Type IV & FGM

Labia elongation (not included in WHO’s classification)


What, Where, Why?

The “labia minora” (inner lips) are the folds of skin on either side of the vulva. Their size varies greatly from woman to woman, so there is no “normal” labial length. Nevertheless, cultural differences exist in terms of aesthetic and sexual preferences for small or long lips.

Lip lengthening is practiced in several parts of eastern and southern Africa, including Uganda, Rwanda, Zambia and Mozambique.

The Baganda, an ethnic group living in Uganda, practice lip-lifting as a female initiation rite, and the practice is still taught to girls nearing puberty, between the ages of 9 and 16, and supplemented by menarche. The final size of the lips is at least one to one and a half inches in length.

In Zambia, the action of pulling is called kudonza, tidonza or ukukuna and the stretched lips, with a final length of 1.5 to 2 inches, are called malepe or imishimo. Zimbabwean migrant women living in South Africa, participating in a study by Perez et al (2015) explained that these terms were only used in intimate spaces. The practice was taught to the women by premarital counselors or by peers and aimed at increasing the sexual pleasure of their male partners. Tools were used to facilitate stretching, and girls organized themselves into groups to meet in secret and practice stretching with each other. Women also reported a variety of other genital modifications such as introducing substances into the vagina; washing with cold saline water, or wiping with cotton/paper soaked in lemon water to “control fluids” and tighten/contract the vagina, and scarification with genital tattooing (Perez, et al. 2015).

In some parts of Mozambique, lip lengthening is also associated with other genital practices such as tightening the vagina with various mildly astringent herbal substances. Up to 65% of women practice this regularly, along with lip lengthening (Audet et al, 2017). A cross-sectional study conducted in Tete province showed that 98% of the more than 900 participating women had performed lip lengthening at some point and few (4.5%) reported experiencing minor adverse effects, including irritation or pain, itching, inflammation and dyspareunia (Hull et al. 2011, cited in Perez et al, 2015).

The reasons behind the practice of lip lengthening are complex and multiple. The practice is intended to increase the pleasure of both men and women during sexual intercourse. A number of other reasons also contribute to the continuation of the practice:

  • Peer pressure;
  • Fear of not being married and desirable to men if it is not practiced;
  • Fear of being stigmatized for not complying with the social expectation of having long lips;
  • Respect for the beautification routine;
  • Helping to solve problems that may arise during childbirth;
  • The sexual gratification of men in that it is reputed to increase the sexual pleasure of men and some women.

(WHO, 2008, Afruca, 2016, Perez et al. 2015)

Finally, in many regions, the practice seems to be slowly disappearing as the socio-economic profile of the region changes. This may or may not be a response to the incorporation of Western ideas about female sexuality. (Thomas, 2018)

Controversies around labial elongation

Surveys show that both men and women seem to have a favourable attitude towards the continuation of this practice. Some authors argue that lip lengthening does not fit the technical or traditional definition of FGM because it is not associated with excision or incision of the external female genitalia. It aims to increase rather than decrease their size, and to increase rather than limit female sexual pleasure (Thomas, 2018). A study of the practice in Rwanda also showed that women saw it as a positive force in their lives (Koster & Price, 2008). In addition, the reproductive health risks of the practice are considered minor, limited to itching and irritation during active stretching. (Mandal, 2018) Thus, instead of the negative connotation of the categorization of FGM, some authors argue that the term “female genital modification” should be applied to the practice.

In fact, the WHO removed lip elongation from the Type IV definition in the 2008 typology. However, in their report, the organization argued that lip stretching could still be defined as a form of FGM, as it was a social convention that put social pressure on young girls to change their genitalia and created permanent genital changes. (WHO, 2008)

The study by Martinez Perez et al (2007) shows an example of the strong social pressure surrounding this practice. Zambian women recalled the psychosocial stress related to the practice and the fear of not being able to achieve the desired lip length :

“As girls, they feared that they would not be able to reach the desired lip length. They were afraid that their future husbands would send them back to their families because they were not fit for marriage. Many women, when they were still little girls, anticipated when they could be checked before marriage.”

Labial elongation in Rwanda (member’s contribution)

Emma-Claudine Ntirenganya, journalist, shared her professional and personal experiences of labia elongation in Rwanda. According to her, the Rwandan society where she grew up, educates girls to practice lip stretching for the satisfaction and pleasure of their future husbands.      

“I have practiced it myself, and I have also received various questions in the course of my work from the women in my audience.”

Emma-Claudine believes that lip stretching should not be encouraged, as many women suffer in their marriages, either because they have not followed the practice or, in a few cases, because they have. Moreover, young girls do not practise it because they are happy and proud to do it, but because pressure from society forces them to do so, whatever the cost.

“Isn’t it appropriate that girls and women have the right to their bodies and do what they want to do with them without being judged? ” wonders Emma-Claudine “If you talk to Rwandan women, some will tell you that the practice of lip stretching was fun and acceptable, while others will tell you that it was difficult, imposed and disgusting. The latter will add that they only did it to make sure they were not rejected by their husbands-to-be. Few Rwandan women have not done this practice. With the new generation of Rwandan girls currently in university and college, most of them have not done so either because they had no one to teach them or because they feel it is an outdated cultural practice.”

According to Emma-Claudine, the “benefits” attributed to lip stretching are “the result of female hormones, the result of love in the couple, the partner’s desire and satisfaction, the partner’s experience and abilities, and a healthy mental health, ready to engage in a loving relationship including making love.”

Main concerns about labia stretching (members’ contributions)

Lip stretching is not something you do for a day or two, a week or two. It is a practice that can take years in order to achieve the desired results. In addition, lip stretching is often accompanied by the use of various herbs or cow’s butter for quick results. The labia minora are irritated and this can be accompanied by pain. The way it is performed also carries risks of STI transmission in that girls practice “gukurakuza” and thus have their lips touched. 

In addition, the practice of lip stretching is mainly justified by sexual considerations for both men and women. Indeed, the education of girls to this practice involves inculcating the fear of being rejected by their husbands if it is not carried out. Thus, male pleasure and the ability to satisfy a future husband are clearly at stake. However, Rwanda’s sexuality also relies heavily on female pleasure and the attainment of female ejaculation. Women are told that they will not be able to achieve this ejaculation without following the process of stretching the lips. They are also taught that failure to achieve it carries the risk of being cheated on by their husbands, turning to other women who have followed the practice. 

Finally, some points of conflict seem to emerge within the couple about lip stretching. With the new generation, most Rwandan boys still wish to marry a girl who has practiced lip stretching, whereas most girls their age have not and do not wish to do so. This dissent appears to be a source of potential marital conflict. It was also noted that many women who do not have their lips stretched are still harassed by their husbands, urging them to do so even when they have been married for years and have had children. Conversely, a few cases of women who have followed the practice are asked by their husbands after marriage to have their labia minora cut off.

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