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Rwandan female genital modification: Elongation of the Labia minora and the use of local botanical species

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Abstract

The elongation of the labia minora is classified as a Type IV female genital mutilation by the World Health Organization. However, the term mutilation carries with it powerful negative connotations. In Rwanda, the elongation of the labia minora and the use of botanicals to do so is meant to increase male and female pleasure. Women regard these practices as a positive force in their lives. This paper aims to assess whether Rwandan vaginal practices should indeed be considered a form of female genital mutilation and whether the botanicals used by women are detrimental to their health. Research was carried out in the northeast of Rwanda over the course of 13 months. Semi-structured interviews were conducted with thirteen informants. Two botanicals applied during stretching sessions were identified as Solanum aculeastrum Dunal and Bidens pilosa L. Both have wide medicinal use and contain demonstrated beneficial bioactive compounds. We suggest that it is therefore more appropriate to describe Rwandan vaginal practices as female genital modification rather than mutilation.
Rwandan female genital modification: Elongation of the
Labia minora and the use of local botanical species
MARIAN KOSTER & LISA LEIMAR PRICE
Department of Social Sciences, Wageningen University, Netherlands
Abstract
The elongation of the labia minora is classified as a Type IV female genital mutilation by the World
Health Organization. However, the term mutilation carries with it powerful negative connotations. In
Rwanda, the elongation of the labia minora and the use of botanicals to do so is meant to increase male
and female pleasure. Women regard these practices as a positive force in their lives. This paper aims
to assess whether Rwandan vaginal practices should indeed be considered a form of female genital
mutilation and whether the botanicals used by women are detrimental to their health. Research was
carried out in the northeast of Rwanda over the course of 13 months. Semi-structured interviews were
conducted with thirteen informants. Two botanicals applied during stretching sessions were identified
as Solanum aculeastrum Dunal and Bidens pilosa L. Both have wide medicinal use and contain
demonstrated beneficial bioactive compounds. We suggest that it is therefore more appropriate to
describe Rwandan vaginal practices as female genital modification rather than mutilation.
Re´sume´
L’e´longation des petites le`vres du vagin (labia minora) figure au classement des mutilations ge´nitales
fe´minines de Type IV de l’Organisation Mondiale de la Sante´. Le mot ‘mutilation’ a toutefois de
fortes connotations ne´gatives. Au Rwanda, l’e´longation des petites le`vres et l’usage d’aromates pour
l’obtenir ont pour finalite´ l’augmentation du plaisir de l’homme et de la femme. Les femmes
conside`rent ces pratiques comme une force positive dans leur vie. Cet article vise a`e´valuer si les
modifications vaginales au Rwanda doivent vraiment eˆtre conside´re´es comme des mutilations
ge´nitales fe´minines ou si les aromates utilise´s par les femmes sont pre´judiciables a` leur sante´. Cette
recherche a e´te´ mene´e dans le Nord Est du Rwanda pendant 13 mois. Des entretiens semi structure´s
on e´te´ mene´s avec 13 personnes ressources. Deux aromates utilise´s au cours des sessions d’e´longation
ont e´te´ identifie´s: solanum aculeastrum Dunal et Bidens pilosa L. Ils sont largement employe´s comme
plantes me´dicinales et contiennent des compose´s bioactifs be´ne´fiques. Aussi sugge´rons-nous de
de´crire ces pratiques vaginales des femmes rwandaises de manie`re plus approprie´e, a` savoir comme
des modifications ge´nitales fe´minines, plutoˆt que comme des mutilations ge´nitales.
Resumen
La elongacio´n del labio menor esta´ clasificada por la Organizacio´n Mundial de la Salud como
mutilacio´n genital femenina Tipo IV. Sin embargo, el te´rmino mutilacio´n lleva fuertes connotaciones
negativas. En Ruanda, se considera que alargar el labio menor con ayuda de especies bota´nicas
aumenta el placer masculino y femenino. Las mujeres consideran que estas pra´cticas son positivas en
sus vidas. En este artı´culo queremos evaluar si en realidad las pra´cticas vaginales en Ruanda deberı
´an
considerarse un tipo de mutilacio´n genital femenina y si los remedios bota´nicos que usan las mujeres
tienen un efecto perjudicial en su salud. Para este estudio llevamos a cabo una investigacio´n en el
Correspondence: Marian Koster, Sociology of Consumers and Households, Department of Social Sciences, Wageningen
University, P.O. Box 8060, Wageningen, 6700 DA, Netherlands. Email: marian.koster@wur.nl
Culture, Health & Sexuality, February 2008; 10(2): 191–204
ISSN 1369-1058 print/ISSN 1464-5351 online # 2008 Taylor & Francis
DOI: 10.1080/13691050701775076
noreste de Ruanda durante un periodo de 13 meses. Y se realizaron entrevistas semiestructuradas con
trece informantes. Se identificaron dos especies bota´nicas que se usan durante las sesiones de
alargamiento: Solanum aculeastrum Dunal y Bidens pilosa L. Ambas se han usado mucho como
remedio me´dico y contienen compuestos bioactivos que han demostrado ser beneficiosos. Sugerimos
que por tanto serı´a ma´s apropiado describir estas pra´cticas vaginales en Ruanda como modificacio´n y
no mutilacio´ n genital femenina.
Keywords: Female genital mutilation, cultural practices, health, sexuality, Rwanda
Introduction
The female external genitalia include two types of labia: the labia majora (the outer vaginal
lips that surround the rest of the genitalia) and the labia minora (the inner vaginal lips).
Natural variation exists in the length of the labia. However, cultural aesthetics affect an
individual’s decisions about the desirable length of the labia. In western countries,
labiaplasty (labia reduction and beautification) is becoming increasingly popular as a form
of female cosmetic surgery (McNamara 2006). Nevertheless, practices that aim to reduce,
enlarge or otherwise beautify the external female genitalia are highly controversial.
The elongation of the labia minora is classified as a Type IV female genital mutilation
(FGM) by the World Health Organization (WHO) and includes: ‘pricking, piercing or
incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by
burning the clitoris and surrounding tissue’; ‘scraping of tissue surrounding the vaginal
orifice (angurya cuts) or cutting of the vagina (gishiri cuts)’; and the ‘introduction of
corrosive substances or herbs into the vagina to cause bleeding or for the purpose of
tightening or narrowing it; and any other procedure that falls under the definition given
above.’ (WHO 2000)
As the term mutilation has powerful negative connotations, Gallo et al. (2006a) note that
its use may be unfitting for selected modifications in the Type IV category such as
stretching of the labia minora. Instead, they suggest the use of the phrase ethnic female
genital modification, since the term ‘modification’ is acceptable to western and African
women and the adjective ‘ethnic’ stresses the cultural diversity and cultural motivations
behind diverse practices (Gallo et al. 2006a: 49–50). The question of ‘to what extent…does
labia elongation violate the rights of women in Africa?’ has been asked by Kenneth
Mwenda, Senior Counsel and Legal Vice-President at the World Bank (Mwenda 2006).
Important in his advice is that the practice is not a violation when ‘As a general rule, as long
as labia elongation does not violate public policy, or any laws of the country, or natural
justice, good conscience and equity, and as long as labia elongation is undertaken freely,
and with full consent, it does not violate the rights of women. To this extent, labia
elongation is deemed a valid customary practice. Again, it must be stressed that a line must
be drawn between voluntary labia elongation and other forms of FGM that either
compromise the health of women or are non-consensual.’ (Mwenda 2006: 353–354).
In reading this paper, it is important to keep in mind the issue of consensual versus non-
consensual engagement in the practice of labial elongation. While we do not discuss this
issue further except for briefly in the conclusions, our findings indicate that a girl is usually
introduced to this practice just before or after first menstruation. This pattern of early
physical introduction to labial stretching has also been documented for Baganda girls in
Uganda by Gallo et al. (2006b). Baganda girls typically start the practice at a mean age of
10.8 with a variation of plus or minus 1.5 years. It is our point of view that informed
consent is questionable at this age. Nevertheless, our female informants regard labial
192 M. Koster & L. Leimar Price
elongation as a positive practice in their lives linked to sexual fulfilment in adulthood
both their own and that of their spouse. Villa and Gallo (2006) come to a similar conclusion
when studying the linguistic terminology surrounding genital modification in Uganda: ‘A
vast gulf divides the ‘expansors’, who are generally more comfortable with sexuality and
who possess a rich and specific vocabulary on the subject, from the ‘reductors’ (excisors
and infibulators), who have a negative view of sex and whose vocabulary on the subject is
relatively poor. (Villa and Gallo 2006: 57)
This paper discusses the cultural importance of labial elongation through manual
manipulation in Rwanda. In addition, we examine the plants used by women during pulling
(stretching) sessions. Knowing the chemical constituents and the physiological effects of
these plants enabled us to understand their value not only from a ritualized perspective but
also from an ethno-medicinal and bio-medical perspective. Two of the botanicals
informants reported using when stretching their labia minora were investigated to see if
they were corrosive herbs as indicated under the type IV female genital mutilation
classification. Our findings suggest, on the contrary, that both species (Solanum aculeastrum
Dunal and Bidens pilosa L.) appear to be beneficial medicinal species, showing antibacterial
and antifungal activity, which is cleansing and pain-reducing.
