Several studies have documented women's use of vaginal practices in South Africa to enhance their desirability to men. This article describes a little known practice of this kind among women in KwaZulu-Natal. It involves the use of small incisions in the genital area (and often abdomen and breasts) to introduce herbal substances, described as love medicines, into the body through the incisions. In-depth interviews were carried out with 20 key informants and 20 women, and eight focus group discussions with women and men, in a rural and urban site in 2005-06. A province-wide household survey was then conducted using a multi-stage cluster sample design among 867 women aged 18-60. Forty-two per cent of the women in the household survey had heard of genital incisions; only 3% had actually used them. The main motivation was the enhancement of sexual attractiveness and long-term partner commitment. It appears to be a very recent practice, but may be an extension of an older healing practice not involving the genitals. It was most prevalent among rural women aged 24-29 (although not significant), those with less education, and those who suspected their partners of having other partners. It is linked to the modern popularity of love medicines, which in turn illustrates the troubling state of gender relations in KwaZulu-Natal today. ©2010 Reproductive Health Matters. All rights reserved.Keywords: vaginal practices, genital incisions, sexual behaviour and practices, gender issues, love medicines, South Africa S EVERAL studies in Africa have documented women's use of vaginal practices to enhance their desirability to men. 1-3 Recent qualitative research has tried to further improve our understanding of these practices by classifying them as follows: intravaginal cleansing or douching, application of substances to the vulva, intravaginal insertion of substances, oral ingestion of substances, and anatomical modification, including genital incisions. 4 Some of 64 these practices have been linked with increased transmission of sexually transmitted infections (STIs), including HIV. 5,6 In South Africa, many vaginal practices are motivated by hygiene, but a substantial proportion are for introducing love medicines into the body, as a way to cement relationships and increase sexual pleasure. 3 Genital incisions were documented in the late 1990s among female sex workers at truck stops in KwaZulu-Natal, in the context of HIV-related research. 7 These women reported the practice of ukugcaba -making small incisions in the genital area close to the labia with a razor blade, after which herbal substances were rubbed into the wounds, allegedly to attract men and keep them sexually satisfied.Ukugcaba, which has a long history in Nguni indigenous healing, is one of several techniques commonly used by Zulu traditional healers to relieve ailments and afflictions. [8][9][10] The incisions themselves (called izingcabo) are shallow, and commonly made on several sites, including the head, abdomen, breasts and joints. 11 The practice is...