Colonial sources describing Tlazolteotl frequently complicate the single name with a set of four related figures, the Ixcuinan or Ixcuiname, sister goddesses whose individual names, Tiacapan, Teicu, Tlaco and Xocotzin, are themselves simply the ordinary Nahuatl terms for the first, second, third and fourth born daughters in a family, so the goddess of transgression and purification is presented, in this tradition, not as one figure but as an ordered set of siblings named for nothing more than their birth order. Different colonial informants and modern scholars disagree about how to read this: some treat the four Ixcuinan as genuinely distinct cult figures each carrying a piece of Tlazolteotl's wider domain, while others read the foursome as a way of representing different life stages or aspects of a single goddess of sexuality and purification, split across the culturally loaded roles daughters of different birth order held within a Nahua household.
The clearest surviving image connected to this cluster is a well known illustration in the Codex Borbonicus, likely produced very close to the conquest, showing a goddess in the pose of active childbirth, squatting with a small figure emerging from between her legs, an image art historians generally identify with Tlazolteotl in her aspect as patroness of birth, shown at the culminating moment of labor rather than in a static, seated pose typical of most other codex deities. Read together with the confession ritual described elsewhere, the image and the sister goddesses show a deity whose single name in modern accounts compresses a considerably more layered set of birth, sibling and life stage associations in the surviving sources themselves.