The notion of doctors performing surgery to remove the female genitalia of elementary school-aged girls seems unthinkable in modern-day America — yet authorities have charged four people in connection with the genital mutilations of young girls.

Such procedures are illegal in the United States.

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“The high-profile criminal case — the nation’s first federal case since female genital mutilation was outlawed in 1996 — is raising awareness about a procedure practiced by some members of the Dawoodi Bohra, a small sect of Shia Muslims,” The Detroit News reported.

This particular case may involve as many as 100 young girls who have gone through genital mutilations.

All four charged in connection with the case are members of the Dawoodi Bohra.

Some young girls who are getting the procedure done in Michigan have traveled across state lines. Two girls from Minnesota allegedly went through the mutilation process in February at a clinic in the Detroit area in Michigan.

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Officials previously indicted Dr. Fakhruddin Attar and his wife, Dr. Farida Attar, in connection with the case. They worked alongside Dr. Jumana Nagarwala — who allegedly committed genital mutilation on the girls at the couple’s clinic in the Detroit area. Authorities arrested Nagarwala and the Attars back in April.

Tahera Shafiq, 48, was recently charged with conspiracy to commit the mutilation and aiding and abetting, according to reports.

“She is accused of arriving at a Livonia clinic before two girls allegedly were mutilated and leaving afterward, according to federal prosecutors,” The Detroit News reported.

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Lawyers for the alleged conspirators site a religious exemption in defense of the controversial practice. In some religious circles, the mutilation is done to reduce sexual pleasure in women.

One of the seven-year-old Minnesota girls told investigators in the case that she believed she was going on a “special girls’ trip” and had to keep her Detroit clinic visit a secret, the Detroit Patch reported.

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“She said she felt ‘a little pinch’ in the area ‘where we go pee’ and that it ‘hurted a lot’ the next day,” according to court documents, the Detroit Patch noted. “Defense attorneys say the procedure involved only the scraping of a membrane from the girls’ genitalia, which was then presented to their parents for burial. However, medical examinations showed evidence of stitches to close cuts, according to court documents.”