Knowing your Vulva

The question is… are we all familiar with the intricate folds and openings of this part of our body?

As a Mooncup advisor and practising nurse specialist in Sexual and Reproductive Health, vulval and vaginal health is paramount. Awareness of normal anatomy and recognising changes can be a tricky business as the complexity of the vulval map can be confusing.

Often the term vulva provokes uncertainty, and the word vagina is commonly used as a general overarching name for female genitalia.

We are of course all different- our shapes and body parts are similar but innately unique. For most of us it is not routine to make comparisons or describe this part of our body, so it is not surprising that the vulva can be unfamiliar territory.

With this in mind:

What is the vulva?

The word vulva aptly means covering (Latin) and refers to the female’s external genitalia, for most this will include:

• The mons pubis – the mound of fatty tissue that covers and protects the pubic bone.

• The Labia majora – commonly known as the outer lips. In some of us the labia meet , covering the inner lips and other parts, but for others these parts can be seen, as the labia majora remains slightly parted.

• The labia minora – the inner lips are located inside the labia majora and the skin is usually darker in colour , though this can vary from person to person, as can the size , shape and length of each side , often there is no symmetry, and it is just a variation of normal to have longer inner lips than outer. The labia minora is home to tiny sebaceous glands that secrete oils for lubrication.
• The clitoris is usually located between the inner folds of the vulva (labia minora), at the top. Under the clitoral hood is the head of the clitoris known as the glans which varies in size from person to person. It is estimated that there are at least 8000s sensory nerve endings here and it is the central hub of sexual response for most females.

• The urethral opening is located above the vagina and below the clitoris, and is where were urine is excreted through a tube connected to the bladder.

• The vestibule refers to the area of skin directly around the vaginal opening and the urethra, outside the body, but inside the labia minora.

• The vaginal opening is situated below the urethra and is like a muscular tube, that connects with the cervix (neck of womb) to the external vulva. The size and shape of the vagina can vary from one individual to another.

• The perineum describes the area of skin and muscle between the vagina and anus.

Self examination of the vulva

If you are not already examining your vulva now and again, maybe now is the time. It is always good to be aware of any skin changes for instance earlier rather than later. A comfortable way to do this is to lie down, with back and shoulders propped up with pillows. Hold a mirror in one hand, and use the other hand to part the labia and have a good look.

Check for any unusual lumps, warts, breaks to skin, or indeed other changes such as colour, thinning or thickening of the skin to the Labia or surrounding areas. If you have any unusual symptoms it would be wise to get this checked by a doctor or nurse.

Pain, itching, burning and general irritation of the vulva, may be signs a common fungal infection such as thrush (candidia). A change in smell or discharge may  indicate a different type of infection such as bacterial vaginosis. Sexually transmitted infections such as genital warts can cause warty lesions to appear anywhere around the vulva. HPV ( Herpes virus) can cause painful blisters or ulcers/sores which will go away but can reoccur. Again in these circumstances it would be wise to be seen by your doctor/gynaecologist or local Sexual Health Service who will offer testing for other infections if appropriate and sign post you to other services such as dermatology or a specialist vulva clinic if necessary.

Other vulval diseases include inflammatory skin conditions such as excema / dermatistis , Lichen sclerosis, Lichen simplex, Lichen planus. Pain syndromes such as vulvodynia  vestibulitis and vaginismus, and pre cancerous skin conditions such as VIN (vulvar intraepithelial neoplasia).

Vulval cancer is a rare cancer. Around 1,200 cases are diagnosed in the UK each year. That is less than 1 in every 100 cancers diagnosed in women. It is more common in older women and many cases are diagnosed in women aged 65 or over. But around 15 out of every 100 cases (15%) are in women under the age of 50. Early stage vulval cancers can occur in young women and they have been seen in women in their 20’s. But it is extremely rare to get vulval cancer at such a young age. (Cancer research UK).

For more information see www.nhs.uk and www.cancerresearchuk.org
Alternatively, Speak to your GP or local Sexual and Reproductive Health Centre.

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