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In what officials say is a first-of-its kind federal case targeting the practice of genital mutilation, Dr. Jumana Nagarwala, 44, of Northville, Mich., was charged Thursday with mutilating the genitals of two girls, although authorities say they believe she has subjected numerous more girls to the procedure, including children in the metro Detroit area.

One of the children told an investigator this week that they were in MI to see a doctor because "our tummies hurt", and were examined by Nagarwala. "I still hear their screams from down the hallway", she said. That same mother, she said, had previously reached out to Nagarwala and told her that the authorities were asking questions.

With her hand trembling as she clutched some documents in the standing-room-only courtroom, defense attorney Shannon Smith disclosed that Nagarwala did perform a procedure on the girls' genitals, but stressed that it wasn't cutting. "The FBI, along with its law enforcement partners, are committed to doing whatever necessary to bring an end to this barbaric practice and to ensure no additional children fall victim to this procedure", said David Gelios, Detroit's FBI chief.

The four types vary from the most severe and complicated procedure, Type 1, that involves full or partial removal of the clitoris. FGM is internationally recognized as a violation of the human rights of women and girls. It's one of the last remaining Muslim sects in India where FGM is still known to be practiced. The goal of this illegal practice is to suppress female sexuality in order to reduce sexual pleasure. Authorities would not comment on whether more charges are coming, but an FBI agent wrote in a court document that the investigation "has identified other children who may have been victimized by Nagarwala" and that "multiple minor girls" in MI have said that mutilation procedures "had been performed on their genitals by Nagarwala". This is believed to be the first case brought under a United States law, which criminalises FGM.

Smith said Nagarwala is a member of the Dawoodi Bohra community, a Muslim sect concentrated mostly in India.

A judge ordered Nagarwala to jail without bond, saying she's a threat to the public.

Nagarwala's trial starts April 27. Medical exams performed on the victims revealed that their genitalia was surgically altered.

Recently, the Detroit authorities confirmed that an emergency room physician working at a Detroit hospital has been performing illegal surgical procedures on several underage patients at an unknown clinic from the same city.

The affidavit also alleges that there are MI victims as well.

"The conduct of the defendant spans years", Assistant U.S. Attorney Sara Woodward said in court, calling Nagarwala's crimes "heinous" acts that were part of an an "incredibly secretive" religious custom.

"Female genital mutilation constitutes a particularly brutal form of violence against women and girls". Additionally, depending on their immigration status, they could also be deported from the United States. "The practice has no place in modern society and those who perform FGM on minors will be held accountable under federal law", he said. "My honest hope is that these charges will give support to those who have allegedly suffered both physically and emotionally".

According to a medical doctor who later examined her, the girl's "genitals are not normal" due to either adjustment or removal and showed "scar tissue" as well as "small healing lacerations".

Henry Ford Health Systems has stated none of the alleged activity occurred at its facilities and it does not support such procedures. "We need to take this into our schools and educate people that this is a practice that is affecting young girls in our country". While on an examining table, with her legs spread, she remembered being "pinched" by the doctor on the "place [where] she goes pee".