ANATOMY 101: VULVA OR VAGINA—DEMYSTIFYING “DOWN THERE”
THERE SEEMS TO BE a taboo about talking about a woman’s “lady parts.”
When was the last time you heard someone say “vagina” loud and proud? Even when speaking to girlfriends, the v-word, if spoken at all, is often whispered or referred to with some sort of overly cute or silly euphemism. Let’s just agree to stop this right now. Culturally, we seem to want to keep our private parts, well, private. But even if you don’t ever say the word aloud or prefer to use a nickname, you should know the proper names for your genitals. No worries if you are shy about discussing it—you aren’t the only one. Many women don’t like to talk about “down there.” The thing is, if you ignore a part of your body, never get to know proper terminology, and don’t become familiar with its appearance, you are cutting yourself off from important knowledge that can have a significant impact on both your sexual wellness and your overall health.
While you might not want to bust out the vagina/vulva talk in the middle of a business meeting or at the dinner table, it is a good idea to be able to name and claim all aspects of your body—it’s actually empowering. Some women become uncomfortable discussing these specific parts of their anatomy, not only in casual conversation with friends but even with their doctors or gynecologists, which doesn’t make for a particularly productive appointment. It’s bad enough that you are having the conversation while you are concentrating on keeping your behind covered with a paper gown; take back some control of the situation by knowing what’s what and where it is and what it’s called and what it is for. Understanding the proper names and location of the parts of your genitals also makes good health sense, because if an issue comes up you will be able to give accurate information to your health-care professional—without whispering or blushing. Well, maybe you will blush, but at least you will be whispering the accurate names of your girl parts. And because you will be speaking the same language, you’ll also know just what your doctor is talking about when he or she works with you to resolve any issues.
EXTERNAL ANATOMY
If you, like many women, have been generally referring to the area between your legs as your “vagina,” you may be surprised to learn that you have been calling it by the incorrect name. Or the less-than-specific name. It’s really common, so don’t be embarrassed. Most people call the whole kit and caboodle the vagina, but there is a lot more going on down there.
VULVA
What many call the “vagina” is actually the external genitalia, technically called the vulva, and is where the pubic hair grows—unless you’ve been waxing, shaving, and plucking (more on that later). The vulva is made up of the pubic mound, or mons pubis, which is fatty tissue over the pubic bone, as well as the inner and outer lips—aka labia majora and labia minora.
LABIA MAJORA
The labia majora—sometimes called the outer lips—is the protective layer of fat covered by skin and hair and the most visible part of your vulva. These outer folds help protect your pubic bone when you are having sex. They give a little cushion when you are pushin’.
LABIA MINORA
The more sensitive, thinner, and usually smaller hairless area within the outer lips is called the labia minora, or inner lips. These folds of skin surround and protect the opening to the vagina, the clitoris, and the opening to the urethra. The labia protect the vagina from bacteria, and they also play a significant role in arousal, because hiding at the top of the labia minora, under the clitoral hood, is the infamous clitoris.
CLITORIS
That little love button known as the clitoris takes refuge under a hood because it is so sensitive that it needs to be protected from overstimulation—there are over 8,000 nerve endings in that tiny organ alone, which is twice the amount in a penis. There is more to the clit than meets the eye however: The clitoral glans—the technical term for the visible little nub of the clitoris—is the just the tip of an internal organ that extends in a shaft toward the pubic bone, surrounding the vagina, and splits into two legs that are shaped like a wishbone. Composed of erectile tissue—meaning it fills with blood and swells when aroused—this organ contains an additional 15,000 nerve endings, making it the pleasure center in bodies that have them.
URETHRA
This tiny opening underneath the clitoris is tough to see, but rest assured that it’s there and it’s the end of a tiny tube leading from your bladder where urine exits the body.
INTERNAL ANATOMY
Although out of sight, parts of your internal anatomy are key players in sex, sexuality, pleasure, satisfaction, and, yes, procreation.
VAGINA
The external anatomy is the gatekeeper, and it protects the internal anatomy, aka the vagina. Your vagina is essentially a tube that is anywhere from approximately 4 to 7 inches long (depending on the woman)—about the length of a tube of lip gloss to the length of a pen. The vagina is very versatile and is involved in sex/sexual activity (it can accommodate penises, fingers, tongues, and sex toys), allows menstrual blood to flow out of the body, and is the canal the baby travels down from the uterus when it is born. The interior walls of the vagina can be a bit lumpy and bumpy because there are folds in the lining that allow the vagina to expand for sex and delivering a baby. The vagina also has nerve endings that respond to stimulation and cause pleasure, just not as many as the vulva or clitoris.
