Female genital mutilation (FGM), also known as female circumcision, is a procedure that removes part or all of the external female genitalia. It is generally performed as part of a ritual. Female genital mutilation is carried out on girls between infancy and puberty. It is largerly a traditional circumcision most likely without anesthesia. The FGM procedure differs depending on what region of the world it is being performed in. Some versions involve the removal of only the clitoral hood and clitoris. A more extreme version, also referred to as "infibulation", also removes both the inner and outer labia and closes the vulva leaving only a small hole for urination and menstruation. In the case of infibulation, the vagina must be opened to allow the woman to engage in sexual intercourse and to give birth.