Two Saudi Arabian doctors, crusading against female genital mutilation (FGM), are painstakingly a huge volume of evidence to prove that the practice is detrimental to women's sexual satisfaction. It is in Saudi the FGM is frequently practised.
"I think the local people can make a change. If we can convince people that there is a complication, we can do something to change this tradition," said Dr Sharifa Sibiani from the King Abdulaziz University Hospital in Jeddah, during a presentation at the American Society for Reproductive Medicine's annual meeting in San Francisco.
The female circumcision is usually performed shortly after birth, but can take place during childhood, adolescence or before marriage. It is a long cherished tradition in that most obdurately patriarchal setup.
The World Health Organisation defines FGM as, "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons."
It affects 100m to 140m women worldwide and is particularly prevalent in parts of Africa. In Egypt, Sudan, Ethiopia and Mali, for example, more than 80% of women have undergone FGM.
Although FGM is most prevalent in Muslim communities, it pre-dates Islam (and also Judaism) and is not mentioned in the Qur'an.
Typically, the procedure is carried out by a Daya (an elderly female birth attendant) when a baby girl is a few days old, but it can be done at any time during childhood, adolescence, before marriage or during a first pregnancy.
The scope of the operation - which is often carried out in non-sterile conditions using household implements - can vary considerably from removing the clitoris to cutting away all of the woman's external genitalia before stitching the wound back together leaving only a tiny hole for menstruation and urination.
Sibian's colleague Prof Abdulrahim Rouzi said he knew of a case in which a newly married woman bled to death as a consequence of this more substantial form of FGM. "[My colleague in Sudan] saw an 18-year-old woman dying in front of him because her husband could not penetrate [during sex] - so he had brought a knife and cut her," he said.
For their study, Sibiani and Rouzi interviewed 260 women who were attending the obstetrics and gynaecology clinic at King Abdulaziz University Hospital between February 2007 and March 2008. Half had been subjected to FGM and half had not.
The team asked them to complete a questionnaire on their attitudes towards sex and their experience during intercourse. "To our knowledge, there is no study in the literature to assess female sexual dysfunction after female genital mutilation," said Sibiani.
They found that women with FGM were no more likely to suffer pain during intercourse or experience lowered sexual desire. However, FGM made them less likely to experience arousal, lubrication, orgasm and satisfaction during sex.
Sibiani said the study would be more powerful than any research carried out in the west, because local people would regard that as an attempt by foreigners to denigrate their traditions. "The change must come from inside, not from outside, because otherwise they will reject it."
Rouzi said it was vital to have concrete evidence to help change attitudes. "We want to document the complications so we can go and argue that there is no real basis for this cultural practice," he said. "I'm interested in presenting a scientific-based discussion."
The study will be published soon in the journal Fertility and Sterility.