Vaginal and vulval problems

Vaginal and vulval problems

What are the vagina and cervix?

The vagina is a tube connecting the uterus (womb) to the outside. At the top is the cervix, which is the base of the uterus. The cervix has a hole in the middle to allow menstrual blood to pass out from the uterus into the vagina. If you put two fingers into the vagina and push upwards, you will be able to feel the cervix. It feels quite large and round, and has a firm consistency (similar to the end of your nose).

During penetrative sex, the penis is in the vagina and sperm are squirted out over the cervix at orgasm (cum). Many of the sperms find their way through the hole in the cervix and up through the uterus. At the top of the uterus, there are two Fallopian tubes, which carry eggs from the ovary to the uterus. The sperm swim up into the Fallopian tubes. If an egg is there, one of them will fertilize it and a baby has begun.

The vagina is about 7 –9cm long, but it is very, very stretchy. It has to be stretchy to allow a baby to pass along it during childbirth. During childbirth the hole in the cervix enlarges to allow the baby to pass through.

What is the vulva?

The vulva is the area that surrounds the vaginal opening.

On the outside, there are the outer lips, which are usually fleshy and covered with hair and skin.
If you spread the outer lips apart, you will see the inner lips. These are usually thin. Like all parts of the body, they come in all shapes and sizes. In some women, the inner lips are completely enclosed by the outer lips. In other women, the inner lips hang down further than the outer lips; this is absolutely normal.
The area inside the inner lips round the vaginal opening and the urethra (pee hole) is moist and pink. The medical name for this area is the ‘vestibule’.
The clitoris is at the top, where the outer lips meet.

What is the clitoris?

If you feel forwards from the opening of the vagina, you will feel the clitoris just before the inner lips join together. It feels like small, soft pea. Its name comes from the Greek word kleitoris meaning ‘little hill’. Anatomically, its structure is somewhat similar to the male penis. It has a sensitive surface (rather like the end of the male penis) sheltered by a hood of skin (rather like the foreskin of the male penis, but not extending all the way round). Most of the time the clitoris is soft and hidden under the hood but, during sexual arousal, it swells with blood (similar to erection of the male penis) and sticks out.

Research from the University of Melbourne, Australia ( Journal of Urology 1998;1892:159) has now shown that the clitoris is much larger than most people realize. It extends quite a long way inside, hidden by fat and bone. The main part is about the size of the end section of your thumb, and only the tip is visible externally. The part that extends inside divides into two arms (rather like a wishbone) surrounding the urethra (pee hole) and reaching towards the vagina. When the clitoris swells during sexual arousal, the whole structure can become quite large.

The clitoris is very sensitive and sexual pleasure is one of its main functions. However, the Australian researchers have found another function. The swollen ‘arms’ probably squeeze the urethra closed to prevent germs being sucked into the bladder during orgasm. They may also support the walls of the vagina so that sex is easier.

Getting help for a vaginal or vulval problem

If you have a problem in the vulval or vaginal area, such as itching or pain or discharge, you may feel too embarrassed to get help. (Of 100 women attending a clinic for vulval problems in Oxford, UK, five had suffered for over 20 years before plucking up the courage to see their family doctor.) To get help, you must overcome that anxiety. Remember that:

most vaginal and vulval problems can be dealt with easily
if you do have an infection, it needs to be treated promptly
doctors are used to examining the genital area – it is just like any other part of the body to them
if you do not want to see your family doctor, you can go to your local genitourinary medicine clinic, or talk to the nurse at your doctor’s surgery.

Thinking about the problem

Before seeing the doctor, think carefully about what the actual problem is. Is it pain or is it itching? Do you have a discharge? Are you worried that someone could have given you an infection? Are you worried that your vulva does not look normal? Remember, your doctor cannot help you if he or she does not know what the problem is!