Methods
The research presented here is based upon interviews with a sample of 13 key informants
(eleven women and two men),
1
a review of the scientific literature and consultations with
various experts in the field of botany. The criteria used in selecting the individuals were in
accord with those proposed by Bernard (2002: 188), namely that ‘good key informants are
people to whom you can talk easily, who understand the information you need and who are
glad to give it to you or get it for you’. All informants had personal experience of the
practice of labial elongation and associated sexual practices.
Seven of the female informants (aged 21 to 28 years, single) worked as research assistants
during a 13-month period of fieldwork in rural northeast Rwanda, collecting data on post-
genocide livelihood and lifeways. These informants spoke fluent English. While they were
urbanized, they stayed in intimate contact with their rural extended families and frequented
their villages. Three women currently reside in the northeast of the country; the other four
live in cities (Kigali and Butare). In addition, two other female informants (aged 35 and
45), both widows and informants in the larger study, were rural women living in the
northeast of the country. Interviews were held in their native language of Kinyarwanda,
with English language translation by research assistants who were fluent in Kinyarwanda.
The two male informants, one married man of 32 years and one unmarried man aged 29,
lived in Kigali City. They were personal friends of the first author and were willing to speak
openly about sex and sexual practices. Interviews were held by the researcher in English
and French. Finally, two Rwandan women (31 and 34 years, married) were interviewed in
the Netherlands where they were conducting post-graduate studies in botany. They were
interviewed in English.
Interviewing followed a semi-structured format and all interviews took place between
2004 and 2005. During the interviews, the practice of labial elongation was discussed, as
were the use of plants, sexual practices and other more general issues.
In Rwanda, one plant species specimen was photographed (including leaves, trunk, fruit,
and whole plant) and later identified through independent assessment, as Solanum
aculeastrum Dunal by Dutch botanists
2
and the two female Rwandan post-graduate
Rwandan female genital modification 193
students in botany. While acknowledging the fact that accurate botanical identification
would have better been based on determination of actual plant material by a herbarium, we
have no doubt that determination of the species is accurate given the agreement by
independent assessment of the knowledgeable experts noted above.
Other plants used for the elongation of the labia minora were identified based on verbal
communication (vernacular names, descriptions of the plants features, and scientific name)
and have been cross-checked with selected key informants and the botanical literature.
After botanical identification, literature on the plants’ known medicinal use and chemical
constituents was examined and the known physiological effects of the plants determined,
notably for Solanum aculeastrum Dunal and Bidens pilosa L.
Labia minora elongation
Cosmology and the social construction of the female body. When talking about reasons to
elongate the labia minora, informants indicated that Rwandan women and men stress
factors of beauty and sexual pleasure. While not contesting their opinions, we would like to
argue that the practice of elongating the labia minora should be viewed as an act of
socialization that helps Rwandan women to identify with their cultural heritage, increase
social integration and maintain social cohesion. The fact that traditionally a female relative
(usually the paternal aunt) introduced the need for the elongation of the labia minora and
physically showed the girl how to pull her labia, emphasizes both the importance of, and
connection to, the (patrilineal) family. The importance of, and connection to, other women
is reinforced by the initiate’s interaction with other adult women as well as female peers,
who assist mentally and physically with the elongation of her labia minora. In the process, a
girl’s identity is shaped, channelled and defined.
In Rwandan culture, body, health and cosmology are closely related (Taylor 1988, 1990,
1992). Liquids, such as rain, honey, milk and beer, but also bodily secretions, such as
blood, saliva, semen and maternal milk, are important symbols ‘for they mediate between
physiological, sociological and cosmological notions of causality’ (Taylor 1988: 1343).
Rain is needed to fertilize the land. Other liquids pass from the self to the other in order to
(re)produce social relations: from person to visitor, or between affines, in the form of milk
or beer, from mother to child in the form of breast milk, from husband to wife in the form
of bodily secretions during intercourse. Social harmony then is maintained by the
continuous exchange of fluids, including bodily secretions.
Any obstruction in the flow of bodily fluids is considered a discontinuity in production,
exchange and fertility. The unimpeded flow of bodily secretions is conceived of as more
than purely a medical or physical condition. Rwandans conceive of health and disease as
states of social integration and disintegration. To produce inadequate vaginal secretion
during sexual intercourse is considered a disease, threatening not only the female owner of
the diseased body, but ultimately threatening the social order. Thus, it may be that
accounts of women divorced for not having sufficiently elongated labia minora are grounded
in the underlying assumption that women without elongated labia cannot produce
sufficient vaginal secretions during sexual intercourse.
Women lacking vaginal secretions, like women lacking maternal milk, are called igihama.
The noun igihama comes from the verb guhaama, ‘to cultivate a field hardened by the sun’ or
‘to have sexual relations with a woman lacking vaginal secretions’ (Jacob 1983 in
Taylor 1988: 1346). But igihama is also the vernacular name of the plant species
Dioscorea dumetorum (Kunth) Pax, the tubercle ashes of which are applied by local
194 M. Koster & L. Leimar Price
healers on wounds and cuts in Burundi (Baerts and Lehmann 1989). Women lacking in
vaginal secretion or maternal milk endanger the exchange of symbolic fluids that
(re)produce the social relations between husband and wife and between mother and child.
It is important for women, then, to ensure a socially accepted flow of vaginal secretion
during sexual intercourse.
Sexual intercourse and female ejaculation
In Rwandan culture, both partners are expected to obtain pleasure from each other
during intercourse. If so, bodily fluids between husband and wife are exchanged and
social relations are maintained. All of our informants were of the opinion that elongated
labia minora aid in the production of vaginal secretions. In addition, the method of
(heterosexual) intercourse is viewed as important in producing these secretions.
During intercourse, the man often positions himself behind the forward-bent
woman, playing with her elongated labia minora and stimulating her labia by tapping
them with his penis. He continues to do so until the woman has an ejaculation. Only then
does he enter her body and allow himself to ejaculate. This practice is locally known as
kunyaza.
While informants were very clear in their opinion that all healthy Rwandan women are
able to ejaculate, in western countries there is, curiously enough, some discussion on
whether or not women are capable of ejaculating or whether all women are capable of
doing so. Some researchers argue that women claiming to ejaculate do no more than squirt
urine. Others are of the opinion that the fluid ejaculated is different from urine and is
produced by para-urethral or Skene’s gland.
3
The fact that female ejaculation in western
countries has been associated with urinary incontinence, with the loss of control over
urinary continence being considered highly embarrassing (Heath 1987), could explain why
not all women in western countries seem to ejaculate, while most if not all women in
Rwanda apparently do.
What could be happening is that the elongated labia minora, the clitoris and the uterus
swell during sexual arousal. This in turn stimulates the tissue surrounding the urethra and
the para-urethral glands, which then fill with fluid. This fluid is released during sexual
arousal or activity (Darling et al. 1990). It is not clear, however, whether female ejaculation
is related to the sexual response or if it is induced by orgasmic contractions (Cabello 1997).
Full tumescence in the vagina is apparently needed to experience and be able to ejaculate
(Darling et al. 1990). This might explain why Rwandan men do not immediately penetrate
during sexual intercourse but rather first stimulate the labia minora up to the point at which
a woman ejaculates.
It is precisely because vaginal secretion is thought to be so important that the practice of
elongating the labia minora can be considered an integral component of the Rwandan social
organization of productive relations. It is important to stress here that the elongated labia
minora are not kept private. This modification of the body is regularly shown to other
women before ultimately being presented to a husband. Each time, public recognition is
sought and socially mediated forms of (sexual) relations are (re)produced since bodily
connection between women, and later between wife and husband, are maintained. Thus,
by showing the elongated labia minora to others, the production of social relations is
formally coordinated. Moreover, by being publicly scrutinized by peers throughout the
years in which they elongate their labia minora, women are imbued with the realization of
the value of this production.
Rwandan female genital modification 195
The practice of elongating the labia minora
The elongation of the labia minora is achieved by a long process. The practice is not
restricted to Rwanda; sporadic information can be found on several tribes and ethnic
communities in Benin, Burundi, the Democratic Republic of Congo (DRC), Malawi,
Mozambique, Namibia, South Africa, Sudan, Tanzania, Uganda, Zambia and Zimbabwe
(Nabaitu et al. 1994, Adeokun et al. 1995, Green et al. 2001, Janssen 2002, Amadiume
2006). Labial elongation is a widespread and old tradition. As early as 1668, Dapper,
writing on Hottentot women in South Africa, referred to elongated labia minora (Baker
1974). However, among the Bushmen/Hottentot, the elongated labia are considered a
congenital feature (Baker 1974, Gallo et al. 2006a), unlike the labia of other women.
Stannus reported that young girls in British Central Africa constantly pulled on the labia
minora and the enclosed clitoris to try to cause elongation (Stannus 1910).
In Rwanda, an extensive vocabulary rich in metaphors is used by women to describe the
practice of elongating the labia minora. Our informants referred to this practice as gukuna
imishino (to do/make imishino, which are elongated labia) and gukubura imbuga (‘to clean the
courtyard’). Veldhuijzen et al. (2006) refer to guca imyeyo (which literally translates as ‘to
collect/cut brooms’). Codere (1973) refers to gucaikoli (literally: to cut ikoli, a type of plant).
