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Picture a seven-year-old girl, bubbling with excitement because her mom promised her a new doll and some sweets after a quick outing. She’s all dressed up, maybe even a little nervous, but happy. Then she’s led into a quiet room. Her favourite aunt—someone she trusts—holds her down. Suddenly, there’s a blade. There’s no painkiller. No doctor. Nobody explains what’s happening or what she’s losing. And the worst part? This isn’t some horror story from the distant past, or something that only happens far away in rural Africa. It’s happening right now, behind closed doors, in Dawoodi Bohra homes across Mumbai, Surat, and so many other Indian cities. They call it Khatna.

Female Genital Mutilation, or FGM, isn’t just one awful moment. The World Health Organisation says it’s any procedure that removes part or all of the external female genitalia for no medical reason. More than 230 million girls and women around the world are living with it—across 30 countries in Africa, the Middle East, and Asia. The damage starts the second the blade cuts, and it doesn’t stop. Survivors carry those wounds for life. The real key to understanding why FGM is such a lasting medical disaster? It’s buried in what happens under the skin: the stubborn, relentless science of scar tissue.

The Reality and Scale of FGM in India's Hidden Backyard

In India, people call FGM “Khatna” or “Khafz.” It almost always happens inside the Dawoodi Bohra community, a Shia Muslim sect with about one to two million members, mostly living in Gujarat, Maharashtra, Madhya Pradesh, and Rajasthan. You don’t hear about it much—the whole thing hides behind silence and shame. For a country as big and noisy as India, it’s shocking how little gets reported about this kind of human rights abuse.

Sahiyo, a group fighting to end FGM in Asia, teamed up with WeSpeakOut and found that around 75% to 85% of Dawoodi Bohra women have gone through Khatna. Most were only six or seven at the time. In a bigger survey—385 Bohra women, between July 2015 and January 2016—80% said they’d been cut. But here’s what really hits you: 82% of those same women said they wouldn’t do this to their own daughters. That’s a huge gap between what people feel inside and what they’re pressured into doing. The weight of tradition is heavy, even when most people privately disagree with it.

Among the Bohras, the cutting usually lines up with what the WHO calls Type I FGM—taking off part or all of the clitoral hood, and sometimes the clitoris itself. But most women don’t even know exactly what was done to them. In Sahiyo’s survey, 65% couldn’t say what kind of cutting they’d had. Dr Sujaat Vali, an obstetrician and gynaecologist, actually examined twenty Bohra women. In most cases, she found their clitoris, not just the hood, had been cut. Half of those women still felt irritation, and 30% said it hurt to walk or pee, or they’d lost all sensitivity.

The Procedure and the Immediate Medical Risks

People in some communities justify Khatna by saying that removing part of the clitoris will lower a woman’s sexual desire. They talk about “taharat”—purity—before marriage, and believe it guarantees faithfulness afterwards. They label the clitoral hood or glans as “haraam ki boti,” basically calling it a sinful piece of flesh. This idea is deeply rooted in patriarchy. It’s not supported by Islam—the Quran doesn’t mention female circumcision at all—and there’s zero backing from medical science.

The World Health Organization is crystal clear: FGM has no health benefits. None. What it does have is a long list of immediate, dangerous risks. Girls can bleed heavily from the clitoral artery, go into shock, or develop septicemia (blood poisoning). Using unsterilized tools opens the door to tetanus. The pain and trauma alone can send the body into neurogenic shock. Infections spread fast—especially when one blade is used on several girls in the same ceremony. That’s how bloodborne diseases like hepatitis B and HIV get passed around. There have even been cases of necrotising fasciitis, a brutal flesh-eating infection, after FGM. One young Bohra girl in India developed sepsis after Khatna and needed major emergency treatment to survive.

