When Jane was about 9, her mother drove her and her friend to a Houston strip mall. She told Jane there was something dirty on their bodies that needed to be cleaned. There, in an empty room, a woman subjected them to female genital mutilation.

“I remember feeling pain for a good three weeks after that. I was continuously bleeding, it hurt to use the restroom,” Jane, who is now 28, said. “It was never something that was discussed even after it happened.”

Jane, who spoke anonymously to protect her family’s identity, is one of a growing number of American survivors breaking the silence on the centuries-old practice of FGM. Despite reports of FGM being performed on Americans, in December a Michigan district judge struck down a federal ban on the practice, leaving girls in many states at increased risk. In April, President Trump’s Department of Justice ignited outrage by declining to appeal the case.

Girls undergo FGM both in the U.S. and abroad, a practice called “vacation cutting.” While recent concern over FGM is centered around diaspora communities from high-prevalence countries in Africa, Asia, and the Middle East — Jane was raised in the Dawoodi Bohra community, a Muslim sect with roots in India — the practice isn’t unique to just one cultural or faith group. In recent years two white women from Christian backgrounds have spoken out publicly about undergoing FGM as children in North Dakota and Kentucky, in the late 1940s and early 1980s, respectively.

The practice is often described as a rite of passage, and the reasons used to justify it include sexual control and marriageability. The severity ranges from pricking or cutting the clitoris to narrowing the vaginal opening. FGM can cause severe bleeding, urinary issues, pain during sex, and pregnancy complications, as well as psychological trauma.

More than 200 million girls and women around the world have been affected. But the secrecy around the practice in the U.S. makes it impossible to know the number of girls and women affected here. The taboo prevents many survivors from coming forward, even as adults.

To offer healing, F.A. Cole, an activist who was subjected to FGM in Sierra Leone as a girl, formed a survivors support group in Washington, D.C. For some of the five women attending the group’s first meeting in March, it was their first time sharing their experience.

“I know it's happening on American soil, but people aren’t going to talk about it. People are afraid of retaliation, and they're also afraid of being ostracized by their family and their communities,” said Cole.

But activists say anecdotal reports show it is more far-reaching than previously thought.

“It seems like every year we learn that it's happening in another community, and not because it just simply started but because no one ever knew or was aware that it happened,” said Mariya Taher, a survivor and founder of Sahiyo, a storytelling organization focused on ending FGM in Asian communities.

In 2017, two Detroit doctors were indicted for allegedly performing FGM on at least nine underage girls. The case brought the issue into the public eye — and challenged assumptions that the U.S. ban of FGM, passed in 1996, was working. Six others, including the girls’ mothers, were also charged for their roles.

But despite the case providing evidence that FGM was indeed taking place on American soil, the Michigan district judge ruled Congress had overstepped on states’ rights by enacting the statute in the first place. All FGM-related charges were dismissed, and the federal ban was thrown out.

With the DOJ refusing to appeal, banning FGM is now up to states. Seventeen still don’t have FGM-specific legislation, and lack strong tools to prosecute or deter the practice.

VICE News talks to survivors turned activists about how they're advocating for change and providing safe spaces for others like them.