In neighbouring Uganda and parts of Rwanda, the practice is also known as okukya`lira ensiko
(‘visiting the bush’) and okusı`ka enfuli (‘pull the labia minora’) (Villa and Gallo 2006).
Like the Baganda girls documented by Gallo et al. (2006b), Rwandan girls start pulling
their labia minora before the onset of menstruation (menarche) and continue to do so up to
marriage, sometimes even continuing afterwards. Not all girls elongate their labia minora,
but many do. While the UN Economic and Social Council (2002) suggests that only Tutsi
women elongate their labia minora, our informants indicated that the other two ethnic
groups in Rwanda, Hutu and Twa, also do so. In a discussion on kunyaza, Taylor (1990)
finds that this sexual practice is not confined to any single category of people and occurs
among Hutu, Tutsi and Twa. This also suggests that all ethnic groups partake in the
elongation of the labia minora. This is further supported in a discussion of forty-eight
Rwandan autobiographies where Codere (1973) mentions that all ethnic groups seem to
practice labial elongation.
In neighbouring Uganda, it is traditionally the Ssenga (father’s sister) who prepares girls
for womanhood and marriage or, in the absence of this category of relations, a paternal
cousin or grandmother (Adeokun et al. 1995), also known as the jaja (Villa and Gallo
2006). The Ssenga gives advice on menstruation, how to deal with a husband both socially
and sexually and the need to elongate the genitals. According to our informants, in Rwanda
no preferred relation exists as to who is to take the young girl aside and stress the need to
start pulling her labia minora. However, all female informants agreed that mothers are not
likely to inform their children, as to discuss such issues with one’s own mother is seen as
shameful. While other adult female relatives can inform a girl, the peers (friends and own
sisters) are usually the ones to inform the girl. They explain that elongated labia minora will
enhance her sexual pleasure at a later age and that men prefer women with long labia
minora. Some of our informants were of the opinion that such reasons have replaced the
original meaning of the practice — when people were not wearing any clothes in the past,
the elongated labia minora functioned to hide their genitals from public scrutiny.
Since the labia minora swell during sexual excitement, there is a larger surface area for
penile friction during coitus. Since the swelling partly takes place inwards, the entrance to
the vagina may also become tighter, thus creating more pleasurable friction for the man.
This suggests that the practice of labial elongation is meant to increase mutual sexual
196 M. Koster & L. Leimar Price
pleasure, an assumption corroborated by all of our informants. However, some informants
noted that by elongating the labia minora, the surface of the birth canal is increased, which
is considered a nuisance during childbirth. On the other hand, informants also thought that
having elongated labia was an asset in childbirth in that the vaginal opening is not visible to
others; the labia shield the opening from view. This latter point is an indication of notions
of modesty.
A girl is instructed on how to pull her labia in a variety of ways. She is told verbally,
illustrated on her own body and can also view demonstrations of other girls as she witnesses
how they apply the technique in pulling their own labia. The girl then engages in daily self-
manipulation (pulling/stretching her labia minora). Girls encourage each other to elongate
their labia minora and may even physically assist each other.
We are not able to say how some social institutions such as religion influence labial
practices, but we have some indication that the practice is conducted in both rural and
urban settings. In the urban context, we find that girls receive positive information on and
social reinforcement of the practice through the media (radio and newspapers). Moreover,
in Kigali, girls can attend public meetings to learn about the practice. Peer pressure seems
to form an important reason for women to elongate their labia minora. Several informants
have commented that communal living and shower arrangements at boarding schools,
where girls easily view each other’s genitals, influenced their decision to further elongate
their labia.
Social pressure to continue the practice of labial elongation is augmented further when
girls are told that women with small labia are known to have been divorced by their
newlywed husbands. In Uganda, women without elongated labia minora are viewed as
abhorrent and brides can be returned to their parents (Sengendo and Sekatawa 1999).
Rwandan women fear the same fate. Interestingly enough, none of the informants in this
study personally knew any woman who had been left by her husband for this reason.
While social pressure to engage in the practice is in evidence, female informants regarded
their vaginal practices as a positive force in their lives. They give them a feeling of self-worth
and pride. Moreover, it is important to realize that, unlike other forms of genital
modification or mutilation, the potential pain caused by pulling the labia minora, is not
inflicted by third parties but by girls themselves. It is important to note that the girls apply
the pulling technique at their own discretion and tempo. Additionally, traditional botanical
preparations that numb and sanitize are utilized. Thus, pain is not always a concomitant to
labial elongation. Factors such as how the manual pulling is done, the type of botanical
used and the time span used to reach the desired length of the labia influence the presence,
absence or intensity of discomfort.
Types of plants used in vaginal practices
Regular use is made of plants when pulling the labia minora. In an article on labial
elongation among the Baganda of Uganda, Villa and Gallo (2006) refer to the use of
namirembe, kabbbo ka bakyala and mukasa. Unfortunately, we were not able to determine
the scientific botanical names of these plants. Use of herbs in vaginal hygiene practices is
noted in a number of studies conducted in Africa (Dallabetta et al. 1995, Brown and Brown
2000, Green et al. 2001, Van de Wijgert et al. 2001, Myer et al. 2004, Veldhuijzen et al.
2006). Two informants in the present study referred to the use of a powder made of dried
bat wings, also mentioned by Janssen (2002) and one informant mentioned that cow cheese
is sometimes used. Not everyone agreed on which plants, or which part of plants, to use.
Rwandan female genital modification 197
Among the plants used in Rwanda to elongate the labia minora, Bidens pilosa L. and
Solanum aculeastrum Dunal were identified. Both of these are applied externally on the labia
minora, not intravaginally. Mwenda (2006) refers to the use of a traditional herb called
umu-tuntula, which is used in Zambia to stretch a woman’s labia. Here, it concerns Solanum
indicum L. (personal communication with Mwenda April 12, 2007), a plant also mentioned
by some of our informants but they were not completely certain whether it was used by
Rwandan women as well.
Solanum aculeastrum Dunal is locally known as umutobotobo, meaning ‘that which
dissolves completely’ (Baerts and Lehmann 1989, own translation) and is also known as
bitterapple, doringapple, prickly apple, goat apple, poison apple or sodaapple nightshade
(Hutchings et al. 1996, South African National Biodiversity Institute website, US
Department of Agriculture website). The berries are first roasted in charcoal and then
peeled. As a result of this process, the core turns into a paste-like texture which is externally
applied to the labia minora during a ‘pulling session’. Bidens pilosa L. is locally known as
nyabarasanya and is also known as black jack, knapsekerel or wewenaars (Hutchings et al.
1996). The leaves are pounded, after which the paste-like texture is externally applied to
the labia minora. All informants agreed that the mixture is believed to pull blood into the
labia minora. This supposedly makes the pulling more effective.
Solanum aculeastrum Dunal, a member of the family Solanaceae, is a shrub or small tree
(Agnew and Agnew 1994) indigenous to tropical South Africa (Adebola and Afolayan
2006). The plant grows as a weed and is sometimes used as a hedge. Moreover, as it is high
in saponin it is used as a mild detergent/soap replacement (Bossard 1996, Adebola and
Afolayan 2006).
Solanum aculeastrum Dunal is a highly valued medicinal plant (Adebola and Afolayan
2006, Koduru et al. 2006). Local healers use different parts of the plant for the treatment of
various diseases in humans and domestic animals. Hutchings et al. (1996) refer to its use as
a powerful cure for pain in the lower back and legs, for bathing the navels of new-born
babies, and its application in cases of anuria, wounds, haemorrhoids and dysentery in
humans and ringworm and anthrax in cattle and horses. In central Kenya, it is used as a
traditional medicine against back pains, diarrhoea, tonsils, toothache and wounds (Njoroge
et al. 2004). In the Eastern Cape Province, South Africa, traditional healers use the plant to
treat cancer (Adebola and Afolayan 2006), including breast cancer (Koduru et al. 2006). In
Angola, it is used to treat pests, headaches, coughs, chest and stomach pains, rheumatism,
incontinency and syphilis, while it is also used to induce abortion (Bossard 1996).
The Nyindu of eastern DRC use the berries to treat tuberculosis, either by roasting the
berry on fire until it becomes soft, after which the patient licks it with salt in his mouth, or
by roasting the berry and then pounding it into a powder which is taken together with salt
(Yamada 1999). In Burundi, the plant is used to treat headaches, rheumatism and
abscesses, while Solanum aculeastrum Dunal, var. albifolium is used to treat various other
diseases, including skin diseases, childhood diseases and several other diseases believed to
be caused by a variety of spirits. Drinks made out of the leaves are used to cure sterility,
strengthen female pregnancy and to ensure a good attachment of the placenta (Baerts and
Lehmann 1989). Ethno-veterinarians use it as treatment against eye diseases and
conjunctivitis in animals and the crushed berries are smeared in the vagina of cows as
treatment against nymphomania (Baerts and Lehmann 1991).
Bidens pilosa L. is an erect annual plant up to one meter high, producing flowers and
seeds and growing as a common weed in all tropical and subtropical areas of the world. In
some African countries, including Uganda, DRC, Tanzania and Kenya, the fresh or dried
198 M. Koster & L. Leimar Price
tender shoots and young leaves are consumed as a vegetable, especially in times of food
scarcity. It is also known for its high saponin content (Mvere 2004).
