The beliefs surrounding the origins of female genital mutilation vary greatly. The predominant school of thought is that FGM originated in ancient Egypt and then spread to East Africa, hence the term 'pharaonic circumcision' coined by the Sudanese. The earliest record of the custom was made by Strabo, the Greek geographer and historian who reported excision on Egyptian girls in 25BC. It is believed that the practice was occurring some centuries before this however, and was spread by dominant tribes and civilizations as a result of tribal, ethnic, and cultural allegiances.
The age at which FGM is performed varies widely between cultural groups. In some groups, FGM is performed as early as infancy, while in other groups the practice may not occur until the girl is of marriageable age, approximately 14 to 16 years old. The most typical age for infibulation seems to be between six and eight, although the age is generally falling, indicating that FGM is having less and less to do with initiation into adulthood. It is also reported that refugees seeking asylum in Western countries are performing the procedure on their daughters at a much younger age so as to overcome laws in recipient countries prohibiting the practice.
FGM is most frequently performed in rural areas by traditional birth attendants, midwives, or 'circumcision operators'. The procedure is carried out using special knives, scissors, razor blades, or scalpels. Anaesthetics and antiseptics are not generally used and pastes containing herbs, local porridge, or ashes are frequently rubbed on to the wound to stop bleeding. The girl is held down by female relatives to prevent her from struggling and there may be unintended damage due to crude tools, poor light, and septic conditions. In urban areas however, FGM is being performed more frequently in hospitals under anaesthetic by trained doctors, nurses, and midwives.