Like the rokuro-kubi, the futa-kuchi-onna is a woman afflicted with a curse or supernatural disease that transforms her into a yōkai. On the back of her head beneath the hair, the woman's skull splits apart, forming lips, teeth, a tongue, until there is an entirely-functional second mouth in that spot. As if that weren't bad enough, the mouth begins the mumble spiteful and threatening things to itself, and demand food. If it is not fed, it will screech obscenely and cause the woman tremendous pain. Eventually the woman's hair begins to move like a pair of serpents, allowing the mouth to help itself to the woman's meals.

A futa-kuchi-onna is often considered to be a woman who lets her stepchild die of starvation while keeping her own offspring well fed; presumably the spirit of the neglected child lodges itself in its stepmother's body to take revenge. In one story the extra mouth is formed when one of these stingy women is accidentally hit in the head by her husband's axe while he is chopping wood, and the wound never heals.

Other times the futa-kuchi-onna is a woman who never eats, sought as a wife by a miser. While no food passes through her normal lips, the mouth in the back of her head consumes twice what the other one would.¹

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1. Mizuki vol. 1 2003, p. 93