Bidens pilosa L. is used in traditional medicines for the treatment of various diseases,
including hepatitis and diabetes (Horiuchi and Seyama 2006). In Trinidad and Tobago, it
is used to treat skin problems, including cuts, injuries and swellings, stomach problems,
pain and internal parasites (Lans 2007). In Angola, the plant is used against bee stings,
abscesses and lower back pain (Bossard 1996). Hutchings et al. (1996) list quite a number
of problems and diseases for which the plant is used, including sexually transmitted
infections, use for constipation, diarrhoea and dysentery, painful joints and rheumatism,
ear and eye complaints, worms, jaundice, and snakebites. They also find that the plant is
used to stop excessive menstruation and to promote conception. Moreover, it is taken for
various sorts of inflammations and burnt seeds are rubbed into scarifications for the relief of
pain. In southern Africa, extracts of the plant are used to cure malaria, and in Nigeria the
powder or ash of seeds is used as a local anaesthetic and rubbed into cuts (Mvere 2004). In
rural Central Kenya, the plant is used as an antihelmintic, coagulant and against diarrhoea
and stomach upsets (Njoroge et al. 2004).
In Burundi, the leaves, and sporadically also the stems or plant ashes, are used to treat a
variety of conditions, including anaemia, headache, sprains and fractures, STIs, and
tachycardia. The leaves are also used to treat fevers, problems in the digestive system,
different skin diseases, including elephantiasis and wounds, child diseases such as measles,
and several diseases caused by different types of spirits (Baerts and Lehmann 1989).
Different parts of the plant are used in Uganda to speed up the clotting of blood in fresh
wounds, to treat headache, ear infection and kidney problems and to decrease flatulence,
while in the DRC the plant is used as a poison antidote, to ease child delivery and to relieve
pain from hernia (Mvere 2004). The entire plant is used in Tanzania to treat wounds and
cuts (de Boer et al. 2005).
Bioactive components of plants used in vaginal practices
Solanum aculeastrum Dunal contains several bioactive compounds. The berries contain the
poisonous alkaloid solanine (Hutchings et al. 1996, Adebola and Afolayan 2006),
solamargine, b-solamarine (Wanyonyi et al. 2002), solasonine and solasodine (Drewes
and van Staden 1995, Wanyonyi et al. 2003). In addition to these, the root bark contains
solaculine A (Wanyonyi et al. 2002) and steroidal alkaloid glycoside (Wanyonyi et al. 2002,
2003), while the berries are rich in steroidal glucasaponins and steroidal glucoalkaloids
(Wanyonyi et al. 2003). In general, Solanaceae species are long known for the presence of
pharmacologically active glycosidal alkaloids and, until recently, anti-spasmodic drugs
obtainable from this family were the only therapeutic agents alleviating Parkinsonism
(Beaman-Mbaya and Muhammed 1976).
Solanine can also be found in peppers, thus explaining the prickly sensation experienced
by women smearing it on their labia minora. However, this compound also acts as analgesic
for migraine and gastralgia and as a nervous sedative for paralysis agitans and chronic
pruritis in certain skin diseases (Hutchings et al. 1996). Thus, it is possible that, due to the
presence of solanine, its application actually temporarily numbs the sensation of the labia
minora some time shortly after application, making it less painful to pull. This would imply
that girls can pull harder or longer than without applying a mixture made out of these
berries, explaining why women feel that the use of the berries of the Solanum aculeastrum
Dunal makes the pulling ‘more effective’. The presence of potential toxins known to be
Rwandan female genital modification 199
present in the genus, such as narcotine and serotonine (Hutchings et al. 1996), may have
the same effect.
Other interesting characteristics of Solanum aculeastrum Dunal are worth noting. The
compounds of spirosolanes, solasodine and tomatidenol are commonly found in the genus.
These closely resemble steroidal sapogenin and diosgenin and are, as such, an alternative
source of pharmaceutical anti-inflammatory and contraceptive preparations (Hutchings et
al. 1996). The steroidal alkaloid solasodine can be used as a raw material in the synthesis of
steroid drugs (Drewes and van Staden 1995). Also, an important trait of Solanum
aculeastrum Dunal is that it demonstrates (Gram-positive) antibacterial and antifungal
activity (Beaman-Mbaya and Muhammed 1976, Addy 2005), antimicrobial (Wanyonyi et
al. 2003), antimitotic (Hutchings et al. 1996) and antibiotic activity (Beaman-Mbaya and
Muhammed 1976). Methanolic extracts of the fresh root bark and berries show high
molluscicidal activity against host snails of schistosomiasis and extracts of the plant can be
used in the control of bilharzia (Wanyonyi et al. 2002, 2003).
The roots, leaves and seeds of Bidens pilosa L. show antibacterial, anti-dysenteric,
antimicrobial, anti-malarial, diuretic, hepato-protective and hypotensive activities, but are
especially known for their antiseptic and anti-inflammatory properties (Mvere 2004). Bidens
pilosa L. contains different groups of active constituents (Dharmananda 2007), among
which polyacetylenes, which inhibit various pathogenic organisms, flavonoids, which reduce
inflammation and are known to have anti-allergic and anti-thrombic activities (Horiuchi and
Seyama 2006) and friedelane triterpenes, which contribute to the therapeutic action of the
plant. Selective antimicrobial activity (in vitro) against Gram-positive bacteria (Hutchings et
al. 1996, Rabe and van Staden 1997) and dermatophytes is related to the chemical
constituent phenylheptatriyene, which also produces anti-fungal action on Candida
albicans, wounds and ulcers (Hutchings et al. 1996). A number of polyacetylenes are toxic
to yeasts and some bacteria and show anti-parasitic activity (Mvere 2004).
None of the informants in this study seem aware of the aforementioned traits of Solanum
aculeastrum Dunal and Bidens pilosa L. However, the skin of the labia minora becomes very
thin by prolonged pulling and thus more susceptible to infections or lesions. The
application of the above-mentioned plants seems to reduce this risk. Moreover, considering
the biomedical properties of the two plants, it is plausible that any experience of pain during
‘pulling sessions’ is reduced by their application on the labia minora. We are not aware of
any research with which to corroborate these assumptions.
Conclusion
As noted earlier in this paper, the elongation of the labia minora is classified as a form of
female genital mutilation (Type IV) by WHO. In our view, such a classification is
problematic because mutilations generally have the effect of reducing women’s sexual
pleasure and violate women’s integrity and rights. This does not appear to be in
evidence from our study. Linguistic terminology of excisors and infibulators,
‘reductors’ in the words of Villa and Gallo (2006), seem to confirm this. Our
informants consider labial elongation as a positive force in their lives, enhancing their
sexual pleasure. Also, the linguistic terminology of ‘expansors’ (Villa and Gallo 2006),
like the women in our study who elongate their labia, is rich and suggests a positive
view on sexuality.
Whileweacknowledgethefactthatconsensualengagementinthepracticeoflabial
elongation is questionable, especially considering the age at which a girl is introduced to
200 M. Koster & L. Leimar Price
this practice and the social pressure she may experience at a later age to continue with it,
we are nevertheless of the opinion that the term female genital mutilation does injustice
to women’s experiences of their own bodies and sexuality in Rwanda. Here it is
important to stress once more that girls are able to stop pulling if the pain is too much
and none of our informants know of any woman actually sent away by her husband or
family-in-law for not having (sufficiently) enlarged her labia minora. We therefore concur
with Gallo et al. (2006a) that the term female genital modification better fits women’s
reality in Rwanda.
The discussion on the practice of labial elongation vividly demonstrates the culturally-
bound notions and experiences of sexuality and female orgasm. Whereas western scientific
literature presents no unequivocal evidence on whether or not women are able to ejaculate,
Rwandan men and women have no doubt that all women can, if properly handled by their
partners. In western countries, female ejaculation is often and most likely wrongly confused
with urinary incontinence and looked upon negatively. The exchange of bodily fluids,
including vaginal secretion, is culturally considered desirable in Rwanda and worth striving
for.
Lastly, it is important to note that WHO mentions the use of corrosive substances
and herbs in vaginal practices and considers these detrimental to women’s health. Our
study suggests that, apart from the risk of lesions and infections that arise from the
elongation of the labia minora, the use of plants by Rwandan women enlarging their
labia minora is potentially beneficial to their health. The medicinal properties of
Solanum aculeastrum Dunal and Bidens pilosa L. indicate that their use is part of
Rwandan medicinal tradition. The plants have demonstrated beneficial bioactive
compounds. Considering the cultural importance attached to the practice of labial
elongation, it seems worthwhile to study the wider ethno-medicinal and biomedical
properties of plants used by women during pulling sessions. More studies are needed to
explore the efficacy of such plants for culturally specific vaginal practices, health and
sexuality.
Notes
1. The ethnicity of informants is not available for all key informants. In post-genocide Rwanda, discussion of
ethnicity is a highly sensitive and emotionally charged issue. In a country where people can and are still arrested
for inciting ‘divisionism’ it was too sensitive to ask individuals their ethnicity. When people talk about ethnicity
it is in a more general sense. However, we know for certain that at least ten of the informants were Tutsi (eight
women and two men). We have not specifically identified any of our informants as Hutu. We do present
informants’ views that labial elongation is practiced by Hutu and Tutsi alike. We have no information on
Rwanda’s third ethnic group, the Batwa.
