Long-term complications include loss of libido, genital malformation, delayed menarche, chronic pelvic complications and recurrent urinary retention and infection. FGM victims are also prone to a number of obstetric complications because the fetus is exposed to a range of infectious diseases and faces the risk of having its head crushed in the damaged birth canal. Infibulated women, whose genitals have been tightly closed, have to be cut open to allow the baby to emerge. Perineal tears, obstructed labour and fistula can occur. The repeated cutting and re-stitching of a woman's genitals with each birth can result in tough scar tissue. In addition to direct adverse health effects, FGM increases the woman's biological vulnerability to HIV transmission if exposed to the virus. The case studies collected by UNICEF as part of a larger survey on Knowledge, Attitudes, Beliefs and Practices around FGM consistently revealed complications and negative consequences of FGM, which can be broadly divided into four thematic areas: 1. The medical effects of the practice; 2. The psychological effects of the practice; 3. The dangerous traditional practices that accompany FGM; and 4. The cultural stigma associated with girls who are not circumcised. Female Genital Mutilation (FGM) is defined as procedures involving partial or total removal of female genitalia or other injury to female genital organs. In Somalia, FGM prevalence is about 95 percent and is primarily performed on girls aged 4-11. FGM can have severely adverse effects on the physical, mental and psychosocial well being of those who undergo the practice. The health consequences of FGM are both immediate and life-long. Despite the many internationally recognized laws against FGM, lack of validation in Islam and global advocacy to eradicate the practice, it remains embedded in Somali culture. Female genital mutilation is a social ritual performed in 28 countries ranging from Africa to the Middle East and some of the Islamic Asian countries. It is estimated that the most severe form of the practice affects 130 million women, most of whom were circumcised before puberty. The practice itself often takes place in remote rural areas by untrained village midwives who use instruments such as knives, razors or even broken glass. The instruments are often not sterile and the ritual is very often performed in unsanitary conditions. In urban areas, some families use a doctor to perform the operation. The operation involves the total removal of the clitoris, labia minora and severing of the inner side of the labia majora. The sides of the labia majora are then sutured together, leaving a small hole to allow urine and menstrual discharge to pass. The practice often occurs without the use of anesthesia. EFFECTS OF FGM Beyond the obvious initial pain of the procedure, the long-term physiological, sexual and psychological effects of FGM/C are well documented. The consequences can even include death as a result of shock, hemorrhage or septicemia.