BARTHOLIN’S GLANDS
Found on either side of the lower end of the vaginal opening, Bartholin’s glands help lubricate the labia and vagina during sex. The lubrication begins when you are aroused, also known as getting “wet,” and is essential in protecting the delicate tissues from injury due to friction from overenthusiastic sex, strenuous exercise, or from those too-tight jeans that look great but don’t feel so great.
G-SPOT
If you were to insert your finger a couple of inches into the opening of your vagina and hook it back toward your front (closer to your belly than your back), you may feel a spongy area that is known as the G-spot—this area can be the source of some mind-blowing orgasms, so it’s good to know its location. Long misunderstood, the G-spot is actually the ends of the two wishbone-like ends of the clitoris! We’ll be revisiting the G-spot later. Once you know more about it, you will probably want to visit the G-spot more often, too!
CERVIX
At the top of the vaginal canal is the cervix, which is the opening to the uterus. The cervix is responsible for the mucus that changes during your cycle, and it’s the part that your gyno is swabbing when you get a Pap test. It remains tightly closed and dilates only to allow menstrual bloodflow and the baby to exit the uterus when a woman is giving birth.
UTERUS
Flexible and capable of expanding with a baby’s growth, going from the size of your fist to the size of a substantial watermelon, the uterus—often called the womb—is shaped like an upside-down pear. Approximately every 30 days or so, the uterus sheds its lining, and anyone who has a uterus menstruates, unless a fertilized egg has implanted itself in the uterine lining, meaning the owner of that uterus is pregnant. No periods when you are pregnant! (More on that in Chapter 2.)
ENDOMETRIUM
The lining of the uterus is tissue called the endometrium. In some women, the tissue will migrate outside of the uterus and grow—typically on the ovaries and fallopian tubes and inside the pelvis—causing intense pain as it continues to grow and shed with nowhere to go. This condition is called endometriosis. (Read more about this in Chapter 4.)
FALLOPIAN TUBES AND OVARIES
The 4-inch-long fallopian tubes essentially collect an egg from the ovary next to it and deliver it to the uterus in a process called ovulation. Your ovaries are about an inch in size and have two jobs: The first is to release hormones like the all-important estrogen, and the second is to produce eggs. Estrogen is responsible for a range of functions, like breast development and regulating the menstrual cycle, and is a key player in the reproductive cycle. Think of it as the queen E that is in charge of all things related to being female. Estrogen is also known as the female sex hormone. (More on the hormonal hall of fame in Chapter 2).
ADDITIONAL ANATOMY THAT YOU SHOULD KNOW
The vagina is not an island. When we are talking about sex and sexuality, there are other body parts that come into play and have a strong connection to your vagina. Your brain is one of them. As we are sure you know, the brain controls all of your bodily functions, fields input from your senses, and allows you to think, plan, and dream—all of which have an impact on your vagina. The way it works is, the sensory experiences you get from your genitals are interpreted by your brain, and the brain then releases the neurotransmitter dopamine that activates the reward center of the brain. That feedback loop of pleasure, chemicals, and lighting up the reward center of the brain keeps people going back for more when it comes to sex and orgasm. We’ll talk more about this later, but your brain plays a big role in sexual behavior, activity, and fantasy. It is also possible that a higher sex drive originates in the brain.
Another part of your anatomy (well, two parts of your anatomy) figures in sex and sexuality and is also linked to having a vagina—although not everyone who has one has the other—breasts. Yep, the girls can be sensitive players when it comes to sex, and stimulation of breasts and nipples can lead to arousal, which in turn leads to your vagina getting ready for sex. They are all connected. Because we are focusing on the vagina in Vagina U, we won’t go into too much depth on breasts except to say that you should do self-exams to help screen for breast cancer, know your family history of breast cancer, and ask your gyno about when you should have mammograms.
SELF-EXAMINATION
When was the last time you took a peek at your vulva or vagina? Never? Once a long time ago? Time to take a look. Women don’t often know what they look like “down there” because so much of our sexual and reproductive anatomy is hidden away. And that which is hidden often seems forbidden, off-limits, or even dangerous. (Don’t get us started on the ridiculous myth of the vagina having teeth. We kid you not. You can look it up!) But unless you are a contortionist, the only way to get a good visual of your labia and become familiar with your anatomy is to use a hand mirror. Breaking out a mirror and taking a look is something you should do every once in a while.
