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

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.

Full text

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

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