The Science of Scar Tissue: Why the Wound Never Truly Heals

To really get why FGM is a lifelong medical crisis, you have to start with scar tissue—what it is, and why it’s especially destructive in the genital area. Normally, wounds heal in four steps. First, your body stops the bleeding. Then, immune cells rush in and spark inflammation. After that, the tissue starts to rebuild, and finally, the scar matures. When this process goes smoothly, collagen forms a neat, organised lattice that gives the tissue strength.

But things rarely go smoothly for FGM survivors. The genital area is packed with blood vessels, nerves, and all sorts of sensory receptors—it’s nothing like skin on your arm. Instead of healing cleanly, the body often creates a keloid: a big, dense mass of scar tissue that actually grows beyond the original wound. According to a huge review in BMC Public Health—almost 487,000 women from about 30 countries—women who’ve had FGM are more than twice as likely to develop tissue damage like keloids, neuromas, or vulvar cysts. For those who went through Type I or II FGM, the risk of this kind of damage jumps to over nine times higher compared to women who haven’t been cut.

One of the worst outcomes is traumatic neuromas. The clitoris alone holds around 8,000 nerve endings—more than almost anywhere else in the body. When FGM severs these nerves, the body tries to regrow them, but without a clear path, the nerves form messy, tangled lumps inside the scar. These are neuromas: not cancerous, but incredibly painful. Research from the NIH describes how these neuromas form when injured nerves heal chaotically, turning into disorganised knots of nerve fibres that can cause relentless pain for life.

Then there’s the scar tissue itself. It’s stiffer and less stretchy than normal vaginal or clitoral tissue, setting off a domino effect of other health problems. Scar tissue can block or narrow the urethra, making it hard to pee and leading to constant urinary tract infections—something that shows up in as many as 22% of FGM survivors. Menstrual blood and vaginal fluids can get trapped, leading to chronic pelvic infections, cysts, and even abscesses. The World Health Organisation reports that women with FGM are over 3.5 times more likely to get urinary tract infections, and almost twice as likely to have trouble urinating or experience pain when they do.

Childbirth: When Old Wounds Become New Emergencies

The most dangerous thing about FGM scar tissue shows up during childbirth. That tough, unyielding tissue across the vaginal opening just doesn’t give the way normal skin does. When it’s time for a woman to deliver, the scar holds firm instead of stretching. So labour gets blocked. It’s not just painful—it can kill both mother and baby.

The numbers are hard to ignore. One huge WHO study looked at 28,000 women in six African countries. They found women with FGM faced way higher risks: labour dragged on, bleeding after birth was more common, more perineal injuries, and more C-sections. For every 100 births, FGM caused one or two extra babies to die around the time of delivery. Later studies back this up. A BMC Public Health review found that women with FGM are 2.6 times more likely to have long or blocked labour. The chance their baby is stillborn or dies soon after is 1.6 times higher. Type III FGM is even more dangerous—these women are 70% more likely to haemorrhage and twice as likely to die giving birth.

Then there’s the risk of obstetric fistula. The Orchid Project reports that women with FGM are far more likely to end up with this devastating injury—a hole between the birth canal and bladder or intestines. It leaves them leaking constantly, cast out from their communities, and suffering deeply. All this adds up to a staggering cost. WHO estimates the world spends about $1.4 billion every year just to treat FGM complications. And unless something changes, that number keeps climbing.

The Psychological Wound: Betrayal Trauma and Its Lifelong Shadow

You can’t see the physical scars from FGM just by looking, but the psychological wounds run just as deep—and they have their own way of cutting through someone’s life. There’s actually a name for this kind of pain: “betrayal trauma.” It’s what happens when the person who hurts you is someone you trust completely, someone you depend on. With Khatna, it’s usually the child’s own mother, grandmother, or another close female relative—the very people who are supposed to keep her safe.

