A/HRC/7/3 page 17 pain and trauma, and overwhelming infection and septicaemia. Other immediate medical complications include ulceration of the genital region, injury to adjacent tissues and urine retention. Although the scientific research addressing the psychological consequences of FGM is limited, some studies have found an increased likelihood of fear of sexual intercourse, post-traumatic stress disorder, anxiety, depression and memory loss, and that the cultural significance of the practice might not protect against psychological complications.57 51. The pain inflicted by FGM does not stop with the initial procedure, but often continues as ongoing torture throughout a woman’s life. Depending on the type and severity of the procedure performed,58 women may experience long-term consequences such as chronic infections, tumours, abscesses, cysts, infertility, excessive growth of scar tissue, increased risk of HIV/AIDS infection, hepatitis and other blood-borne diseases, damage to the urethra resulting in urinary incontinence, painful menstruation, painful sexual intercourse and other sexual dysfunctions.59 FGM increases the risk for both mother and child during childbirth, including higher incidences of caesarean section and post-partum haemorrhage. In addition, women who have been infibulated have to be deinfibulated upon marriage, and later again during childbirth, hence causing further pain and psychological trauma.60 52. With regard to the element of powerlessness it must be noted that the cutting is usually carried out before a girl’s tenth birthday.61 In such circumstances, girls are clearly under 57 See for example, J. Whitehorn, O. Ayonrinde and S. Maingay, “Female genital mutilation: cultural and psychological implications”, Sexual & Relationship Therapy, vol. 17, No. 2, (May 2002), pp. 161-170; Alice Behrendt and Steffen Moritz, “Post-traumatic stress disorder and memory problems after female genital mutilation”, The American Journal of Psychiatry, vol. 162, No. 5 (May 2005), pp. 1000-1002; Haseena Lockhat, Female Genital Mutilation: Treating the Tears, (United Kingdom, Middlesex University Press, 2006); A. Elnashar and R. Abdelhady, “The impact of female genital cutting on health of newly married women”, International Journal of Gynecology & Obstetrics, vol. 97, No. 3, (June 2007), p. 169. 58 According to the World Health Organization, there are different types of female genital mutilation practised today. See http://www.who.int/reproductive-health/fgm/terminology.htm. 59 See http://www.who.int/mediacentre/factsheets/fs241/en/. See also the report of Special Rapporteur on violence against women E/CN.4/2002/83, p. 15. 60 UNICEF, Changing a Harmful Social Convention: Female Genital Mutilation/Cutting, (Italy, Innocenti Digest, 2005), p. 18. 61 The Demographic and Health Survey carried out in 1997 in Yemen found that as many as 76 per cent of girls underwent FGM in their first two weeks of life. UNICEF mentions that about 90 per cent of girls in Egypt are cut between the ages of 5 and 14 years, while in Ethiopia, Mali and Mauritania, 60 per cent or more of girls surveyed underwent the procedure before their fifth birthday. In Sudan, a 2004 study found that at least 75 per cent of girls had undergone FGM by the age of 9 to 10 in South Darfur. Ibid., p. 6.