2. W.J. van der Burg and J. Wieringa, Biosystematics, Department of Plant Sciences, Wageningen University,
Netherlands.
3. For a review of literature on the different stances taken on female ejaculation by the medical and social science
community, see Darling et al. 1990, Cabello 1997 and Schubach 2001.
Acknowledgements
The data collection was part of a larger Ph.D. study at Wageningen University by M.
Koster, with L. Leimar Price and one of the academic supervisors. Financial support for the
larger study was provided by Jo Kolk Studiefonds, Mansholt Graduate School, CECEIP-
W, and the Netherlands Organization for Scientific Research (NWO).
Rwandan female genital modification 201
References
Addy, M. E. (2005) Western Africa Network of Natural Products Research Scientists (WANNPRES), First
Scientific Meeting August 15–20, 2004, Accra, Ghana: A report. African Journal of Traditional,
Complementary & Alternative Medicines, 2, 177–205.
Adebola, P. O. and Afolayan, A. J. (2006) Germination responses of Solanum aculeastrum, a medicinal species of
the Eastern Cape, South Africa. Seed Science & Technology, 34, 735–740.
Adeokun, L. A., Twa-Twa, J., Ssekiboobo, A. and Nalwadda, R. (1995) Social context of HIV infection in
Uganda. Health Transition Review, 5, (Suppl.), 1–26.
Agnew, A. D. Q. and Agnew, S. (1994) Upland Kenya wild flowers. A flora of the ferns and herbaceous flowering plants
of upland Kenya (Nairobi: East Africa Natural History Society).
Amadiume, I. (2006) Sexuality, African religio-cultural traditions and modernity: Expanding the lens. CODRESIA
Bulletin, 1&2, 26–28. Available at: http://www.codesria.org/Links/publications/bulletin-06/page26–28-
amadiume.pdf (accessed 11 December 2007).
Baker, J. R. (1974) Race (Oxford: Oxford University Press).
Beaman-Mbaya, V. and Muhammed, S. I. (1976) Antibiotic action of Solanum incanum Linnaeus. Antimicrobial
Agents & Chemotherapy, 9, 920–924.
Baerts, M. and Lehmann, J. (1989) Gue´risseurs et plantes me´dicinales de la re´gion des Creˆtes Zaı¨re-Nil au Burundi
(Tervuren, Belgium: Muse´e Royal de l’Afrique Centrale).
Baerts, M. and Lehman, J. (1991) Plantes me´dicinales ve´te´rinaires de la re´gion des Creˆtes Zaı¨re-Nil au Burundi
(Tervuren, Belgium: Muse´e Royal de l’Afrique Centrale).
Bernard, H. R. (2002) Research methods in anthropology: Qualitative and quantitative approaches. 3rd edition (Walnut
Creek: AltaMira Press).
Bossard, E. (1996) La medicine traditionelle au centre et a` l’ouest de l’Angola (Lisboa, Belgium: Instituto de
investigac¸ao cientifica tropical).
Brown, J. E. and Brown, R. C. (2000) Traditional intravaginal practices and the heterosexual transmission of
disease: A review. Sexually Transmitted Diseases, 27, 183–187.
de Boer, H. J., Kool, A., Broberg, A., Mziray, W. R., Hedberg, I. and Levensfors, J. L. (2005) Anti-fungal
and anti-bacterial activity of some herbal remedies from Tanzania. Journal of Ethnopharmacology, 96,
461–469.
Cabello, F. (1997) Female ejaculation: Myth and reality. In J. J. Baras-Vass and M. Perez-Conchillo (eds)
Sexuality and human rights: Proceedings of the XIII World Congress of Sexology (Valencia, Spain: ECVSA), pp.
325–333.
Codere, H. (1973) The biography of an African society, Rwanda 1900–1960, based on forty-eight Rwandan
autobiographies (Tervuren, Belgium: Musee Royal de L’Afrique Centrale).
Dallabetta, G. A., Miotti, P. G., Chiphangwi, J. D., Liomba, G., Canner, J. K. and Saah, A. J. (1995) Traditional
vaginal agents: Use and association with HIV infection in Malawian women. AIDS, 9, 293–297.
Darling, C. A., Davidson, J. K. and Conway-Welch, C. (1990) Female ejaculation: Perceived origins, the
Grafenberg spot/area, and sexual responsiveness. Archives of Sexual Behavior, 19, 29–47.
Dharmananda, S. (2007) Bidens: A popular remedy escapes notice of western practitioners. Available at: http://
www.itmonline.org/arts/bidens.htm (accessed on 22 March 2007).
Drewes, F. E. and Van Staden, J. (1995) Aspects of the extraction and purification of solasodine from solanum
aculeastrum tissues. Phytochemical Analysis, 6, 203–206.
Gallo, P. G., Tita, E. and Viviani, F. (2006a) At the roots of ethnic female genital modification. In G. Denniston,
P. Grassivaro Gallo, F. M. Hodges, M. F. Milos and F. Viviani (eds) Bodily integrity and the politics of
circumcision: Culture, controversy, and change (Dordrecht: Springer), pp. 49–55.
Gallo, P. G., Villa, E. and Pagani, F. (2006b) Graphic reproduction of genital stretching in a group of Baganda
girls: Their psychological experiences. In G. Denniston, P. Grassivaro Gallo, F. M. Hodges, M. F. Milos and
F. Viviani (eds) Bodily integrity and the politics of circumcision: Culture, controversy, and change
(Dordrecht:
Springer), pp. 65–84.
Green, J., Pool, R., Harrison, S., Hart, G. J., Wilkinson, J., Nyanzi, S. and Whitworth, J. A. (2001) Female control
of sexuality: Illusion or reality? Use of vaginal products in southwest Uganda. Social Science and Medicine, 52,
585–598.
Heath, D. (1987) Female ejaculation: Its relationship to disturbances of erotic function. Medical Hypotheses, 24,
103–106.
Horiuchi, M. and Seyama, Y. (2006) Anti-inflammatory and anti-allergic activity of Bidens pilosa L. var. radiata
Scherff. Journal of Health Sciences, 52, 711–717.
202 M. Koster & L. Leimar Price
Hutchings, A., Scott, A. H., Lewis, G. and Cunningham, A. B. (1996) Zulu medicinal plants and inventory
(Pietermaritzburg, South Africa: University of Natal Press).
Jacob, I. (1983) Dictionnaire Rwandis-Franc¸ais. 1st Edition (Kigali, Rwanda: Institut National de Recherche
Scientifique).
Jansen, D. F. (2002) Growing up sexually in sub-Saharan Africa. World reference atlas. Interim report. Available at:
http://www2.rz.hu-berlin.de/sexology/GESUND/ARCHIV/GUS/AFRICAOLD.HTM (accessed March 5,
2007).
Koduru, S., Grierson, D. S. and Afolayan, A. J. (2006) Effect of high temperatures on seed germination of
Solanum aculeastrum. Asian Journal of Plant Sciences, 5, 353–356.
Lans, C. (2007) Comparison of plants used for skin and stomach problems in Trinidad and Tobago with Asian
ethnomedicine. Journal of Ethnobiology and Ethnomedicine, 3, 3, Available at: http://www.ethnobiomed.com/
content/pdf/1746-4269-3-3.pdf (accessed on 11 December 2007).
McNamara, K. R. (2006) Pretty woman: Genital plastic surgery and the production of the sexed female subject.
Gnovis. [Georgetown University’s Peer-Reviewed Journal of Communication, Culture and Technology], 7.
Available at: http://www.gnovisjournal.org/files/Karen-Roberts-McNamara-Pretty-Woman.pdf (accessed
August 28, 2007).
Mvere, B. (2004) Bidens pilosa L. Electronic record from Plant Resources of Tropical Africa (PROTA) protabase.
Website hosted by Wageningen University. Available at: http://database.prota.org/search.htm (accessed 11
December 2007). Original print source In G. J. H. Grubben and O. A. Denton (eds), 2004. Plant Resources
of Tropical Africa 2. Vegetables. PROTA Foundation. (Leiden: Backhuys Publishers).
Mwenda, K. K. (2006) Labia elongation under African customary law: A violation of women’s rights? International
Journal of Human Rights, 10, 341–357.
Mwenda, K. K. (2007) Personal communication.
Myer, L., Denny, L., De Souza, M., Barone, M. A., Wright, T. C.Jr. and Kuhn, L. (2004) Intravaginal practices,
HIV and other sexually transmitted diseases among South African women. Sexually Transmitted Diseases, 31,
174–179.
Nabaitu, J., Bachengana, C. and Seeley, J. (1994) Marital instability in a rural population in South-West Uganda:
Implications for the spread of HIV-1 infection. Africa: Journal of the International African Institute, 64,
243–251.
Njoroge, N. G., Bussmann, W. R., Gemmill, B., Newton, L. E. and Ngumi, V. W. (2004) Utilisation of weed
species as sources of traditional medicines in central Kenya. Lyonia: A Journal of Ecology and Application,7,
71–87.
Rabe, T. and van Staden, J. (1997) Antibacterial activity of South African plants used for medicinal purposes.
Journal of Ethnopharmacology, 56, 81–87.
Schubach, G. (2001) Urethral expulsions during sensual arousal and bladder catherization in seven human
females. Journal of Human Sexuality, 4, Available at: http://www.ejhs.org/volume4/Schubach/ (accessed
March 5, 2007).
