In Rwanda women practice the stretching and pulling of their labia minora in order to elongate them. Marian Koster MSc and Dr. Lisa Price of Wageningen University, Netherlands, emphasize that Rwandan women experience their elongated labia as positive and as having a positive impact on their sexual pleasure and that of their partner. The elongated labia are viewed by Rwandan women as facilitating female ejaculation and orgasm. In western countries, labiaplasty (labia reduction and beautification) is becoming increasingly popular as a form of female cosmetic surgery.

Koster and Price note that while practices that aim to reduce, enlarge or otherwise beautify the external female genitalia are influenced by cultural aesthetics they are nevertheless highly controversial.

Koster discovered this practice while conducting field research in Rwanda surrounding the effects of genocide on rural livelihoods and life-ways. She found that girls start pulling their labia during puberty and use local medicinal plants to facilitate the pulling. After learning how to pull the labia from female relatives or friends, girls and women continue to pull their own labia through to adulthood and marriage.

The practice is of particular interest because it opens the door to understanding the intimate relationship between women's views on sexual pleasure and sexuality which are little documented outside of the Western context. Koster and Price suggest that it is of equal interest because of the biomedical properties of the plants women actually use in the elongation process. Price says the study illustrates a woman centered area of ethnobotanical knowledge embedded in practice. The evidence suggests that Solanum aculeastrum Dunal and Bidens pilosa L., two species the women apply externally, have antibacterial, antimicrobial, antiseptic, anti-inflammatory and analgesic properties.

The World Health Organization classifies the elongation of the labia minora as a form of female genital mutilation. Mutilation, however, carries powerful negative connotations. Koster and Price find such a classification problematic because mutilations generally have the effect of reducing women's sexual pleasure and violating women's integrity and rights. This does not appear to be in evidence from their study. Thus, Koster and Price question the use of the term mutilation and propose that the term female genital modification may better capture the reality of this practice in the context of Rwanda.

The World Health Organization is scheduled to release an amendment later this month where labia elongation will be treated differently.

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