The current structural temple, built and renovated many times in the period 8th-17th century, gave rise to a hybrid indigenous style that is sometimes called the Nilachal type: a temple with a hemispherical dome on a cruciform base. The temple consists of four chambers: garbhagriha and three mandapas locallycalled calanta, pancharatna and natamandira aligned from east to west.
It is likely that this is an ancient Khasi sacrificial site, and worshiping here still includes sacrifices. Devotees come every morning with goats to offer to Shakti.
The Kalika Purana, an ancient work in Sanskrit describes Kamakhya as the yielder of all desires, the young bride of Shiva, and the giver of salvation.Shakti is known as Kamakhya.
The worship of all female deity in Assam symbolizes the "fusion of faiths and practices" of Aryan and non-Aryan elements in Assam. The different names associated with the goddess are names of local Aryan and non-Aryan goddesses. The Yogini Tantra mentions that the religion of the Yogini Pitha is of Kirata origin. According to Banikanta Kakati, there existed a tradition among the priests established by Naranarayana that the Garos, a matrilineal people, offered worship at the earlier Kamakhya site by sacrificing pigs.
The goddess is worshiped according to both the Vamachara (Left-Hand Path) as well as the Dakshinachara (Right-Hand Path) modes of worship. Offerings to the goddess are usually flowers, but might include animal sacrifices. In general female animals are exempt from sacrifice, a rule that is relaxed during mass sacrifices.
According to the Kalika Purana, Kamakhya Temple denotes the spot where Sati used to retire in secret to satisfy her amour with Shiva, and it was also the place where her yoni fell after Shiva danced with the corpse of Sati. It mentions Kamakhya as one of four primary shakti peethas: the others being the Vimala Temple within the Jagannath Temple complex in Puri, Odisha; Tara Tarini) Sthana Khanda (Breasts), near Brahmapur, Odisha, and Dakhina Kalika in Kalighat, Kolkata, West Bengal originated from the limbs of the Corpse of Mata Sati. This is not corroborated in the Devi Bhagavata, which lists 108 places associated with Sati's body, though Kamakhya finds a mention in a supplementary list.
The Yogini Tantra, a latter work, ignores the origin of Kamakhya given in Kalika Purana and associates Kamakhya with the goddess Kali and emphasizes the creative symbolism of the yoni.
Vatsyayana, a Vedic Sage in Varanasi during the later first Century was approached by the King in the Himalayan region (now Nepal) to find a solution to convert the tribals and their rituals of human sacrifice to a more socially accepted worship.
The Sage suggested the worship of a tantric goddess Tara that spread towards the eastern Himalayan belt till the Garo Hills where the tribals worshipped a fertility 'yoni' goddess 'Kameke'. It was much later in the later Brahaminical period Kalika Purana that most tantric goddess were related to the legend of 'Shakti' and began to be erroneously worshiped as a 'devi' by the Hindus.