The practice of elongating the labia minora of the vagina, known as ‘visiting the bush’, is very common in central and western Uganda but is rarely discussed openly. Yet there are many questions about the practice that need to be answered.
Does this cultual practice transmit HIV? Is it a missed opportunity to address the sexual and reproductive health issues of young women? How does it relate to women’s sexuality and rights?
Labia stretching is a cultural practice common in sub-Saharan Africa and is performed for aesthetic purposes as well as sexual gratification. It involves pulling the labia minora and can include the use of weights. In Uganda the practice is referred to as visiting the bush because girls often perform it while in the bush on errands such as collecting firewood.
Female genital mutilation
The World Health Organisation (WHO) has retracted its earlier stand where it classified labia elongation as class IV female genital mutilation. This had outraged many Africans as the practice is supposed to provide immense sexual pleasure and WHO’s stance was considered a misunderstanding of the cultures and ways of African people.
Sylvia, 21, a university student in Kampala, says: “We started pulling while we were in primary school. Most of my friends have done it. It can be painful but you eventually get used to it. I’ve heard it can prevent you from getting HIV. We know all the bush herbs that are used for the purpose. It is trendy for a girl to have pulled and many girls say men sometimes rebuke girls who never ‘pulled’ as backwards.”
Josephine Namyalo, a senior teacher in charge of girls aged 11 to 18 from Mpigi, says: “The major purpose of pulling the labia among the Baganda tribe, is to assist the couple especially the woman to ejaculate when a man strokes the elongated labia gently without any form of sexual penetration. They begin the practice at 9 to 12 years, because at this age the young girl’s tissues are softer and flexible for pulling.”
Labia elongation and HIV
According to Paul Ssekawungi, an HIV and AIDs counsellor based at Mulago national referral hospital in Kampala, pulling could have an association to HIV. In some cases another partner helps the girl elongate the muscles. Among Baganda communities the ssenga (paternal auntie) teach girls at puberty how to pull their labia to lengthen them.
Paul says: “We always encourage people not to use sharp instruments because this risks transmitting HIV – but if they are carrying out such a practice with bare hands or instruments and it is done without gloves, chances could be that vaginal fluids will be shared. What if some of them have cuts and STIs? This could also be risky. Given the fact we have so many young people who are HIV positive, we may need to re-examine these practices to ensure they are safe. We are talking of zero new HIV infections. We need to exhaust all avenues and ensure that young people are not taking chances here as well.”
Although the practice itself is unlikely to put girls at high risk of HIV, Josephine says: “The problem with elongation of the labia is the talk, excitement and mysteries that go with it. Normally young girls’ expectations after elongating the muscles are high and they would like to experiment with men because it arouses their curiosity. They want to know how sex feels after pulling. This is the point that things may get out of hand and they may put themselves at risk of unintended pregnancies, HIV and other sexually transmitted infections.”
Call for further research
To really understand labial elongation there is a need for scientists to find out more about its relationship to sexual pleasure and importantly, whether there are associated HIV risks. There is also the need to take a rights-based approach to the issue – some believe it is their right to undergo the practice, while for younger girls forced into it, it is a violation of their rights.
In future, if research confirms a correlation between practices like pulling the labia minora and an increased risk of STIs, HIV and unintended pregnancies, locally developed guidance at health facilities will be needed to manage some of these practices. But regardless, there should be greater efforts to integrate sexual health, family planing and HIV as well as incorporating aspects of traditional sexual practices like non-penetrative sex and pulling of labia minora, which will help increase access to comprehensive sexual and reproductive health services.
HIV counsellors like Paul have an important role to play in educating young people like Sylvia who believes pulling the labia may protect a person from HIV. For now however, labia elongation is still associated with positive perceptions of women’s sexuality, and a clampdown on the practice would be seen as infringing on the rights of girls and women.
Whether labia stretching is harmful or beneficial remains contested. Some research finds that labia stretching or elongation is physically harmless, and may be beneficial to women’s and men’s enjoyment of sex and could be considered a ‘modification’, rather than a ‘mutilation’. Other research acknowledges a range of known risks, calling for further quantitative work to assess risks associated with the practice and initiatives to reduce risk.
Questions remain about the ability of young girls to provide informed consent for the procedure and whether the practice may violate their rights. In 2007 the World Health Organization removed labia elongation from its definition of class IV FGM, but still recommend it is categorised as FGM ‘because it is a social convention, and hence there is social pressure on young girls to modify their genitalia, and because it creates permanent genital changes’.
Read more stories about HIV and sexual and reproductive health rights