A key element of Sande initiation is the clitoridectomy, or female genital mutilation. A clitoridectomy is often done to remove malignancy or necrosis of the clitoris. In a clitoridectomy for intersex infants, the clitoris is often reduced instead of removed. In the most extreme cases, doctors would perform a clitoridectomy, removing the clitoris entirely. A British doctor, Robert Thomas, suggested clitoridectomy as a cure for nymphomania in 1813. Bariba children are baptized or undergo clitoridectomy as rites of passage. Beta Israel women examined had experienced it; 27 percent had undergone partial or total clitoridectomy. The fact of the clitoridectomy was not disputed by the defense. The shared pain of the clitoridectomy creates permanent bonds among the initiates. Seven sections cover the subjects of clitoridectomy, forced marriage, HIV/AIDS, struggle, survival, economics and politics. Clitoridectomy or clitorectomy is the surgical removal, reduction, or partial removal of the clitoris. In the 19th century, a clitoridectomy was thought by some to curb female masturbation. Clitoridectomy surgical techniques are used to remove an invasive malignancy that extends to the clitoris.