Each year, an estimated 2 million girls worldwide undergo excision or female genital cutting (FGC). FGC is practiced throughout West Africa, but Guinea has a particularly high prevalence of 98%.

Nearly 50 years after her excision, Tante Mado still finds it traumatic to discuss the experience.

"The day of my excision I bled a lot and went into shock. My mother cried and screamed thinking I was dead . . . These are very painful memories. Excision was worse than giving birth."

Most excisions are performed without anesthetic. The first experience is extreme, with unexpected pain. The most common immediate complication is excessive bleeding due to accidental cutting of a major vein or artery. Other complications are urinary retention, tetanus and other wound infections. Deaths of girls during initiation ceremonies are not uncommon. In the long term, there are complications for giving birth, menstruation, scarring, as well as problems for sexual intercourse.

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