Countries that have banned female genital mutilation should allow less invasive practices such as small surgical nicks to girls' genitalia as a compromise, two U.S. gynecologists said on Monday.

But campaigners against mutilation strongly criticized the proposal, saying it would undermine global efforts to eradicate the internationally condemned ritual.

At least 200 million girls and women have been subjected to FGM in over 30 countries, according to UN estimates.

The ancient practice usually involves the partial or total removal of a girl's external genitalia. In some cases the vaginal opening is also sewn up.

But some communities practice less invasive rituals such as pricking or nicking the clitoris.

The U.S. gynecologists, writing in the Journal of Medical Ethics, argued that permitting more minimal procedures could allow families to uphold cultural and religious traditions while protecting girls from more dangerous forms of cutting.

Communities which support FGM often consider it a prerequisite for marriage. Many also see it as a religious obligation, although it is not mentioned in the Qur'an or Bible.

But female genital mutilation can cause a host of physical and psychological problems.

Gynecologists Kavita Shah Arora and Allan Jacobs said procedures that slightly changed the look of a girl's genitalia without damaging them were comparable to male circumcision or cosmetic procedures in Western countries like labiaplasty.

Laws against mild modifications were "culturally insensitive and supremacist and discriminatory towards women", they wrote in the specialist publication that is published by the British Medical Journal.

'Behind the times'

Female genital mutilation is practised in many African countries, pockets of Asia and the Middle East, as well as by diaspora communities living in the West.

The gynecologists suggested that global attempts to stamp out FGM with legislation had failed and may be driving the practice underground.

"We are not arguing that any procedure on the female genitalia is desirable," they said. "Rather, we only argue that certain procedures ought to be tolerated by liberal societies."

They said the term "female genital mutilation" should be replaced with the less emotive "female genital alteration" to avoid "demonising important cultural practices".

But experts on medical ethics, commenting on the proposal, said procedures to modify girls' genitals could not be compared to male circumcision because they are designed to control women and curb their sexual desire.

They also predicted that legalising more minimal procedures would generate a litany of legal, regulatory and medical problems.

Global campaigners against FGM said doctors should challenge harmful social norms, not condone them.

"Any form of FGM is a violation of a child's rights," said Adwoa Kwateng-Kluvitse, head of global advocacy at the charity FORWARD, which campaigns against FGM in Africa and Europe.

"Why would you put a little girl through that? There should be no medicalization of FGM. They [the gynecologists] are completely behind the times.

"This is very different to male circumcision."

In 2010, the American Academy of Pediatrics made a similar proposal. Within a month, the contentious statement was retracted.

In an email, the Society of Obstetricians and Gynaecologists of Canada said female genital cutting is recognized as a harmful practice and a violation of girls' and women's rights to life, physical integrity, and health.

Performing or assisting in female genital cutting is a criminal offence in Canada.