Sengendo, J. and Sekatawa, E. (1999) A cultural approach to HIV/AIDS prevention and care: Uganda’s
experience–country report. UNESCO/UNAIDS Research Report (Kampala: Studies and Reports, Special
Series, Issue 1, Special Series of Cultural Policies for Development Unit).
South African National Biodiversity Institute, website PlantzAfRICA.com. Available at: http://www.plantza-
frica.com/plantqrs/solanacul.htm (accessed April 18, 2007).
Stannus, H. S. (1910) Notes on some tribes of British Central Africa. Journal of the Royal Anthropological Institute of
Great Britain and Ireland, 40, 285–335.
Taylor, C. C. (1988) The concept of flow in Rwandan popular medicine. Social Science and Medicine, 27,
1343–1348.
Taylor, C. C. (1990) Condoms and cosmology: The ‘fractal’ person and sexual risk in Rwanda. Social Science &
Medicine, 31, 1023–1028.
Taylor, C. C. (1992) Milk, honey and money: Changing concepts in Rwandan healing (Washington: The Smithsonian
Institution Press).
UN Economic and Social Council (2002) Integration of the human rights of women and the gender perspective:
Violence against women. Report of the special Rapporteur on violence against women, its causes and
consequences. Available at: http://www.hri.ca/fortherecord2002/documentation/commission/e-cn4-2002-
3.htm (accessed March 15, 2007).
US Department of Agriculture website: Plants.USDA.gov, Available at: http://plants.usda.gov/java/
profile?symbol5SOAC2 (accessed April 17, 2007).
Van de Wijgert, J., Mbizvo, M., Dube, S., Mwale, M., Nyamapfeni, P. and Padian, N. (2001) Intravaginal
practices in Zimbabwe: Which women engage in them and why? Culture, Health & Sexuality, 3, 133–148.
Rwandan female genital modification 203
Veldhuijzen, N., Nyinawabega, J., Umulisa, M., Kankindi, B., Geubbels, E. and Basinga, P., et al. (2006)
Preparing for microbicide trials in Rwanda: Focus group discussions with Rwandese women and men.
Culture, Health & Sexuality, 8, 395–406.
Villa, E. and Grassivaro Gallo, P. (2006) Psycholinguistic approaches to ritual labia minora elongation among the
Baganda women of Uganda. In G. Denniston, P. Grassivaro Gallo, F. M. Hodges, M. F. Milos and F.
Viviani (eds) Bodily integrity and the politics of circumcision: Culture, controversy, and change (Dordrecht:
Springer), pp. 57–64.
Wanyonyi, A. W., Chhabra, S. C., Mkoji, G., Eilert, U. and Njue, W. M. (2002) Bioactive steroidal alkaloid
glycosides from solanum aculeastrum. Phytochemistry, 59, 79–84.
Wanyonyi, A. W., Chhabra, S. C., Mkoji, G., Njue, W. and Taurus, P. K. (2003) Molluscicidal and antimicrobial
activity of Solanum aculeastrum. Fitoterapia, 74, 298–301.
World Health Organisation (WHO) (2000) Female genital mutilation. Fact sheet No.241. Available at: http://
www.who.int/mediacentre/factsheets/fs241/en/print.html (accessed 5 April, 2007).
Yamada, T. (1999) A report on the ethnobotany of the Nyindu in the eastern part of the former Zaire. African
Study Monographs, 20, 1–72.
204 M. Koster & L. Leimar Price
... However, dissatisfaction with the external genitalia varies according to age, ethnicity, education level, and geography (7,8). For example, large labia minora are said to be considered attractive in Rwanda, Japan and Mozambique (9)(10)(11). ...
... Considering these rates, asymmetry and protrusion could be considered normal. In the literature, protusion rates are reported above 50% (9,21). The values de ned as normal in the literature actually seem to be ideal vulva criteria. ...
... Therefore, the term "labial hypertrophy" and the use of terms such as "normal" and "pathological" labial size were not recommended. The authors emphasized that it was not possible to de ne speci c threshold values for these terms that could be associated with complaints (9). In our study, we observed that labia minora protrusion was not associated with base and width measurements of labia minora, the differences in these measurements between the two labia minora, or asymmetry. ...
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Full-text available
Background: The purpose of this study to determined women’s perceptions of the vulva with the criteria defined in the literature for the ideal vulva and determine their relationship with anatomical measurements in order to determine the extent to which women’s perceptions of normal align with our aesthetic standards of normality. Methods: First of all, a questionnaire was applied to all participants. The items of the data collection form were included personal information, obstetric and gynecological information, their perceptions of their external genitalia and any physical, sexual, psychological, and hygiene problems they experience. Then examination and measurements of the external genitalia were performed. Results: The majority of participants considered their genitalia normal (n=101, 89.4%), while 12 participants (10.6%) considered them abnormal. Statistical analyses showed that women’s perception of their genitalia as normal in appearance and size was associated with labia minora asymmetry (p=0.023 and p=0.006, respectively) and hyperpigmentation (p=0.010 and p=0.047, respectively) but not with labia minora measurements or protrusion (p>0.05) Conclusions : Although there is a tendency in the field of aesthetic surgery to define ideals and aesthetic standards for all parts of the body, our definitions of normality do not always coincide with those of the individual. The appearance of the genitalia is as personal as the face, and an individual’s self-perception is more important than our ideal. Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
... Importantly, the desire to restore or return the vagina to its "natural" or "optimal" state of "being a virgin" was identified as a strong motivator for the insertion of products intravaginally (Gafos et al., 2010;Humphries et al., 2019;Lees et al., 2014). In other instances, local botanical species, were used to elongate the labia minora (Koster & Price, 2008) in a practice purported to increase sexual wetness or dryness for the sexual pleasure of both partners. ...
... Although in many East African countries, including Rwanda and Uganda, surgical mutilation similar to what is practiced in West Africa is not generally observed, elongation of the labia minora through non-surgical means, called Gukuna is common (Koster & Price, 2008;Pérez et al., 2013). Despite its technical distinction, Gukuna is classified by the World Health Organization (WHO, 2008) as type IV FGM, which carries a negative connotation even if it is not a mutilation per se (Koster & Price, 2008). ...
... Although in many East African countries, including Rwanda and Uganda, surgical mutilation similar to what is practiced in West Africa is not generally observed, elongation of the labia minora through non-surgical means, called Gukuna is common (Koster & Price, 2008;Pérez et al., 2013). Despite its technical distinction, Gukuna is classified by the World Health Organization (WHO, 2008) as type IV FGM, which carries a negative connotation even if it is not a mutilation per se (Koster & Price, 2008). The aim of labial elongation is to provide enhanced sexual pleasure during intercourse to both the female and her partner through Kunyaza, which is a rhythmic sexual technique aimed at providing multiple orgasms and female ejaculation during intercourse among other supposed benefits (Audet et al., 2017;Bizimana, 2010). ...
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This manuscript considers intravaginal practices prevalent among African and African-American women, with the aim of providing a framework for how these practices may affect vaginal health and the vaginal microbiota, and consequently, impact pregnancy outcomes. Intravaginal practices are influenced by traditional socio-cultural beliefs and gender norms, with prominent practices including intravaginal insertion of substances (herbs and traditional medicines), intravaginal cleansing (douching), and anatomical modification of the female organs (labia elongation and female genital mutilation). Common motivations for such practices included hygiene, prevention of infection, enhancement of sexual pleasure, and compliance with societal or cultural norms. The use of soaps and other chemicals for vaginal douching has been reported to reduce diversity of the vaginal microbiota and lower pH, thus increasing the chances of bacterial vaginosis, but the evidence is minimal. The practice of vaginal insertion of natural or other substances is associated with physical abrasions, disruption of the vaginal flora, bacterial vaginosis, and HIV and other infections, but effects on pregnancy outcomes and the vaginal microbiota are unclear. Finally, female genital mutation has been reported to have immediate and prolonged physiological and psychological effects, including frequent infections and chronic inflammation, but similar to most other practices, consequences for preterm birth remain understudied and for the vaginal microbiota, unknown. Overall, findings identify the need for additional research, focusing on how these common practices influence both birth outcomes and the vaginal microbiota, so that nurses, midwives, physicians, and other providers worldwide are better equipped to assess and care for pregnant women.
... For example, in some African populations they can be as large as 20 cm and are known as a ''Hottentot apron'' . Today, elongation of the labia minora is classified in the type IV female genital mutilation (Koster and Price, 2008;Abdulcadir et al., 2011). ...
