts of methods are used to coerce unwilling girls into submission. "I will never forget that day. My mother woke me up very early in the morning and told me firmly to get ready for circumcision," says 13-year-old Ahlam from Egypt. Immediately, an old woman entered the room and got a razor out of her bag. My mother held my arms very tight so that I could not move. The woman used her razor to circumcise me. I cried loudly, but nobody listened, the pain was unbearable. A few hours later, I started to bleed."
FGM is recognised internationally as a violation of the human rights of girls and women and constitutes an extreme form of discrimination against women. In the majority of countries, where FGM is concentrated, there are national laws prohibiting the practice. Additionally nations are bound by regional and international treaties. Despite this prosecutions are extremely rare. Often customary laws governing traditional practices are used to override such treaties.
Genital cutting is now also being reported from new parts of the world. According to a recent Unicef report, minority groups and immigrant communities from Africa and the Middle East where FGM is concentrated, continue to practise cutting in other countries, including Europe and North America. This means that the overall FGM figures could be higher.
Legislation and enforcement alone will not end FGM. A much wider effort, involving communities who practise them, is required to change deep-rooted attitudes and social norms. Child rights organisation Plan International is successfully using community mobilisation approach in Africa to bring about lasting change. The organisation works in several African countries where FGM practice is most concentrated and uses engagement with communities, religious leaders and children in addition to working with the governments to end the practice.
"Through community awareness and education 44 villages in areas where we work have declared themselves FGM-free," says Madina who herself has undergone a transformation from being someone who was subjected to infibulation in her childhood to leading Plan's project to eliminate FGM in her country Mali. "Besides parents and elders, engaging with children and young people, is key part of our approach. Girls and boys are not only rights holders themselves but also future parents who will play a crucial role in ending this generational scourge," she says.
Campaigners like Madina have a tough job on their hands. FGM continues to be practised, tolerated and endorsed as a private familial matter sanctioned by customs and traditions on too vast a scale.
FGM needs to be put on political centre stage. It needs the hashtags, the likes, the virals to bring the silent suffering of millions out in public discourse.
Until such time 140 million girls and women will continue to be told that their genitals have been cut and mutilated to make them "clean" and "beautiful".
(A long version of this article first appeared on Al Jazeera.)