This discussion within this Community of Practice will deep-dive into the issue of type IV FGM and other types of female genital alterations.
The World Health Organization classifies FGM into 4 main types and considers all types of FGM to be a violation of the human rights of girls and women. FGM type IV encompasses a range of procedures carried out on the female genitals that do not fall under the first 3 types (partial or total removal of the clitoral gland, excision of the labia minora or majora, and infibulation).
The definition for type IV was adapted in the new typology, published in 2007, to be less detailed than the previous one (1995). Practices such as the introduction of corrosive substances and herbs into the vagina, as well as labia stretching were removed but are still practiced by numerous communities.
As usual, we have prepared a Thematic note for the members. This note gives information on the main types of FGM IV.
- Genital piercing
- Vaginal incisions, scraping, hymenotomy, including
- Dangouria/Haabize, Angurya and Gishiri in Niger and Nigeria
- “removal of warts” (southieutes) in Senegal
- Incisions to introduce herbs, South Africa
As well as other types of female genital alterations which are not currently included in the WHO typology:
- Labia elongation, stretching or pullin
- Vaginal drying
- Esthetical genital surgeries
- Clitoris massaging
What are they? Where & Why are they practiced? Why are some of them not considered as “FGM”? What are the consequences of these practices on the lives of the women/girls who undergo them?
What are the controversies around some of these practices?
This list is not exhaustive, nor is the information given on each type (such as country/community practicing).
- Africa, 2016, Type 4 FGM – Focus: Labia elongation, Access here
- Agence Nationale de la Statistique et de la Démographie (ANSD) Sénégal & ICF, 2018, Sénégal : Enquête Démographique et de Santé Continue 2017, Access here
- Anonymous author, 2016, Female genital mutilation – An agonising choice, Access here
- Arora K. S. & Jacobs A. J., 2018, Female genital alterations: A compromise solution, Access here
- Askew I. et al, 2016, A repeat call for complete abandonment of FGM, Access here
- Audet, C.,M. et al, 2017, Understanding intra-vaginal and labia minora elongation practices among women heads-of-households in Zambézia Province, Mozambique, Access here
- Bagnol B. & Mariano E., 2008, Vaginal practices: eroticism and implications for women’s health and condom use in Mozambique, Access here
- Caliendo, C. et al, 2005, Self-reported characteristics of women and men with intimate body piercings, Access here
- Community of Practice on FGM, 2019, “The Removal of the Southieuntes” in Senegal : An unknown type of FGM IV – Interview with Fatou, Access here
- Ghanaweb, 2016, Genital piercing increasing among Kumasi youth, Ghanaweb, Access here
- Kelly B. & Foster C., 2012, Should female genital cosmetic surgery and genital piercing be regarded ethically and legally as female genital mutilation?, Access here
- Kitui, B. 2012, Female genital mutilation in South Africa, Access here
- Koster M. & Price L, 2008, Rwandan female genital modification: Elongation of the Labia minora and the use of local botanical species, Culture, Health & Sexuality, Access here
- Lunde, I. & Sagbakken, M., 2014, Female genital cutting in Hargeisa, Somaliland: is there a move towards less severe forms?, Access here
- Mandal, A., 2018, Health guide for young women regarding labiaplasty, Access here
- Millner V., S. et al, 2005, First glimpse of the functional benefits of clitoral hood piercings, American Journal of Obstetrics and Gynecology, Access here
- Moulton, L. J. and Jernigan, A. M., 2017, Management of Retained Genital Piercings: A Case Report and Review. Case Reports in Obstetrics and Gynecology, Access here
- National Population Commission (NPC) [Nigeria] and ICF International, 2014, Nigeria Demographic and Health Survey 2013, Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.
- National Population Commission (NPC) [Nigeria] and ICF Macro, 2009, Nigeria Demographic and Health Survey 2008, Access here
- Obianwu, O., 2019, personal communication, Access here
- Ouedraogo, T., et al, 2018, Gurya cutting and female genital fistulas in Niger: ten cases, Access here
- Perez, G. M. et al, 2015, Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation, Access here
- Preslar D., Borger J., 2019, Body piercing infections, Access here
- Richard F., 2018, Why we should be against the medicalisation of Female Genital Mutilation, International Health Policies, Access here
- Scorgie, F. et al, 2010, “Cutting for love”: genital incisions to enhance sexual desirability and commitment in KwaZulu-Natal, SouthAfrica, Access here
- Thomas, L., 2018, Labia Stretching, Access here
- UNHCR, 2001, Guinea: Report on Female Genital Mutilation (FGM) or Female Genital Cutting (FGC), Access here
- UNICEF, Unknown year of publication, Priorities in child survival, education and protection, Access here
- Wahlberg A. et al, 2017, Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants, Reproductive Health, Access here
- WHO, 2008, Eliminating Female genital mutilation: An interagency statement, Access here
- WHO, 2018, Female genital mutilation, Access here
RESOURCES SHARED BY MEMBERS
- Dridi Ibtissem B., 2010, Est-ce que ça marche? A propos du tasfih, rituel protecteur de la virginité des jeunes filles tunisiennes, Access here
- FDA, 2018, Warns Against Use of Energy-Based Devices to Perform Vaginal ‘Rejuvenation’ or Vaginal Cosmetic Procedures: FDA Safety Communication, Access here
- Federal Register, 2006, Skin bleaching drug products for over-the-counter Human use; Proposed rule, Access here
- Ferhati B., 2010, Les clôtures symboliques des Algériennes : la virginité ou l’honneur social en question, Access here
- Oranges C.M., Sisti A. & Sisti G, 2015, Techniques de réduction de la Labiaminora: une revue complète de la littérature, Access here
- Ouar N., Guillier D., Moris V., Revol M., Francois C. & Cristofari S., 2017, Complications post-opératoires des nymphoplasties de réduction. Étude comparative rétrospective entre résections longitudinale et cunéiforme, Access here
- Runacres S. A. & Wood P. L., 2016, Cosmetic labia plasty in an adolescent population, Access here
- Shaw D., Lefebvre G., Bouchard, C., Shapiro, J., Blake, J., Allen, L & Awadalla, A., 2013, Chirurgie esthétique génitale chez la femme, Access here
- Smarrito S., 2017, Classification of labia minora hypertrophy: A retrospective study of 100 patient cases, Access here
- Yurteri-Kaplan L., Miranne J. M. & Iglesia C. B., 2014, Vulvaranatomyand labiaminoraplasty, Access here
Type IV & FGM Court cases concerning type IV FGM, UK & Australia (members’ contributions) Two members, from the United Kingdom and Australia, shared information on ongoing trials concerning the identification of possible FGM type IV in a girl child. La...
Type IV & FGM Harmful practices in the MENA region (member’s contribution) Isma Benboulerbah, Project Officer at the European Network END FGM, shared her knowledge of procedures aimed at modifying women’s genitalia and controlling their sexuality in the...
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...
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....
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...
Type IV & FGM Cutting in the vaginal opening to "remove warts" (southieute) in Senegal What, Where, Why? An exploratory study by Senegalese sociologist Fatou Kebe is currently examining a practice of cutting women’s vaginal openings, justified by the...
Type IV & FGM Vaginal incisions, scraping, hymenotomies Niger & Nigeria What, Where, Why? Hymenotomies are incisions made to the hymen. In some communities, they are performed on girls for non-medical reasons. The practice should not be confused with...
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...
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...