Warning: Before you start searching for pictures on the Internet to see how your parts compare to other women, know that everyone is different. Repeat: Everyone is different. Unfortunately, porn has set a distorted standard for vaginal appearance that makes some women feel insecure about the appearance of their own vulvas. Rest assured, there is no “perfect” vulva or vagina. The color, size, and shape of a woman’s labia is unique to her. You can have “big” lips or “small” lips. One side can be larger than the other side; one side can be smaller than the other side—in fact, most women do not have labia that are equal in size or perfectly symmetrical. If they are not equal and don’t look like anyone else’s, it is NBD. You are unique. Depending on your own skin tone, the color of your vulva and labia can vary from pink to dark brown and be any shade in between. Your genitals are like any other part of your anatomy in that they are generally the same as everyone else’s but also unique to you. For example, everyone’s fingers have similar form and function, but their appearance, shape, size, and color are yours and yours alone.1, 2, 3
Just as the appearance, shape, and size of your vulva and labia are unique to you, so is the shape and size of your vagina. Many women worry that they are too big or too small, too wide or too narrow, but there actually isn’t much difference among vaginal canals. “Tightness” or “looseness” is all relative. Your state of arousal, particular positions, and the anatomy of your partner (or shape of sex toys) can made a difference in how tight or loose you feel to yourself or your partner. Contrary to popular belief, frequent sex or sex with a partner with a large penis will not leave your vagina in a permanently stretched-out state. Your versatile vagina has the ability to expand to accommodate anything from a large penis to a baby! And despite what you may have heard, women who have given birth aren’t too stretched out after delivering a baby to enjoy sex either. The vagina is pretty flexible and, yes, while it can expand to allow a baby to be born, it does not stay in that expanded state forever. As you heal after childbirth, the muscles and tissues often revert to the way they were before you pushed the baby into the world. In Chapter 5, we’ll get into how and why there can be issues with your vagina, but for now, know that the muscles and tissues of the vagina are very adaptive and become lubricated and loose for vaginal penetration but at the same time remain tight to promote pleasure.
Unless you have pain or discomfort during penetrative sex or can’t insert a tampon, you are in all likelihood completely within the realm of normal when it comes to the length, width, and “tightness” of your vagina.
WORK IT OUT
The vagina is a powerful muscle that, like any muscle in your body, can improve its function through exercise. You have probably already heard of Kegel exercises to strengthen the pelvic floor—that’s the group of muscles that supports your uterus, bladder, small intestine, and rectum—to prevent leaking pee when you sneeze or losing your strong grip during sex. Exercising your vag with Kegels are a great way to tone the muscles of your pelvic floor, which is helpful for stopping the leaks but also for improving orgasm. Next time you go to the bathroom, you can figure out which muscles are doing the work by stopping your pee midstream (this is not something you should do all the time, as it’s not good for your bladder, but it is okay just to figure out which muscles you need to be working). Once you have identified the muscles, then you can do Kegel exercises to get them in shape. For a few minutes each day, you can engage the muscles and hold them for 5 to 10 seconds, then release. These daily squeezes can lead to more intense orgasms. And who could say no to that?
If you want to take it to the next level, you can use vaginal barbells, Kegel exercise weights, or Kegel trainers. These are weights or devices that you insert into your vagina that require you to contract the muscles to keep the weight from sliding out. Some have apps to track your progress and some even vibrate! Over time, whether you use weights or not, you can increase your pelvic floor power and look forward to an increase in pleasure to go with it!
WHAT’S IN A NAME?
Recently there has been a movement to reclaim the use of the word pussy and move it away from being a derogatory term to one of power and protest. The euphemisms for female genitalia are endless, and while they are sometimes fun to throw around when chatting with girlfriends and being silly, it’s important to be aware of the impact of failing to use the proper anatomical terminology when discussing women’s bodies. Leah Millheiser, MD, ob-gyn and chief scientific officer for Nuelle, feels that it’s important to normalize the word vagina because her concern is that by not saying it, we are making it a shameful taboo and communicating that message to young women and girls. In an interview, she said, “We can say erectile dysfunction very easily, we can say penis very easily, but we don’t have that same opportunity to say vagina. So you’re promoting shame in young women. We know from research that you actually reduce a young girl’s willingness to report sexual abuse when she doesn’t know proper genital terminology. So we really need to look at this from a public health perspective of what impact the incorrect terminology is having on young women.”5
So let’s lay off beaver, cooter, honeypot, box, and all of the other cringe-worthy and creative names that we’ve called it and start calling a vulva a vulva and a vagina a vagina, k?
