Understanding Harmfulness and Socio-Cultural Aspects of Vaginal Practices across Cultures: A Systematic Review of Qualitative Research

The World Health Organization defines vaginal practices as ‘a variety of behaviors that involve some modification to the labia, clitoris, or the vagina’. These practices have also been described as harmful cultural practices. Based on a systematic review of qualitative research, we aim to understand the relationship between the conceptualizations of harm and vaginal practices, and to identify those factors motivating vaginal practices across cultures. Eight databases were screened in order to find qualitative research on vaginal practices across different settings up until 8^th August 2017. Studies were selected according to inclusion and exclusion criteria; subsequently the quality of the studies was assessed and data extracted. Findings were analyzed and synthesized along key themes using NVivo. In total, 43 articles were reviewed including a wide range of vaginal practices in 31 countries. Qualitative studies on vaginal practices are mainly carried out in low-and middle income countries particularly in Sub-Saharan Africa. Most studies described the negative health consequences of vaginal practices and women’s awareness about these, with six studies describing psychological and social consequences. This focus on medical harm within literature fits within the current discourse on harmful cultural practices relying on notions of the integer body to support human and women’s right claims. Several scholars warned against the victimization of women practicing vaginal practices and situate vaginal practices in a context of cultural beliefs and gender relationships which (in)directly influenced norms regarding the female body. In these contexts, vaginal practices can be tools for women to manage their health, hygiene and sexuality. A multidimensional approach taking into account all these aspects of women’s lives, provides a more nuanced portrait to understand these practices instead of a focus on harm.