All about the vulva and the vagina

The vulva and vagina are parts of women's bodies that are central to life, pleasure ... and sometimes a good deal of confusion. It's okay if you feel uncomfortable reading or talking about women's genitals.

Some stigma still exists in our culture about women's anatomy, as well as misinformation that prevents women and men from understanding female anatomy basics. Since a woman's genitals are more hidden than a man's, it can make them seem more mysterious or complicated, which they're not. The lack of familiarity with women's genitals is all the more reason to learn about them: for health reasons, to identify when there may be a problem, and also for sex, since an awareness and comfort with the genitals allows a woman to communicate what feels good and to enjoy more sexual satisfaction.

Even if you think you're knowledgeable about the female anatomy, women's bodies change throughout the lifespan—as a result of childbirth, aging and the reproductive cycle—and it's always important to continue learning more about how to recognize and work with those changes.

A vulva is not a vagina
If you thought the name for a woman's external genitals (the parts that you can see) was vagina, you're not alone. The truth is, many of us don't know the proper name for a variety of body parts, especially the sexual ones. The correct name for a woman's external genitals is vulva. And just one part of the vulva is the opening to the vagina. In fact, the vagina itself is not considered part of the vulva, since it is inside a woman's body.

The vulva describes a woman's external genitals. In addition to the vaginal opening, the vulva includes the labia minora, the smooth "inner lips" that are free of hair; the labia majora, the fleshier "outer lips" that typically have hair on one side; the clitoris; the clitoral hood; the mons veneris, the fatty mound of tissue that covers the pubic bone; and the perineum, a smooth patch of skin that lays between the vaginal opening and the anus.

Using the right words for the external genitals matters, whether for clarity of communication with a health care provider or with a partner. Women tend to know less about their genitals, both because they are more hidden than a man's and also because they've never been taught the right names, so it can be helpful to look at the vulva with a mirror and get to know its various parts.

How a woman's genitals change during arousal

When a woman is sexually aroused, a variety of changes take place in her genitals and elsewhere on her body. Many women aren't aware of these changes, but understanding them can help make sex a more enjoyable experience, by giving women and their partners a better sense of what to expect, and alerting a woman to changes in her sexual response.

During arousal, blood flow to the genitals increases. The increased blood flow helps to spur the production of vaginal lubrication, and causes swelling in the clitoris, labia minora, labia majora and vagina. How much lubrication a woman produces varies widely and also from one sexual encounter to the next, since stress, hormonal fluctuations and even common medications like antihistamines all can affect it. The amount of vaginal lubrication that a woman produces may also vary throughout her menstrual cycle, as well as with age.

As arousal continues, the labia minora and majora may swell in size and deepen their natural color. The vagina expands and lengthens, too, as the uterus is pulled upward into the body, changing the position of the cervix. As arousal continues, the vaginal opening tightens and the clitoris retracts underneath the clitoral hood, protecting the nerve-rich clitoris from direct stimulation, which may feel uncomfortable. Feelings of tingling, throbbing and fullness may be felt throughout the pelvic area.

What's normal for women's hair 'down there'
Many men and women have questions about pubic hair. The variety of grooming treatments available today can make it seem like reducing or removing pubic hair is a necessity, as can unrealistic ideals in pornography and the media. The truth is, there is no single standard of grooming and no reason, hygienically speaking, to remove pubic hair. A woman should decide how she feels most comfortable.

Like the hair on our heads, natural pubic hair varies from one woman to the next. Some women have dense hair; others have sparse, fine hair. Some women's pubic hair extends to the inner thighs and lower abdomen, while for others it is confined to the pubic triangle. Grooming the pubic hair is a personal preference that can reduce or reshape the amount of hair.

Options like shaving, depilatory, waxing and laser treatment provide a range of possibilities. Grooming may also be done to spice things up with a partner; however, a woman should never feel pressured to change her pubic hair to a style that she does not like or feel comfortable with. Ultimately, grooming is a personal choice that can be a mode of expression throughout a woman's life. A woman may wear her pubic hair one way for months or years, then change her mind, depending on what feels right to her.

