The United Nations estimates 200 million girls and women in more than 30 countries have undergone female genital mutilation (FGM).
Somalia has the highest rate in the world recorded by the United Nations, with about 98 percent the country's female population between the ages of 15 and 49 affected by FGM.
Although the procedure is illegal in the United States, many Somali natives now residing in the U.S. underwent FGM as young girls and still live with pain. And, in some Somali communities, the practice is carried out in secret.
The U.S. state of Minnesota is home to a large number of refugees from Somalia. Fadumo Afi, who lives in the Twin Cities area, a 55-year-old mother of seven who complains of medical problems, remembers how she was mutilated with an unsterilized instrument. She said she underwent the procedure, along with another girl, when she was 6.
FILE - A counselor holds up cards used to educate women about female genital mutilation (FGM).
"It was too harmful to us because we have not even had anesthesia," she said. "We were living in the areas where medication wasn't [available]. We couldn't even pee."
Physical, emotional scars
Fartun Weli says she's unable to have children due to FGM, which is why she founded Isuroon, a nonprofit organization that advocates for Somali women living outside Somalia and works with women who have life-threatening medical conditions as a result of having undergone FGM.
Weli underwent what is considered the most dangerous type of FGM, known as Type III, which includes the complete sewing shut of the vagina. She says she still has physical and emotional scars.
According to the U.N. Population Fund, which works with youth and women, there are three types of FGM, and Type III, called infibulation, causes vaginal obstruction that can result in accumulation of menstrual flow in the vagina and uterus. Infibulation can also cause difficulties during sexual intercourse or childbirth, and can be fatal.
"Well, the complication is hard. You have a problem with sexual issues. You have a problem going to see the doctor...when they going to do pelvic exams," Weli said. "It really, really hurts. You are self-conscious about your sexual needs and you are asking yourself 'Why am I not normal?' Now we are living [in] America, second or third generations, and we are becoming friends with non-Somalis, so we discuss about this issue."
Imam: FGM prohibited
FGM is a traditional practice that has nothing to do with Islam, says Sheikh Hassan Jami'i, an imam in the Twin Cities area. He said he has four daughters and none have been subjected to FGM.
FILE - А traditional surgeon is seen holding razor blades used to carry out female circumcision, also known as female genital mutilation.
"All scholars of Islam agree that FGM is prohibited," he said, "That's why I'm proud as a father that I have never practiced this harmful FGM. In Islam, there is a principle that says whatever is harmful, it's prohibited."
Khalid Mohammed, a Somali-American Twin Cities resident, agrees. He has seen his sisters suffer from the practice and wouldn't recommend that others go through the same ordeal.
"I have sisters who have suffered from FGM and because of the trauma and problems they have gone through, I see it as something too bad,” he said. “Their menstrual cramps last longer and they experience more pain and can't even afford to do their daily work."
Untold problems, pain
Dr. Ahmed Roble, who runs a clinic in St. Paul, Minnesota, treats many women who have been subjected to FGM.
"This is an aggression done to innocent girls at a very tender age, and sometimes even newborns," he said.
The average age that girls are subjected to FGM is between 5 years old and 10 years old, he added. Roble said that women who live with the scars of FGM suffer during childbirth.
"Because of the scars, they are not as elastic and stretching is difficult," he said. "You get more stitches to repair because this is not a normal opening."
Since the medical complications of FGM are severe, even those who undergo surgery will not regain what they have lost in terms of health or appearance. Although there are now numerous campaigns and laws against the procedure in African countries, it is still widely practiced and causes untold problems and pain for women.
The World Health Organization says FGM is performed for different reasons from one region to another. Among them is trying to ensure premarital virginity and marital fidelity, reducing a woman's libido to therefore "help her resist extramarital sexual acts," and "increasing marriageability."
There are also "cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male."