Type IV

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.

  • Pricking
  • 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 
  • Cauterization       

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 pra

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


  • 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

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

Other forms of Type IV FGM

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...

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