One labia is larger than the other
Some women have concerns about the appearance and size of their vulvas. In particular, some women worry about the shape of their labia minora, which vary significantly from one woman to another and also from one side of a woman's anatomy to the other. Unfortunately, pornography has created an unrealistic standard of small, perfectly symmetrical labia, which extremely few women have.

The labia minora may be barely noticeable on some women, scalloped or wavy and everything in between. For some women, the labia minora are more pronounced than the labia majora and extend beyond them. In rare cases, long labia can interfere with the enjoyment of sex, or the ability to comfortably wear certain types of clothing or engage comfortably in exercise.

As with most parts of a woman's body, asymmetry is more common than both sides of the anatomy looking the same. Most women find that one breast is larger than the other or one leg slightly longer than the other. Each side of the labia minora, as a rule, looks a little different. It's important for women and their partners to embrace realistic ideals about women's bodies. We're all different, from head to toe, and acceptance is always a greater aphrodisiac than perfection.

Changes to the vagina after childbirth
Women and their partners often worry that childbirth will wreak havoc on a woman's genitals, and her vagina in particular, forever changing their sex life in the process. Every woman's birth experience is different and the effect on sex after a baby varies, but for the most part, couples find their way back to a satisfying sex life within six months postpartum, though it can take longer with women who continue breastfeeding.

During vaginal childbirth, the vagina expands in size to accommodate the delivery of a baby. Women who have difficult labors may incur damage to the pelvic floor, the network of muscles that support the vagina, and other parts of a woman's anatomy. Women who tear or have an episiotomy may find the vaginal opening is actually tighter after delivering a child, which can be painful but tends to expand more comfortably with time.

The vast majority of women find that their bodies bounce back within six to twelve months after giving birth. Some women actually respond more easily in bed after having given birth. Many couples explore new positions to find what feels good or leads to orgasm after having a baby. And contrary to popular belief, a C-section does not prevent sexual problems after childbirth. Most women still need to adjust what they do during sex, since hormonal and structural changes still occur as a result of pregnancy and also the postpartum.

Tightening the vagina
Many women worry about a loss of vaginal tightness, whether because of childbirth, anxiety about pleasing a partner or other concerns that the vagina is bigger than it should be. Most of the time, these worries are unfounded.

Much of the concern about vaginal tightness focuses on the vaginal opening. This area is rich in nerve endings and plays a key role in satisfying intercourse for both partners, mostly because of friction. The good news is that regular Kegel exercises can often help a woman strengthen the pelvic floor muscles, which can improve orgasm quality. Performing Kegel exercises on a regular basis can also teach a woman to improve her muscular control during sex, by squeezing and releasing to improve friction, which can be feel enjoyable for both partners.

In some cases, a loss of vaginal tone can be a sign of a larger issue, such as pelvic floor prolapse, which can usually be treated. Check with a health care provider if something doesn't feel right; if you don't like what you're hearing, it is okay to check with another provider for a second opinion.

Clitoral sensitivity and size
A lot of emphasis is placed on the clitoris as the key to a woman's sexual satisfaction. And while it is true that the clitoris plays an important role in women's sexual response, too much or too direct stimulation of the clitoral glans (or not the preferred type of stimulation) can actually interfere with a woman's pleasure during sex or, in some cases, feel painful.

The clitoris is a woman's sexual powerhouse and consists of several different parts. The clitoral glans is the external bump, visible on most women's anatomy. The size of the visible clitoris can vary, but the length of the shaft is usually 1-2 inches and about a little more than a half an inch wide. It is full of thousands of nerve endings. The clitoral hood often acts as a shield for the clitoral glans, protecting it from too much stimulation, but direct stimulation of the area can still be uncomfortable and the hood often retracts when a woman becomes aroused, exposing the glans. Behind the shaft of the clitoris is more than the visible eye can detect, as it attaches to the pubic bone and separates into two legs or crura that are each about 2 to 4 inches in length.

