My Lords, the Medical Women's Federation, of which I am a past president, has for many years called for action to prevent female genital mutilation. I feel humbled to follow the noble Baroness, Lady Rendell of Babergh, and the noble Baroness, Lady Gould of Potternewton, who has campaigned to outlaw this barbaric practice for many years and to try to safeguard the girls in Britain who are at risk of female genital mutilation.

Female genital mutilation is just that—it is excessively mutilating. I have thought long and hard about whether to outline what happens. I feel that, as a doctor, not to do so would be to comply with the myth that has sustained denial about how terrible female genital mutilation really is. However, I sympathise with Hansard who have to transcribe our words.

The girls, usually between seven and nine years of age, are subjected to forcible restraint and, without any anaesthesia, have their genitalia operated on. Do not forget that, anatomically, this area is highly innervated with sensory nerve endings, so the pain is excruciating. Girls have died from the force of being restrained. The same blade is often used on girl after girl. There is no aseptic technique and there are deaths in Africa from infection, including from gas gangrene. Since HIV in children is now increasing through vertical transmission, cross infection must also now be considered a risk.

The mutilation ranges from cutting off the skin over the top of the clitoris, to completely cutting off the labia minora and even the middle third of the labia majora—the inner and outer lips of the vagina—and stitching and/or clamping the vaginal wall closed around a piece of wood, so that just urine and menstrual blood can escape, although stagnant pools of blood often remain behind the scars. If the girl does not die at the time from haemorrhage or infection, the scarring is horrible. When pregnant, these women have terrible labours, with the risk of major tears and the resulting incontinence of faeces.

Cutting the clitoris is done to reduce the woman's sexual desire and, hence, to ensure her virginity until she is married. The more extensive operations involve stitching the vagina and have the same aim of ensuring chastity until marriage. The reduction in the size of the vaginal opening is supposed to increase the husband's enjoyment of the sexual act. It does not. Penetration may be difficult and very painful for both partners, if possible at all. Sometimes, these couples present as infertile, but actually penetration has never occurred.

From the family's point of view, social and religious pressures mean that the operation ensures a satisfactory bride price. An eligible man would not consider marrying a girl who had not had the operation. The practice is widespread in Africa, especially in Somalia, among all communities, not only the Muslim groups. By and large, female genital mutilation is carried out in Western countries among immigrants from African countries. Conservative estimates in the UK published in the British Medical Journal suggest that about 10,000 girls are currently at risk or have been mutilated. Yet, no prosecutions have been brought, as the previous speakers have said. That demonstrates that, sadly, the previous legislation proved impotent.

It is estimated that about 32,000 to 42,000 girls are at risk in France and possibly 168,000 in the United States. It is not a minor problem. The operation can be regarded as an exercise in male supremacy for purported sexual pleasure. Many genitally mutilated women who have had their daughters mutilated to make them marriageable report bitterly regretting it.

This is a major issue for male education to alter men's attitudes and to safeguard the lives of girls. For too long, our society has been cowardly in addressing just how terrible female genital mutilation is. The Bill should act as a template for other governments. It must move unhindered and with speed.