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| accessdate=2011-09-27
}}</ref><ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The authors suggested that a “ritual nick,” in which the clitoral skin is pricked or incised, might satisfy these symbolic requirements, and “is no more of an alteration than ear piercing”. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref> the reasoning being that female circumcision had symbolic or ceremonial aspects for many parents,<ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=...female circumcision had symbolic or ceremonial aspects. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref> and offering a "ritual nick" might dissuade parents that were resolute, from sending their daughters to their home countries,<ref>{{REFnews
| last=Luscombe
| accessdate=2011-09-27
}}</ref> The AAP had deviated from a much more forceful statement published in 1998, which unequivocally condemned FGC in any form.<ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=...the AAP revised a much more forceful statement published in 1998, which unequivocally condemned FGC in any form. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref>
The AAP's endorsement of a "ritual nick" sparked a backlash<ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The American Academy of Pediatrics (AAP) sparked a backlash... | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref> which was swift and universally negative. The AAP's recommendation had been perceived by many as a tacit endorsement of the "ritual nick," and an effort to appease parents who threatened to subject their daughters to worse procedures.<ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=...was interpreted by many as a tacit endorsement of the ritual nick... | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref> In short, the AAP was forced to retract its endorsement, and on May 1, Judith Palfrey, President of the AAP, released a statement that read in part, “the AAP does not endorse the practice of offering a ‘clitoral nick’. This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members”.<ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=On May 1, Judith Palfrey, President of the AAP, released a statement... | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref> Palfrey reiterated this stance in an interview with The Lancet, saying “we want to make it clear to the international community we are opposed to any form of female genital cutting, and that includes the ritual nick.” <ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=we want to make it clear to the international community we are opposed to any form of female genital cutting, and that includes the ritual nick. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref> The AAP has since withdrawn the committee's report and has rewritten it completely.<ref>{{REFjournal
| last=MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The AAP has since withdrawn the committee's report and has rewritten it completely. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27
}}</ref>
FGC consists of several distinct procedures. Their severity is often viewed as dependent on how much genital tissue is cut away. The WHO—which uses the term Female Genital Mutilation (FGM)—divides the procedure into four major types<ref name = "WHO - Terminology"/> (see Diagram 1), although there is some debate as to whether all common forms of FGM fit into these four categories, as well as issues with the reliability of reported data.<ref name="Elmusharaf_2006">{{REFjournal
| last=Elmusharaf | first=S. | coauthorsfirst2=N . |last2=Elhadi, |first3=L . |last3=Almroth | title=Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study | journal=BMJ | volume=333 | issue=7559 | pages=124 | url= | quote= | pubmedID=16803943 | pubmedCID=1502195 | DOI=10.1136/bmj.38873.649074.55 | date=2006-07-15 | accessdate=
}}</ref>