No one was sure exactly what was going to happen.

The midwife told Susannah she would make her a ''beautiful lady''.

''A woman without circumcision, she will stink, her husband he's not going to like her,'' she was told.

''We as children were happy to do this because mum told us that and we believe our mum no matter what they say,'' Susannah says. ''I'm happy because all my cousins are going to do the same thing.''

One by one Susannah and her cousins were circumcised. They were lucky because the midwife used an anaesthetic. But afterwards the pain was shocking.

Susannah heard her cousin cry out when she went to the toilet. She then tried to avoid urinating but her older relatives made her.

''They pushed me into the room and made me do two or three drinks of water and I did one [urinated] and I screamed,'' Susannah says.

''Then I woke up in bed. My mother said, 'Your cousins didn't do that.' I said it hurt. My mother said, 'Now you're a lady.' So I thought it was a good thing.''

Susannah, from an African country, later moved to Australia with her four children.

She never enjoyed sex. Childbirth was difficult, as is typical for victims of female genital mutilation (also known as female circumcision), a practice in which the genitals are partially or completely removed.

When Susannah first gave birth she was attended by a doctor who reopened her vagina. But this does not always happen, which means the baby may be unable to pass through the birth canal, possibly resulting in the death of mother, baby or both.

Aside from the risks at the time - including severe bleeding and trauma - genital mutilation can also cause long-term problems such as infections and nerve damage.

It occurs in more than 40 countries across Africa, southern parts of the Arabian Peninsula and along the Persian Gulf, and in communities across Asia.

It is not a religious practice. It is illegal to perform or assist in arranging the procedure in Australia. It is also illegal to remove a child from the country for the purposes of having it done overseas.

Susannah moved to Australia with her family in 1979.

While working at the district court she became aware of a program run by NSW Health that focused on the health of migrant women, including those with genital mutilation.

It was not until she participated in the program that she realised what had happened to her.

''I didn't hear in my country this was bad,'' Susannah says.

''When I come here and the lady was explaining what happened to us, I was very, very upset. I hate my mother and I really cried. I hate my mother. I hate her.''

Susannah was one of the first women to complete the women's health education course.

She became so determined to protect other girls from undergoing the same trauma that she now runs the same workshops for migrant women she once participated in.

''I fight every family, every woman,'' she says. ''Sometimes it's not the women, it's the family, it's the husband. The man doesn't know how it affects the woman. Still people are convinced they want it.''

The program is based at Sydney's Cumberland Hospital and educators travel all over the state to run the workshops. The program's manager, Vivienne Strong, says a group of male bilingual workers have recently been trained, the first time any health service in the world has employed men to educate their compatriots about genital mutilation.

''Many times the man of the family has the final say about whether a girl is circumcised, so it's really important they understand what's happening,'' Strong says.

''Most of the men I speak to do not understand. It's a taboo subject for men. It's women's business. Unless a woman has the support of her husband, she often can't do anything to prevent the circumcision.''

The job of the community educators, Strong says, is to be ''the bridge between people who know and understand, and the people who have limited understanding of what occurs and who do not know the legislation in NSW''.

Twenty years ago, migrants were not as likely to know that female genital mutilation was banned in Australia.

Now people are more likely to know it's illegal here, so there's a push to do it to younger girls before they arrive, Strong says.

''Sometimes, if a woman marries a man from an FGM-practising community and she is not circumcised, the woman is forced to be circumcised before the marriage can take place.''

The NSW program is so well regarded internationally that community workers in Egypt, Pakistan and Indonesia have requested copies. Susannah has forgiven her mother who, she says, was as much a victim of culture as she.

''I lost my mother, I lost my enjoyment, I lost important things God gave to me,'' Susannah says.

She is committed to eradicating the practice and has worked out a way of reaching women who say they do not want to know about it.

''Some don't want to hear about it so I say I have a nice program about women's health and in between I tell them about it,'' she says, laughing.

For more information about FGM see dhi.health.nsw.gov.au.