Type IV & FGM

Other forms of Type IV FGM


The definition of type IV has been modified in the new typology, published in 2007. Some forms are no longer found in the WHO definition of FGM type 4. It was decided to focus on “cuts” because of their obvious consequences. The reasons were:

  • There was not enough research on the subject and there was a desire to avoid stretching supporters destroying efforts already made, particularly in the area of FGM
  • Communities such as those in the central and western region were not sensitized to the issue; and some, especially in the central region, were very protective of this culture.
  • The obvious dangerous impact of FGM can be used as a stepping stone to address other practices such as stretching, application of herbs to narrow or dry out the passage and others.

The following article briefly presents forms of genital modification not included in the 2007 WHO classification or not well studied, such as cauterization, introduction of corrosive substances into the vagina, and massage of the clitoris. The practice of lip elongation, although not understood as FGM type IV, is the subject of a separate, more detailed article.


What, Where, Why?

Cauterization is defined here as the destruction of tissue by burning it with a hot iron. This has been described as a remedy for several health problems, including bleeding, abscesses, sores, ulcers, and wounds, or for “counter-irritation”. The term “cauterization” was retained in the WHO description of FGM type IV, but the specifications were removed to make the description more general, as there are little data on this practice. (WHO, 2008)

Incisions to introduce herbs, South Africa (not included in WHO’s classification)

What, Where, Why?

Different types of harmful female genital alterations have been reported in South Africa. Studies from the 1990s documented genital incisions among female sex workers in KwaZulu-Natal. These women reported on the practice of ukugcaba, that is carried out by making small incisions in the genital area close to the labia with a razor blade, after which herbal substances were rubbed into the wounds, allegedly to attract men and keep them sexually satisfied. (Scorgie et al, 2010)

Furthermore, other types of harmful vaginal alterations have been recorded in the country, including the ritual breaking of the hymen with a finger or animal horn, a tiny cut above the clitoris (Lobedu) and labia majora elongation. It should be noted that the WHO does not report South Africa as country in which FGM is practiced, except for migrant communities (Kitui, 2012).

Vaginal drying and tightening (not included in WHO’s classification)

What, Where, Why?

Intra-vaginal drying and tightening are commonly practiced in some parts of southern Africa. The practice has been a topic of discussion amongst scholars since the 1950s. Common intra-vaginal practices include the insertion of herbs and other agents to tighten the vagina precoitally as well as soap and water to clean the vagina. In communities where they are practiced, these practices are seen as fundamental to the construction of female identity, eroticism and the experience of pleasure. Women themselves have described vaginal drying and tightening as empowering, increasing perceived vaginal cleanliness and sexual pleasure for both her and her partner. (Audet et al, 2017)

Nevertheless, vaginal drying and tightening may be associated with the alteration of the vaginal flora and vaginal lesions resulting in irritation and inflammation and making women more vulnerable to sexually transmitted infections, HIV, and bacterial vaginosis (Bagnol & Mariano, 2008, Audet et al, 2017)

Clitoral massaging (not included in WHO’s classification)

Evidence collected during a study carried out by the Population Council suggests that some communities in Imo State, Nigeria, perform “pressing” or “massaging” of the vulva/clitoris. This is performed as a transition from type I or type II cutting in FGM practicing communities, which is typically done in the first weeks or months after birth.

In families that decide to not have girls undergo a cut, the clitoris or external genitalia is instead pressed or massaged while bathing the baby girl, typically with warm water or Vaseline. The “massage” is carried out for the same reasons as cutting e.g. decrease sensitivity to reduce sexual urge and prevent promiscuity/extra marital or pre-marital sex and for aesthetics (prevent clitoris/labia minora from growing and protruding out of the labia majora).

The evidence suggests that some health workers in Imo state encourage this transition as a non-harmful alternative to cutting. Anti-FGM advocates (from both the government and civil society) describe pressing/massaging as type IV FGM and strongly discourage the practice. However, some obstetricians and gynecologists have challenged this and state the “clitoral massage” is benign, has no physical effect and can not be classified as FGM. (Obianwu, 2019)

During the discussion, a CoP member informed us about the use of Alum stone in West Africa. 

“The stone causes a momentary contraction of the vagina, which can give the appearance of virginity to a woman who has already had sex. It is claimed that if a woman uses the alum stone regularly, the walls of the vagina become rigid and can tear during childbirth. This stone destroys the vaginal flora that helps protect women from sexually transmitted diseases. In addition, because the powder of the stone has the consistency of sand, it inevitably causes irritation that can lead to serious cases of vaginitis.”

On the same topic

Aesthetical genital surgeries and procedures

Type IV & FGM Aesthetical genital surgeries and procedures   Aesthetic or cosmetic genital surgeries and procedures include a wide variety of practices performed for aesthetic or sexual reasons, including labioplasty (inner labia surgery), labia majora...

read more

Labia elongation (not included in WHO’s classification)

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....

read more

Genital Piercing

Type IV & FGM Genital Piercing   What, Where, Why ? Piercing can be defined as “an opening in any part of the body through which jewellery can be worn”. Among the most common forms of female genital piercing is the clitoral cap, of which there are different...

read more


Type IV & FGM Pricking   What, Where, Why? The piercing the clitoris or surrounding tissue, pricking, is a procedure in which the skin is pricked with a sharp object. Blood may flow but no tissue is removed and no stitching is done. Pricking is practiced in...

read more