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

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

“The Community of Practice on Female Genital Mutilation” is part of the “Building Bridges between Africa and Europe to tackle FGM” project, supported by the “UNFPA-UNICEF Joint Programme on the Elimination of FGM”.
The project is coordinated by AIDOS in partnership with GAMS Belgium.

The views expressed on this website are those of the authors and do not necessarily reflect the official policy or position of the UNFPA, UNICEF or any other agency or organization.

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