VAGINAS AGE, TOO
When we talk about aging, we often speak of graying hair, aching backs, smile lines, and crow’s-feet, but we don’t often think of our genitals aging. Of course they do, however, right along with the rest of us.
IN YOUR TWENTIES
All of your internal reproductive organs have reached their full size and won’t change significantly as time goes on once you reach your twenties. The only aspect of your anatomy that may change is your labia: The older you get, the less fat you have in your genitals, and both the labia majora and minora can become a little thinner, more fragile, and prone to injury.
IN YOUR THIRTIES
Your next decade of your thirties can have an impact on hormones. The fluctuation in your hormones at this age can actually lead to your labia minor becoming a little bit darker in color. Nothing dramatic, and you’d need your hand mirror or a particularly detail-oriented long-term partner to notice, but it happens. Good old hormones.
Also, by this age many women have given birth: The uterus has ballooned to watermelon proportions during pregnancy, and during vaginal delivery the vagina has been stretched to the point of tearing for many women. It returns to its original size within 6 weeks after birth.
IN YOUR FORTIES
When you reach your forties, although you still may be having a period, your egg supply (that’s essentially been with you since you were born) will begin to diminish. Many women also make a stop at perimenopause as their fertility and menstrual cycles wind down.
As you age, those hormones that have been driving all things in the reproductive area, particularly estrogen, can decrease and can disrupt the pH balance in your vagina. The walls of the vagina can also thin and become dry, so use personal lubricant to keep things supple and—here’s a tough assignment—have plenty of sex to keep your systems primed. Be sure to use water-based lube, as the thin, dry walls of the vagina can be damaged if they do not have enough moisture.
IN YOUR FIFTIES
Your period may fade away around age 50 or so, and you will be in full-blown menopause. You are officially in menopause when you have not had a period for 12 months. Because your reproductive organs are held in place by muscles and tendons, anything that can weaken those muscles can lead to discomfort or bladder leakage. Unfortunately, as you age you can lose muscle tone and elasticity of ligaments and tendons. Your defense against drooping reproductive organs is Kegels. Do them often and keep your pelvic floor strong and supportive.6
VAGINOPLASTY
You can get plastic surgery for just about any part of your anatomy, so it is no surprise that there are specialized surgical procedures—vaginoplasty or vaginal rejuvenation for the vagina, and labiaplasty for, you guessed it, the labia.
Women sometimes choose to have a procedure that will reduce the size and change the appearance of their labia minora. Reasons for having the surgery can include having labia that protrude or are uneven, or because their size leads to rubbing, chaffing, and discomfort. Some serious cyclists have had labia reduction surgery to stop the discomfort they feel from spending so much time in the saddle.
Vaginoplasty or vaginal rejuvenation surgery is done to make the vagina “tighter” and potentially lead to more pleasure during sex. Women may seek this procedure after childbirth or even as they age to correct what they may feel is a “loose” vagina. You should know that the American College of Obstetricians and Gynecologists (ACOG) challenges the claim that the surgery can restore sensitivity.7
Whether you are pro plasty or against it, it’s important to remember that everyone is different. You will need to discuss your concerns with your gynecologist and then with a plastic surgeon to determine if either of these surgeries is something that would be appropriate for your situation. As with any surgery you undertake, you need to understand fully what the procedure is for, be confident in the expertise and experience of your doctor or surgeon (your surgeon should be board certified), what the surgery will do, how much it will cost, what the recovery is like, and what you can expect in terms of healing and the ultimate results.
Another treatment that some women are using to improve their genitals and their ability to achieve orgasm is something called the O-Shot. The shot is basically platelet-rich plasma extracted from your own blood, then injected into your clitoris and vagina. Typically done for women in menopause or those who have trouble orgasming, the theory behind the shot is that it will give a boost to stem cell growth, allow tissue to grow, and get you more sensitive and able to orgasm.8
Your internal and external anatomy is impressively designed to serve a range of functions from pleasure to reproduction, and knowing where the parts are and how they work puts you in charge of your sexual and reproductive self. Knowing what your girl parts are called contributes to ownership and understanding your body as well as better control over your medical care and sexual health. While it can be playful and fun to have nicknames for your vulva or vagina, when it comes down to it, you should know the real deal.
Let’s honor our bodies with knowing the right names. After all, if your name is Jane, and I always call you Ann, we could never have a very good relationship, could we? So if you retain nothing else from this chapter, remember: When you say “vulva” and I say “vagina,” we are actually talking about two different part of a woman’s anatomy.