Know Thy Genitals

I often find people (and often catch myself too) from time to time using the term vagina as a catch-all to describe anything that is happening with the genitals. People oftentimes confuse the vagina with the vulva, labia, or perineum… and that mostly happens because everything down there is labeled as the vagina. But this seemingly harmless confusion can backfire when people find themselves not being able to describe their symptoms correctly when they see their gynecologist, urologist, and/or their pelvic health PT.

 So, first, tell me:

• Did you know that it’s not all VAGINA down there?!
• ⁣Do you know what are different parts of your genitals called? ⁣
• Can you recognize them? 
• Have you ever taken the time to look down there using a mirror?⁣
• Have you ever experienced genital pain with or without sex and did not know where it was coming from? ⁣

If you answered NO to any of these questions, this is for YOU… keep reading!

⁣Female genitalia is a complex collection of various structures that includes:⁣

1. 𝗩𝗨𝗟𝗩𝗔: the external genitalia, including the outer and inner lip. The outer lip is the hairy fold of the skin. The inner lip usually doesn’t have any hair on it. The vulva includes everything from the Clitoris, the Vestibule, Bartholin, and Skene glands (produce lubrication) and the opening of the Vagina (yes, 𝘫𝘶𝘴𝘵 the opening— called the Introitus). ⁣

2. 𝗩𝗘𝗦𝗧𝗜𝗕𝗨𝗟𝗘: the innermost (and most overlooked) part of the Vulva that surrounds the Urethral opening at the top and the Vaginal opening at the bottom. It also contains both the Skene glands at 10 and 2’o clock positions and the Bartholin glands at 4 and 8’o clock positions. The vestibule region could be one of the sites of pain (clinically referred to as Vestibulodynia) with insertion and should be carefully differentiated from other reasons for painful insertion such as Vaginismus. It is usually examined with a Q tip (cotton bud) to precisely locate the area of the pain.

3. 𝗩𝗔𝗚𝗜𝗡𝗔: the vagina is a fibromuscular tube that connects the Introitus to the Cervix (most of it is internal). The vaginal tissue looks like the inside of a HEALTHY MOUTH! 👄 Nice and pink and supple! ⁣

4. 𝗖𝗟𝗜𝗧𝗢𝗥𝗜𝗦: is the pleasure house of our body and hosts more than 10000 nerve endings, and is located at the top of the vulva (12’o clock). However, we still can only locate a teeny tiny part of the clitoris externally. Most of it is located internally going alongside the urethra and the vaginal tube. Embryologically, it is derived from the same tissue as the penis. The external part of the clitoris has 2 parts– the glans and the hood. The hood of the clitoris retracts back upon arousal. The hood sometimes can get adhered secondary to infections, Keratin Pearls, etc., and can create pain around the clitoris called Clitorodynia.

5. 𝗨𝗥𝗘𝗧𝗛𝗥𝗔𝗟 opening: lies at the top part of the Vestibule as a teeny-tiny hole, and no, people with vulva DO NOT pee through their vagina. 

6. 𝗣𝗘𝗥𝗜𝗡𝗘𝗨𝗠: The space between the lower end of the Introitus and the upper end of the Anus. Usually feels like a taut band, as all pelvic floor muscles attach to this region via. a central tendon. Episiotomy is performed here. 

⁣I cannot emphasize enough how important it is to know our bodies down there and NOTICE any unusual redness, heavy discharge (note the color too), dryness, bumps, unusual white patches, or the fusion of the labia.

⁣Getting to know each part of our genitals using a mirror is the first step towards accepting, learning, and understanding more about our bodies. Body literacy empowers us and can help us stay out of trouble, help us seek care at the right time, and improve our communication with care providers.

⁣𝘕𝘖𝘛𝘏𝘐𝘕𝘎 𝘐𝘚 𝘛𝘔𝘐 when it comes to your health! Do share any unusual findings with your medical provider without hesitation, no matter how silly it may sound to you!!

References

Sexual Medicine Society of North America, Peters B, et al "How many nerve fibers innervate the human clitoris? A histomorphometric evaluation of the dorsal nerve of the clitoris”, SMSNA 2022; Abstract 1.

Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society), Jacob Bornstein, MD, et al, and on behalf of the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women's Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS)⁣.