Determinants of Elongation of the Labia Minora in Tete Province, Central Mozambique: Findings of a Household Survey

Guillermo Martínez Pérez, Brigitte Bagnol, Matthew Chersich, Esperanza Mariano, Francisco Mbofana, Terence Hull, Adriane Martin Hilber


A WHO-supported provincial-level population-based survey was conducted in 2007 to understand the determinants and implications for health of vaginal practices. A total of 919 women aged 18-60 were selected randomly for enrolment. This is the first population-based study of females in Tete Province, Mozambique. At some time over their lives, 98.8% of women had practiced elongation of their labia minora and a quarter (24.0%) had done so in the past month. Currently practicing women were more likely to have engaged in sex recently, and used contraceptives and condoms at last sex than women who had stopped labial elongation. Younger age, residence in rural areas and having two or more male partners were also determinants of current practice. Women commonly reported they practiced for no specific reason (62.8%). Discomforting itchiness and lower abdominal pain were more frequent in women who had stopped labial elongation than in women who were currently practicing. Although women may not report current vaginal ill health, it is possible that prospective cohort studies could uncover alterations in genital vaginal flora or other indicators of impact on women’s health. The findings of this study do not suggest that labial elongation is linked with high-risk behaviors for HIV transmission. (Afr J Reprod Health 2016; 20[2]: 111-121).

Full Text:



Martínez Pérez G, Tomás Aznar C and Bagnol B. Labia minora elongation and its implications on the health of women: A systematic review. International Journal for Sexual Health 2014; 26(3): 155–171. 2. Blacking J. Venda children’s songs. Johannesburg: Witwatersrand University Press, 1967. 3. Krige EJ and Krige JD. The realm of a rain-queen. Johannesburg: Juta, 1980. 4. Arnfred S. Sexuality and gender politics in Mozambique: Rethinking gender in Africa. Suffolk: James Currey, 2011. 5. Johansen E. Sculpted female bodies. Discourses and practices on genital manipulation in the context of globalization. Uppsala, Sweden: Nordic Africa Institute, 2006.

Tamale S. Eroticism, sexuality, and ‘‘women’s secrets’’ among the Baganda. IDS Bulletin 2006;37(5):89– 97. 7. Richards A. Cisungu. A girl’s initiation ceremony among the Bemba of Zambia. London: Oxford University Press, 1956. 8. Gelfand M. Growing up in Shona society from birth to marriage. Gweru, Zimbabwe: Mambo Press, 1979. 9. Aschwenden H. Symbols of life. Gweru, Zimbabwe: Mambo Press, 1982. 10. World Health Organization (WHO). Female genital mutilation: a joint WHO/UNICEF/UNFPA statement. Geneva: WHO, 1997. 11. Bagnol B and Mariano E. Elongation of the labia minora and use of vaginal products to enhance eroticism: Can these practices be considered FGM? Finnish Journal of Ethnicity and Migration 2008; 3: 42–53. 12. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHRC, UNICEF, UNIFEM and WHO. Eliminating female genital mutilation. An interagency statement. Geneva: World Health Organization, 2008. 13. Arnfred S. Female sexuality as capacity and power? Reconceptualizing sexualities in Africa. African Studies Review 2015;58(3):149-170. 14. Hull T, Martin Hilber A, Chersich M, Bagnol B, Prohmmo A, Smit JA, Widyantoro N, Utomo ID, François I, Tumwesigye NM and Temmerman M. Prevalence of vaginal practices in Africa and Asia: Findings of a multi-country household survey. Journal of Women’s Health 2011; 20(7): 1097– 1109. 15. François I, Bagnol B, Chersich M, Mbofana F, Mariano E, Nzwalo H, Kenter E, Tumwesigye NM, Hull T and Martin Hilber A. Prevalence and motivations of vaginal practices in Tete Province, Mozambique. International Journal of Sexual Health 2012; 24(3): 205–217. 16. Martin Hilber A, Hull TH, Preston-Whyte E, Bagnol B, Smit J, Wachasarin C and Widyantoro N. A cross cultural study of vaginal practices and sexuality: implications for sexual health. Social Science & Medicine 2010;70(3):392-400. 17. Bagnol B, Chersich M, François I, Mbofana F, Mariano E and Martin Hilber A. Determinants of vaginal cleansing, application, and insertion in Tete province, Mozambique, and products used. International Journal of Sexual Health 2015;27(3):324-336. 18. Martínez Pérez G, Mariano E and Bagnol B. Perceptions of men on puxa-puxa, or labia minora elongation, in Tete, Mozambique. Journal of Sex Research 2015; 52(6): 700-709. 19. Bagnol B and Mariano E. Gender, sexuality, and vaginal practices. Maputo, Mozambique: DAA, FLCS, UEM, 2012 20. African Development Bank. Gender, Poverty and Environmental Indicators on African Countries. Tunis: African Development Bank, 2010.

