In women the external genitals are hidden between the thighs, making them impossible to see from above. Because the openings of the bladder (urethral meatus), vagina (introitus) and bowels (anus) are close together, we are taught to clean carefully after going to the toilet by wiping ourselves from the front to the back. This helps create the myth very early in life that this area of our body is not only mysterious and invisible, but dirty.
Women rarely have the opportunity to see the variations which can occur from one individual to another. Therefore we are likely to worry if our genital area looks a bit different from what we might see in text books or in the media.
Understanding the proper medical names given to the genital area helps us understand what our doctors and other health professionals tell us. It will also help us to explain our problems to our doctors if we know the right names, and avoid potential embarrassment and confusion.
If you wish, you can use this as a guide for examining your own body, although it is not compulsory or necessary in order to understand what follows. Set aside a time and place where you can be guaranteed not to be interrupted. You will need a hand mirror. Sitting on a firm surface with your back supported and your pelvis tilted forwards is probably the most comfortable position. Pull your knees up and put your heels together and then let your knees fall out to the sides as far as is comfortable. You may hold the hand mirror in one hand and use the other to explore your body, or you may choose to prop it up either against your feet or on an extra pillow so that you can see clearly.
Pubic hair is very variable from one woman to another. In general the hairs are thicker, curlier and coarser than those of your scalp, and they can even be a different color. In women of Mediterranean descent they are usually very thick and very extensive. They can extend onto the inner thigh and around the anus and onto the buttocks. Asian women tend to have much less pubic hair. As women grow older and past menopause the amount of pubic hair, as well as underarm hair, reduces dramatically and can sometimes disappear altogether.
The labia majora (literally ‘large lips’) are the outer lips which touch along their edges when we stand. When they do this they form a covering over the vulva. This creates a warm and moist environment—an important point to remember because it can influence skin problems in this area. These warm, moist conditions explain why some skin diseases, for example psoriasis, look quite different on the vulva as compared with other skin areas. The main bulk of the labia majora is fatty tissue. In older women they tend to shrink and become thinner. The outside of the labia majora looks like normal skin and is covered by pubic hair whereas the inner surface is shiny and hairless.
Inside the labia majora are the inner lips (labia minora). Starting from the front near the mons pubis the inner lips form the clitoral hood. The little knob which is the visible part of the clitoris is called the glans clitoris or head of the clitoris. This is the most sensitive sexual part of our anatomy. Whilst this can be a great source of pleasure in the right circumstances, inflammation around this area can be a great source of discomfort. If you gently feel the tissue above the clitoris you will feel a little ridge of tissue deep inside. The tissue here becomes swollen or engorged with blood when we become sexually aroused.
The labia minora or inner lips vary a lot in size and in color, and also become engorged when we are sexually aroused. In some women the tiny oil glands there are visible as little yellow dots along the edges of the labia minora. Moving in further, we find the opening of the bladder (urethral meatus). On each side of this are glands which help in lubrication called Skene’s glands.
Below this we find the vaginal opening (introitus). The hymen which separates the vulval area from the vagina varies enormously from woman to woman. It may be a nice neat complete rim but sometimes it is fragmented, even from birth. Sometimes it may seal off the vagina completely, a problem which is usually picked up when women first start menstruating. Period pain and discomfort will occur monthly but there will be no blood loss and a lump forms at the entrance to the vagina as menstrual blood builds up. After childbirth the hymen may be totally disrupted with very little left. On the outside of the hymen, on either side and just a little bit towards the back of the vulva, are the openings of the Bartholin’s glands. These are also a source of lubrication. Other lubricating glands occur in a ring around the vaginal entrance—and are called minor vestibular glands.
The whole area enclosed by the labia minora from the clitoris in front to the point where the labia minora merge at the back (known as the fourchette, which literally means fork) is known as the vestibule. The space between the fourchette and the anus is called the perineum. This is very variable in length from one woman to another.
Episiotomies may distort the anatomy a little, although proper correction at the time of childbirth will usually result in a virtually invisible scar. The cleft between our buttocks (natal cleft) is lined by skin similar to that of the rest of our body whereas the skin at the anus is rather like that of the labia minora.
We perspire from ordinary sweat glands in the creases of our upper thighs and around the pubic area. We also have special sweat glands on the vulva which are stimulated by hormones. This fluid seems to play some role in sexual attraction.
The vagina is a hollow tube lined by specialized skin which contains no mucus glands and also, surprisingly, has no sensory nerves from about 5 cm inside. This means that sensation inside the vagina can be quite different from other parts of the body and largely results from stretching of the wall rather than from stimulation of the actual vaginal lining. At the end of the vagina is the cervix.