"The whole family was gathered in celebration. Everybody was eating and the children were dancing to Egyptian music on full volume," Mahmoud told Al Jazeera.

"Suddenly, the wound [from the operation] tore open, and blood stains spread all over my white dress."

She tried to dance in step with her cousins but the pain was unbearable.

"I was 12 and in deep pain ... I collapsed."

Her circumcision had gone horribly wrong; instead of a clean, straight cut, the barber miscalculated and sliced off her clitoris with a shaky hand, causing the wound to break open constantly.

Condemned cultural ritual

Mahmoud is one of many Egyptian women who have undergone circumcision or female genital mutilation (FGM).

A common cultural ritual that some believe pre-dates Islam, it has been condemned by the Egyptian authorities but remains widely practised.

Muslim as well as Christian women are circumcised in Egypt but the rituals vary in each community. The most popular ritual is meant to ensure fertility after the girl gets married.

"When a girl gets circumcised they take the clitoris, powder it with sugar and attach it to the upper arm with a thread," says Mahmoud.

"They say the girl has to be 'sweet' when she gets married. In our culture that means the girl will be able to have a lot of children."

Most families wait until the summer to have their daughters circumcised so that the girls have ample time to heal before school starts in the fall.

After having the clitoris tied to the arm for a week, the family performs another ritual by throwing the dried remnants into the Nile.

Not religious

Amel Fahmy, the technical officer at the World Health Organisation (WHO) department of reproductive health and research and an expert on FGM at the UN Population Fund (UNFPA), said: "The procedure isn't confined to religious boundaries but has deeper cultural roots."

Fahmy says many Egyptians believe that in addition to the perceived hygienic benefits, a circumcised genital area is more aesthetically pleasing and contributes to the overall beauty of the woman.

It also is a rite of passage for young girls into womanhood.

"These rituals are hard to track back and they are definitely not Islamic, but there are also no records of similar ancient Egyptian rituals. I think, somehow through time, they just manifested in the Egyptian culture. Nowhere else that I know of, where FGM is practiced, do they perform these rituals," Fahmy said.

Awareness campaigns

According to the UN, Egypt, Guinea and Mali are ranked as having the highest FGM prevalence rates in Africa.

A 1996 demographic and health survey showed that 97 per cent of Egyptian women between the ages of 15 and 49 have been circumcised.

According to 2005 data published by the WHO, some 94 per cent of married Egyptian women were found to have been circumcised between the ages of 9 and 18.

In the past decade, the Egyptian government, in collaboration with the UN Development Programme (UNDP), and the National Council for Childhood and Motherhood (NCCM), has mounted successive - and aggressive - campaigns to raise awareness of the inhumane and illicit practice.

A ministerial decree condemned the practise in September 2007 and there are efforts under way to sentence to jail those who perform the dangerous operations. 

Street barbers

Until recently, FGM was mainly performed by local street barbers, using unhygienic razor blades that could result in infections.

In September 1994, CNN aired footage of a FGM operation as world leaders gathered for a UN conference on population and development in Cairo.

The Egyptian government was pushed into action and in 1996, the ministry of health and population banned FGM in state hospitals.

However, resistance has emerged in the most unlikely of quarters; one of the biggest obstacles facing human rights advocates is the widespread acceptance of the procedure by the medical community.

In 1996, a group of Egyptian doctors challenged the ban saying that female genital circumcision was entrenched in Islamic life and teaching. 

When several girls bled to death after being circumcised by street barbers, many families resorted to doctors who could charge as little as 150 Egyptian pounds ($27) in poorer areas and up to 1,500 ($270) in middle and upper class residential areas of Cairo.

Fahmy says, "The medicalisation of the procedure has almost legitimised it even more. This has to stop."

In November 2006, a conference of scholars from the Muslim world ruled by overwhelming majority that FGM was contrary to the teachings of Islam and should be stopped immediately.

It was not until June 2007 when an 11-year-old girl died while a doctor performed the procedure that the government universally banned the practice.

Sanctioned by religion?

However, Fahmy concedes that eradicating FGM entirely has been hindered by the common arguments tying the bloody practice to Islam.

Others claim that FGM is a remnant of ancient Egyptian rituals, though there has been no historical evidence supporting such a theory.

Ali Gomaa, the grand mufti of Al Azhar University, the highest body of jurisprudence in Sunni Islam, issued a fatwa - or religious edict - in late 2007, clearly denouncing FGM.

He emphasised that FGM is a sin and forbidden in Islam.

However, that has failed to stop many from continuing the practice.

A beautiful cut?

Mahmoud now uses her experiences to educate young women in Egypt's rural areas about the illegality and adverse effects of FGM.

Despite the ordeal she says she has been through, Mahmoud remains boisterous and energetic, telling jokes and teasing her friends.

"This is the only way I can deal with what has happened to me. I have to laugh about life. Otherwise I would cry all the time," she said.

"And to be quite honest some of the things I went through seem funny in retrospect."

She and Fatma Ibrahim, who was circumcised when she was 10, are part of a team that regularly visits schools and colleges educating young women about FGM.

However, they realised early on that it is important to educate adolescent men about the procedure and its consequences as well. 

"The only way we can get the support from boys and men is by playing on their selfishness," said Mahmoud.

"When we go to youth centres around Egypt, we make clear to the boys that a circumcised woman will at the end of the day be worse in bed. We tell them men will have less pleasure if she is circumcised and that it is much more fun for him if she isn't."

"If we tell them that it is only bad for the woman. They wouldn't care," she told Al Jazeera. 

Intolerable crimes

In 2008, the NCCM launched large billboard campaigns on main highways and thoroughfares, bought television commercials to target a broad audience, and set up a national hotline as part of its media drive hoping to change perceptions.

Their message is that FGM will no longer be tolerated by the authorities. 

Ibrahim says people frequently call the hotline with questions about the safety and appropriateness of FGM. She says many are confused and some parents are seeking help for their daughters.

The UNDP has been assisting the NCCM in holding lectures in elementary and high schools and has launched the Free Village Model whereby 120 villages throughout Upper and Lower Egypt promise to actively tackle FGM after participating in workshops and attending lectures.

According to a study by the Egyptian Demographic and Health survey (EDHS) in 2005, the prevalence of FGM among girls aged 11 to 17 dropped to 66 per cent, indicating a trend change over the time of a generation. 

However, Ibrahim and Mahmoud say this is not good enough.

Source: Al Jazeera