Martinez Perez et al. Labial Elongation in Central Mozambique

African Journal of Reproductive Health June 2016; 20 (2): 121

Instituto Nacional de Estatística. Terceiro censo geral população e habitação, 2007. Indicadores sócioDemográficos. Província de Tete. Maputo, Mozambique: Instituto Nacional de Estatística, 2010. 22. Instituto Nacional de Saúde. Inquérito nacional de prevalência, riscos compotamentais e informações sobre o HIV e SIDA em Moçambique. INSIDA 2009. Relatório Preliminar sobre a Prevalência da Infecção por HIV. Maputo, Mozambique: Ministério da Saúde e Instituto Nacional de Saúde, 2010. 23. Katz MH. Multivariable analysis. A practica guide for clinicians and public health researchers. Third Edition. California: Cambridge University Press, 2011. 24. Grassivaro Gallo P and Catania L. Modificazioni espansive dei genital femminili, tra eredità e ambiente. Padova, Italy: Altravista, 2015. 25. Martínez Pérez G, Mubanga M, Tomás Aznar C and Bagnol B. Zambian women in South Africa: insights into health experiences of labia elongation. Journal of Sex research 2015;52(8):857-67. 26. Koster M and Price LL. Rwandan female genital modification: Elongation of the labia minora and the use of local botanical species. Culture, Health & Sexuality 2008;10(2):191-204. 27. World Health Organization (WHO). Female Genital Mutilation. Integrating the Prevention and the Management of the Health Complications into the

curricula of nursing and midwifery. A Teacher's Guide. Geneva, Switzerland: World Health Organization, 2001. 28. Chilundo B, Mariano E, Cliff J, Augusto O and Palha de Sousa C. Trabalhadoras do sexo respondem ao HIV/SIDA: Segunda avaliação de intervenção da organização da mulher educadora do SIDA (OMES). Maputo, Mozambique: Burnet Institute, 2005. 29. Larsen J. The social vagina: Labia elongation and social capital among women in Rwanda. Culture, Health & Sexuality 2010;12(7):813–826. 30. Pool R, Hart G, Green G, Harrison S, Nyanzi S and Whitworth J. Men’s attitudes to condoms and female controlled means of protection against HIV and STDs in South-Western Uganda. Culture, Health & Sexuality 2000;2(2):197–211. 31. Grassivaro Gallo P, Moro D and Manganoni M. Female genital modifications in Malawi: Culture, health, and sexuality. In: Denniston GC, Hodges FM and Milos MF (Eds.). Circumcision and human rights. New York, NY: Springer, 2009, 83-95. 32. Martínez Pérez G, Tomás Aznar C and Namulondo H. It’s all about sex: What urban Zimbabwean men know of labia minora elongation. Cadernos de Cultura Africana 2014; 27: 127–147. 33. Vera Cruz G and Mullet E. The Practice of Puxa- Puxa among Mozambican Women: A Systematic Inventory of Motives. Journal of Sex Research 2013;51(8):852-862.


  • There are currently no refbacks.