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For sexologists, physicians, psychologists, gynecologists etc., it is a duty to update their knowledge. Female and male orgasm-sexuality, free pdf with 36 Pubmed-full text Dr Vincenzo Puppo-New Sexology Project: Eur J Obstet Gynecol, Eur Urol, Clin Anat, BJOG, J Urol, Int Urogynecol J, J Sex Med, BJU Int, J Pediatr Adolesc Gynecol, ISRN Obstet Gynecol, Gynecol Obstet Fertil, Maturitas, Int J Urol, etc. Sexual pleasure/orgasm, (clitoris, labia minora and vestibular bulbs, exist in all women) is a source of physical and psychological wellbeing that contributes to human happiness. Female sexual anatomy is not has been a neglected area of study and the existing terminology is accurate from centuries... The key to female orgasm are the female erectile organs of the vulva (external organs)... Female orgasm is possible in all women, always, with effective stimulation of the female erectile organs... female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm... Female sexual satisfaction is based on orgasm: sexologists must define having sex/love making when orgasm occurs for both partners, always, with or without vaginal intercourse (definition for all human beings)... the duration of penile-vaginal intercourse is not important for a woman’s orgasm: premature ejaculation is not a male sexual dysfunction... Website http://www.vincenzopuppo.altervista.org/articoli.html Free video: clitoris/labia minora erection in woman https://www.researchgate.net/publication/273966598_Flaccid_Erect_Clitoris_Labia_minora_in_woman_Clin_Anat_2013 Free video: orgasms in all women https://www.researchgate.net/publication/343851657_Video_Female_orgasms_in_all_women_always_with_stimulation_clitoris-labia_minora_with_fingers https://www.youtube.com/watch?v=Pm_Qg2b4kKI
... ese include traditional use of (a) the berries and leaves in treatment of lymphatic filariasis in the KwaZulu-Natal and Mpumalanga regions of South Africa [121]; (b) the berries, leaves, roots, and bark against cancer in the Kakamega county of Kenya and Eastern Cape Province of South Africa [98,122]; (c) the roots to treat stomachache in Limpopo Province of South Africa [123]; and (d) the berry juice against ditlapedi (a facial skin condition) in the Central Sekhukhuneland of South Africa [124]. Although the practice is regarded by Rwandan women as "a positive force in their lives," S. aculeastrum has been described as being used as medicine applied during stretching sessions for elongation of the labia minora, which is classified as Type IV female genital mutilation by the World Health Organization [125]. Publications, categorized under the DoP bioactivity , reported low antioxidant activity of the berries and low antimicrobial activity of the berries and leaves against ten bacterial and five fungal strains [126][127][128][129]. ...
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In ethnopharmacological research, many field assessment tools exist. Yet, these miss that critical point of how to really determine which species merit the costly lab studies, e.g., evaluation of traditional use via pharmacological assays and isolation of bioactive secondary metabolites. This gap can be filled with the introduction of a new tool for literature assessment: the Degrees of Publication (DoPs). In this study, its application is illustrated through an extensive bibliographic assessment of 16 medicinal plant species that were recently identified in the Greater Mpigi region of Uganda as being frequently used by local traditional healers in the treatment of medical disorders (namely, Albizia coriaria, Cassine buchananii, Combretum molle, Erythrina abyssinica, Ficus saussureana, Harungana madagascariensis, Leucas calostachys, Microgramma lycopodioides, Morella kandtiana, Plectranthus hadiensis, Securidaca longipedunculata, Sesamum calycinum subsp. angustifolium, Solanum aculeastrum, Toddalia asiatica, Warburgia ugandensis, and Zanthoxylum chalybeum). These species are suspected to be understudied, and a thorough bibliographic assessment has not been previously performed. Thus, the objectives of our study were to undertake a comparative assessment of the degree to which each of these plant species has been studied in the past, including evaluation of the quality of the journals where results were published in. The determination of the DoPs enabled successful assessment of the degrees to which each individual plant species has been studied so far, while also taking into account the methodological “research chain of ethnopharmacology” from ethnobotanical studies (“traditional use”) to pharmacological assays (“bioactivity”) and finally to pharmacognostic research (“structure elucidation”). The significance of a research paper was assessed by determining whether its journal and publishing house were members of the Committee on Publication Ethics (COPE). In total, 634 peer-reviewed publications were reviewed covering the period of 1960–2019, 53.3% of which were published in journals and by publishing houses affiliated with COPE (338 publications). The literature assessment resulted in the identification of understudied plants among the selected species. The majority of plants reviewed have not been sufficiently studied; six species were classified as being highly understudied and three more as being understudied: C. buchananii, F. saussureana, L. calostachys, M. lycopodioides, M. kandtiana, and S. calycinum subsp. angustifolium and A. coriaria, P. hadiensis, and S. aculeastrum, respectively. The newly introduced DoPs are a useful tool for the selection of traditionally used species for future laboratory studies, especially for pharmacological bioassays, isolation procedures, and drug discovery strategies. 1. Introduction Throughout human history and across the globe, plants were regarded as the major source of medicine and natural remedies. Traditional medicine is defined by the World Health Organization (WHO) as “the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, and improvement or treatment of physical and mental illness” [1]. In the developing world, over 80% of the population still rely on traditional herbal medicines for their day-to-day healthcare needs [2–4]. This is largely attributed to their ease of access, affordability, perceived fewer side effects, and cultural appropriateness, among other reasons [5]. Despite the general loss of cultural practices worldwide [6, 7], traditional medicine practices and medicinal plant use are still the predominant form of healthcare services in East and Central Africa today [8, 9]. The global importance of plants as a source of medicine is also often emphasized by scientists worldwide [10–14]. Around 25% of the Western drugs prescribed contain active ingredients that were initially isolated as natural products from plants [10]. Still, the majority of Earth’s plant species has never been screened for pharmacological effects in a research facility [10, 15]. In consideration of this global importance, there are many assessment tools applied when reporting field studies in the science of ethnopharmacology. These include field assessment indices for medicinally used species, such as the frequency of citation, use value, informant consensus factor, and fidelity level, among others. However, none of these take into account how to really determine which species merit the costly lab studies. This is why we introduce the Degrees of Publication (DoPs), providing a standardized way to examine how well studied individual species are (or are not) in an ethnopharmacological context. In this study, 16 medicinal plant species from the Greater Mpigi region were selected to illustrate how the new tool works. Situated in West-Central Uganda, the tropical Greater Mpigi region displays a high abundance of traditional medicine practitioners and diverse use of a vast amount of medicinal plant species [14, 16, 17]. Consequently, local people are still highly dependent on these traditional healers and their medicinal plants in order to secure their primary health care. A recently published ethnobotanical survey from the Greater Mpigi region [14] and an ethnopharmacological study [18] identified 16 medicinal plant species that are often used in the treatment of medical disorders in the local traditional medicine system while displaying high pharmacological activity in our ongoing in vitro evaluation in a lab setting. A preliminary literature review resulted in a few results. Therefore, these 16 plants are suspected to be understudied species, and a thorough literature review using the new DoP method for bibliographic assessment enables the selection of traditionally used species for pharmacological bioassays and drug discovery strategies. Our study, therefore, aims to undertake a comparative literature assessment, applying the DoP method, regarding (a) other reports of these species, (b) the quality of the journals where results were published in (assessment of international standards and best practice in scholarly publication ethics), and (c) the degree to which each plant species has been studied thus far. 2. Materials and Methods 2.1. Study Objects Our study objects are 16 tropical plant species identified to be frequently used by Ugandan traditional healers in treatment of diverse medical disorders in the Greater Mpigi region. This choice of species can be considered taxonomically diverse, representing 13 different plant families. Table 1 lists these species, stating their scientific names, local names at the study site (Luganda language), their plant families, and their Relative Frequencies of Citation (RFC), calculated from absolute values of the ethnobotanical survey (n = 39) previously published by Schultz et al. [14]. Botanical name Local name (Luganda language) Family RFC (%) Albizia coriaria Oliv. Mugavu Fabaceae 100.0 Cassine buchananii Loes. Mbaluka Celastraceae 61.5 Combretum molle R.Br. ex G.Don Ndagi Combretaceae 89.7 Erythrina abyssinica DC. Jjirikiti Fabaceae 100.0 Ficus saussureana DC. Muwo Moraceae 94.9 Harungana madagascariensis Lam. ex Poir. Mukabiiransiko Hypericaceae 97.4 Leucas calostachys Oliv. Kakuba musulo Lamiaceae 43.6 Microgramma lycopodioides (L.) Copel. Kukumba Polypodiaceae 43.6 Morella kandtiana (Engl.) Verdc. & Polhill Mukikimbo Myricaceae 87.2 Plectranthus hadiensis (Forssk.) Schweinf. ex Sprenger Kibwankulata Lamiaceae 97.4 Securidaca longipedunculata Fresen. Mukondwe Polygalaceae 38.5 Sesamum calycinum subsp. angustifolium (Oliv.) Ihlenf. & Seidenst. Lutungotungo Pedaliaceae 87.2 Solanum aculeastrum Dunal Kitengo Solanaceae 71.8 Toddalia asiatica (L.) Lam. Kawule Rutaceae 97.4 Warburgia ugandensis Sprague Abasi Canellaceae 92.3 Zanthoxylum chalybeum Engl. Ntaleyaddungu Rutaceae 46.2
... Health Organisation (2000) listed it as female genital mutilation that subjects women to unhealthy conditions for the sake of sexually pleasing themselves and their husbands, and Perez and Namulondo (2011) associate the practice with health risks. This is a contentious issue because other researchers have argued that it is genital modification (Koster and Price, 2008) and women regard the practice as a positive force in their lives. ...