The Sahiyo survey really brings this to life. Survivors talk about being promised candy or toys, only to end up pinned down while a stranger did the cutting. Sometimes, mothers just walked out of the room because they couldn’t bear to watch. Often, no one even explained what happened, and the whole community stayed silent, as if nothing had happened at all. One woman shared how she waited outside a room, listening to another girl scream, before being led in herself—her own aunt holding her down while someone used a razor blade on her genitals. She was under seven. No doctor. No anesthesia. No consent. Just pain and confusion.

The psychological fallout doesn’t just fade away. The BMC Public Health meta-analysis shows women with FGM are almost twice as likely to develop PTSD, and nearly three times as likely to struggle with depression or anxiety. Many talk about feeling cut off from their own bodies, like their anatomy is something to fear or hide. Pleasure seems out of reach for many, and sex hurts. Some spend years in therapy just to get close to someone again. Right after Khatna, 23% of women in the Sahiyo survey said they dealt with pain, bleeding, burning when they peed—and a lot of them can’t even remember everything that happened. That’s what dissociative trauma looks like.

Legal Status and the Fight for Change in India

India doesn’t have a specific law that bans FGM. Back in April 2017, a human rights lawyer from Delhi, Sunita Tiwari, took the issue to the Supreme Court. She filed a Public Interest Litigation—Sunita Tiwari vs. Union of India—saying the practice breaks several parts of the Constitution: the right to life with dignity, equality, and protection from discrimination. She also pointed to the UN Convention on the Rights of the Child. The case bounced from a five-judge bench in 2018 to a seven-judge bench the following year, and it’s still stuck there. The delay really shows just how tangled the debate is between individual rights and religious freedom in India’s legal system.

FGM isn’t directly mentioned in the Protection of Children from Sexual Offences (POCSO) Act of 2012. Still, legal experts say the law’s rules on aggravated sexual assault—especially when a family member or a weapon is involved with a child under 12—cover what’s known as Khatna. Even the Supreme Court agreed at one point that POCSO applies here. But community leaders push back, insisting there’s no “sexual intent” with Khatna, which POCSO requires.

All this legal back-and-forth happens while community pressure keeps the practice alive. In the Bohra community, if a family refuses to have their daughter cut, they can get kicked out, losing almost everything—friends, support, even their livelihood. That threat of isolation is what keeps the tradition going, far more than any deep religious belief. Kids just don’t get a say.

Breaking the Silence: The Survivor-Led Movement

In India, the real force pushing back against Khatna isn’t the law—it’s the determination of survivors. Groups like Sahiyo, started by Bohra survivors like Aarefa Johari and Mariya Taher, along with WeSpeakOut and the Asia Network to End FGM/C, have turned this fight into a movement. They keep survivors at the heart of it all. Through photo campaigns, storytelling, documentaries, and retreats, they’ve carved out places where women—who were always told to keep quiet—finally get to share their stories.

Sahiyo’s survey didn’t just reveal that Khatna is common (80% prevalence). It also found that 81% of Bohra women don’t want it to continue. That’s huge. Imagine it: eight out of ten women, tired of the pressure to conform, quietly stand against the practice. The trouble is, they don’t have the support—legal or otherwise—to push back openly. That’s why survivor advocates keep saying: we need a law that bans FGM. It’s the first thing that will let these women refuse, and do it without fear.

Scar tissue doesn’t lie. When someone cuts healthy genital tissue for no medical reason, the body reacts in ways you can’t ever fully reverse. Keloids show up, nerves twist into painful knots, the urethra can get blocked, and birth canals can stiffen. The worst part? The mental scars often harden into PTSD that sticks around for life. Khatna isn’t just a “small nick,” and it’s not some harmless tradition. The WHO, the United Nations, and more and more Bohra women who’ve survived it keep saying it loud and clear: this is a lifelong medical crisis forced on a child who never got to choose.

People can’t pretend Khatna in India is a secret anymore. The proof is everywhere—surveys, courtrooms, medical journals, and most of all, in the stories and bodies of hundreds of thousands of women. The only real question left is whether India will finally listen, and whether the law will step in to protect a seven-year-old girl from the blade.

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