Many women find that less direct types of stimulation feel better. Rubbing the mons veneris, the labia minora or the labia majora often feels good. So does stimulation from inside the vagina, since the clitoris extends back into a woman's body and wraps around the vagina. In fact, most of the clitoris is hidden inside of a woman's body, and it plays an important role in how enjoyable just about any kind of sexual activity feels.

If a woman finds her clitoris is persistently sensitive, including when she is not feeling aroused, she may want to check in with her health care provider.

What's normal vaginal discharge
Vaginal discharge is one of those things most women just don't want to talk about. Many women are curious, however, to know if their discharge is normal and rightly so—changes in vaginal discharge can teach a woman about her body, her fertility and how to know when something might be wrong.

The vagina produces secretions to prevent it from becoming dry, as well as to maintain a healthy pH balance to fight off infection. Most women find that discharge changes over the course of a menstrual cycle and also as a result of aging. Many medications, overall health, and dietary and lifestyle choices also can affect a woman's discharge. In general, women in their childbearing years will find that discharge is lightest during and just after a period, and creamier, more abundant or slippery as she approaches ovulation.

Keeping track of daily discharge can help a woman learn what's normal for her body. Pay attention to sensations of wetness and the appearance of discharge in underwear. Discharge that is excessive, smells different or changes color, especially if accompanied by itching or burning, should be checked out by a health care provider. Most vaginal infections are easily treated but can lead to complications if left untreated. And remember, since the vagina is self-cleaning, douching interferes with the natural balance and can actually increase a woman's risk of infection and her production of discharge.

The incredible stretching and contracting vagina

Many women and men believe that too much sex, a large partner or use of certain sex toys will permanently make the vagina larger. Similar concerns include that too much sexual activity or masturbation will lead to larger labia or other changes to the vulva. The truth is, these concerns have more to do with feelings of guilt, shame or anxiety about sex than they do with the physical facts. Can you imagine if a man thought his penis would grow as he has more sex? Many women believe too much sex will "mark" their bodies in some way, or are pestered about vaginal tightness by a partner who worries he doesn't match up to a former partner.

The vagina is an incredibly elastic organ that is designed to accommodate different sizes and return to its baseline shape afterwards. The vagina is a potential space, meaning that it can grow in size to accommodate a penis or a baby, then contract afterwards. No matter how much sex a woman has, her vagina will not permanently change in size in any substantial way. Even women who have had a partner with a large penis or used large sex toys will find their vagina adapts to future sexual activity.

Common causes of pain during vaginal intercourse

The most common causes of painful sex also happen to be the most treatable. For most women who are in good health, painful intercourse is usually the result of vaginal dryness or a vaginal infection. The best treatment is to get checked out by a doctor to confirm whether a bacterial or yeast infection is present and, if so, get treatment.

If vaginal dryness is the culprit, a woman may be helped by using a store-bought lubricant or spending more time in foreplay to reach maximum arousal before intercourse. Menopausal women may find that certain vaginal moisturizers recommended by her healthcare provider may be particularly helpful. Another common culprit is that he's hitting her cervix with each thrust. Often, this indicates that she's not as aroused as she needs to be. When a woman is maximally aroused before intercourse, she benefits from a vaginal tenting process, in which muscular contractions pull the cervix farther back into the body, lengthening the vaginal canal.

Other common causes of uncomfortable or painful penetration are underlying health issues that require treatment beyond foreplay and a lubricant. These include: endometriosis; a tipped or retroverted uterus; scar tissue from a c-section, hysterectomy or other pelvic surgery; interstitial cystitis; and vulvodynia, a painful condition that is estimated to affect as many as 15% of women.

Keep in mind, too, that many women experience pain as a result of hormonal changes during menopause and after childbirth, especially if a woman is breastfeeding. Certain medications decrease vaginal lubrication, too, including certain anti-histamines, anti-hypertensives and anti-depressants.

When pain is not happening every time a woman has intercourse, it is less likely that a chronic condition is causing the pain, though it's still possible. If more foreplay and using a lubricant aren't doing the trick, it is important to make a visit to a health care provider and perhaps to get a second (or third) opinion if needed, as many healthcare providers have had little training related to vulvovaginal pain conditions.