I'm thinking there's anal fingering going on, judging by where her left hand is in the inner panel.

Urm, it's her left hand in the main pic but in the cut out it's her right hand behind her. Is there a tag someone can put on this?

theres some "right hand on left arm" tag somewhere..

It's not even as bad as that. The artist just forgot to consider which arm was which and drew the right arm in the foreground in both images. As far as the anal fingering, she'd have to have a ridiculously long finger if her anatomy is anything close to normal, but I'll leave the tag for now.

It may be mirror reflection I believe