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Bride welcoming ceremony or relegation of women to the subaltern? by Wonder Maguraushe and Treda Mukuhlani The institution of marriage is a place where Shona women have often suffered oppression instead of fulfilment. Women have lamented Shona cultural practices that are not cognisant of human rights despite Zimbabwe being a signatory to the SADC Declaration on Gender and Development. Practices which are harmful to women and tantamount to gender inequality need to be discontinued in Shona culture. We notice that the impact of patriarchy and the vulnerability of females have been perpetuated in Shona culture through the performance of traditional bride welcoming ceremony songs. Folk songs are an important element of Shona culture in terms of women's construction of their personal identities. Kupururudzira muroora (traditional bride welcoming ceremony) songs are part of
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Literature attempting to understand the extent to which labia elongation (LE) affects women is virtually non-existent. Twenty qualitative interviews were conducted with Zimbabwean women in the UK seeking to understand the extent to which the practice was seen as harmful. Currently LE is not considered as harmful as types 1–3 and is therefore absent in global campaigning against FGM/C. The findings from this study strongly argue that LE is indeed a form of violence but the ways in which it causes harm are less visible than with types 1–3. The critical feminist lens applied in this article demonstrates that LE needs to be considered as linked to other forms of VAWG including IPV. It is also strongly linked to other harmful practices such as child marriage and bride-price. Ultimately, as with all forms of gendered violence, structural inequalities found the continuance of LE. Transforming patterns of abuse are made harder by the perception that LE makes a girl more beautiful to her future husband. Young women perform the practice on themselves in the belief that it will secure them a good marriage. The challenge to end the practice is therefore complex and no less urgent than other forms of FGM/C.
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Rotator Manşet Sorunları
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Anterior Omuz İnstabiliteleri
Thesis
Background: Female Genital Mutilation (FGM), also referred to as Female Genital Cutting (FGC) or female circumcision (FC), remains a contributor to the high morbidity and mortality among females in Africa. Despite concerted efforts to curb it, the practice continues among many ethnic groups, especially in Africa. Various studies have been conducted, focusing on this practice. However, in Africa, there is a paucity of literary work on the experiences of females who underwent FGM/C, and the experiences of healthcare practitioners who care for these genitally mutilated females is also unknown. Aim of the study: The aim of this study was to obtain insight into the Female Genital Mutilation/ cutting (FGM/C) experiences of females and healthcare practitioners in South Eastern (SE), Nigeria where the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) Nigeria (2016) reported a steady rise in their FGM/C prevalence; and also to develop a comprehensive, context-specific health education pamphlet (HEP) for the females based on the identified health information needs. The study was underpinned by the self-concept theory and the theory of ethical relativism. Methods: This was a multi-method study which employed a scoping literature review, a qualitative descriptive method, and a methodological triangulation for the development of a HEP for the genitally mutilated females. Therefore, the study had three phases. Phase one was the scoping literature review of FGM/C in Africa, Phase two was a qualitative description of the FGM/C experiences of genitally mutilated females, mothers of genitally mutilated girls and the healthcare practitioners in SE Nigeria, while Phase three was the development of a health education pamphlet (HEP) for use by the genitally mutilated females. Findings: The first phase of the study revealed FGM/C was still being practiced widely in Africa despite interventions such as anti-FGM/C laws and campaigns. Evidence found has also revealed there might have been an increase in “early-age” (0 to 10 years) FGM/C in some communities, and that the FGM/C studies done between 1 January 2007 and 31 December 2016 were mostly quantitative studies focused on the prevalence, attitude, perpetrators and health consequences of FGM/C. Studies investigating the experiences of all the role players involved in this practice and how to prevent it were absent. Understanding these phenomena could guide efforts to curb this harmful practice. In the second phase of the study, the participants equated FGM/C to male circumcision and noted that culture was mostly responsible for the continuation of the practice over the years. Regardless of the pain associated with this practice, some of the participants were forcefully circumcised to ensure adherence to their culture. Among the female participants, feelings of uncertainty, fear, and helplessness were experienced. Moreover, healthcare practitioners reported feelings of not being adequately equipped with the advanced skills required in the care of genitally mutilated females, especially during childbirth. Also reported were cases of child mortality and other healthcare challenges owing to FGM/C. In the third phase, three synthesized findings were generated from the methodological triangulation of conclusions from Phases one and two: “FGM/C: past and present situations,” “factors that sustained FGM/C” and “health information needs.” In response to the health information needs identified, a health education pamphlet (HEP) was developed to improve self-care among the females. Conclusion: This study provided evidence that FGM/C is ongoing in Africa. Although it is illegal in many countries, females and healthcare practitioners still support this procedure as it is seen as a part of the culture. Some women were forcefully circumcised. Feelings of uncertainty, fear and helplessness were reported among the females. Cases of child mortality and other healthcare challenges due to FGM/C were also experienced. In response to the information needs that emerged from the scoping review and the qualitative investigation, a health education pamphlet was developed to inform the genitally mutilated females on what FGM/C was all about, self-care after FGM/C, and what to do when under pressure to circumcise their daughters.
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Background: Despite concerted efforts to curb Female Genital Mutilation/Cutting (FGM/C), it is still a con�tributor to the high morbidity and mortality rates among females in Africa. Purpose: To describe the publication output on FGM/C conducted in Africa over a period of 10 years and identify trends and gaps to guide future research. Method: A scoping review on FGM/C in Africa was conducted. The keyword ‘Africa’ in combination with the terms ‘female genital mutilation,’ ‘female genital cutting’ and ‘female circumcision,’ were used to search the databases PubMed, CINAHL, Web of Science and Scopus. Reference lists of tracked articles were used to track other relevant articles. Only peer-reviewed works published between 1 January 2007 and 31 December 2016 were included. The data were captured onto an extraction sheet, while content analysis was used to categorize the findings of the studies and group the categories into themes. Results: Of the 401 articles identified for possible inclusion, only 28 articles met the inclusion requirements. Most of the studies (n = 17; 60.7%) were quantitative and focused on prevalence, attitudes, perpetrators, and health consequences of FGM/C. Two themes and six sub-themes arose from the data. The themes were the practice of FGM/C and the attempts to end FGM/C. Conclusions: FGM/C is still widely practiced in Africa and there may have been an increase in early-age FGM/C in some communities. Studies investigating the experiences of all the role players involved in this practice and how to prevent it were absent. Understanding these phenomena could guide efforts to curb this harmful practice.
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Weed control measures and policies often view weedy plants as problem species that interfere withagricultural productivity. This results in these plants being eradicated sometimes indiscriminatelywithout regard for their other economic importance. In rural Central Kenya however, people areturning to use of traditional medicinal plant species that include important weeds. This study analyzedthe use of weed species in contemporary traditional medicine in Central Kenya. The results show that75 species in 34 plant families are used as sources of traditional medicine for 59 ailments. Informantconsensus analysis for the ailments cited reveal that 32 of these ailments have a consensus factor of0.5 and above. These weed species therefore deserve to be considered as important plants whenKenyan government is legislating problem plants species. In resource use efficiency variation andmanagement of this variation are crucial and hence agrobiodiversity conservation strategies shouldinclude weedy species of medicinal value. Indigenous as well as non-indigenous weed species werefound to form part of the Central Kenya pharmacopoeia. This implies that traditional medicine in thisregion may be undergoing changing patterns as far as medicinal plant utilization is concerned. Themedicinal weed species used for the treatment of ailments with high informant consensus need to beincorporated in agroecosystems in this region as domesticated plants or plants in the process ofdomestication. Further study of these plants especially phytochemical and pharmacological studiesmay contribute to development of important pharmaceutical products in future. Key words:Biodiversity conservation, ethnobotany, medicinal plants Utilisation of weed species as sources of traditional medicines in central Kenya. Available from: https://www.researchgate.net/publication/287013032_Utilisation_of_weed_species_as_sources_of_traditional_medicines_in_central_Kenya [accessed Dec 21, 2015].
Book
How is it that, at the beginning of the twenty-first century, it is still possible for males and females to be denied their inherent right to keep all the body parts with which they were born? Every year 13.3 millions boys and 2 million girls are subjected to circumcision, the involuntary removal of part or all of their external sex organs. Few people, however, ask why such practices persist or how modern societies can tolerate this inherent violation of human rights. The problem of female circumcision is being addressed on an international level, while male circumcision remains a subject many academics are reluctant to fully or impartially examine. This book explores the problem of male and female circumcision in modern society from religious, anthropological, psychological, medical, legal, and ethical perspectives. Bodily Integrity and the Politics of Circumcision: Culture, Controversy, and Change illuminates the vulnerability of human society to medical, economic, and historical pressures. It offers a thoughtful, detailed and much-needed analysis of the devastating impact of circumcision on bodily integrity and human rights, and provides hop.
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Intravaginal practises are widespread in sub-Saharan Africa. They may increase HIV transmission and interfere with the acceptability and efficacy of barrier methods of HIV prevention. This survey provides detailed quantitative descriptions of intravaginal practises, and predictors and reasons for such practises, in a cohort of Zimbabwean women. Finger-cleansing and wiping were extremely common, practised an average of once or twice per day, and considered an essential part of a woman's routine hygiene. The insertion of traditional substances, mostly used to dry and tighten the vagina, was less common and practised less frequently. Users were more likely than non-users to be of lower socio-economic status, and in search for a steady partner or marital stability. The relationship between intravaginal practises and condom use was unclear, because condom use was rare and strongly associated with sex work in this cohort. The need to determine how much lubrication women and men desire and tolerate during sex in different parts of the world is discussed. We recommend to take intravaginal practises into account when developing new methods of HIV prevention (such as topical vaginal microbicides), and when designing HIV prevention programmes.
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