The question we hear perhaps the most often is different versions of, “Why does it hurt down there?” Many women are rather unfamiliar with their own anatomy when it comes to their vagina and vulva. When we were younger, our families may have used different names for this area, such as “privates,” “ti-ti,” choo-choo,” – you name it!

As we get older, we learn more about the vagina from either our peers, a parent, a health or anatomy class, when trying to use a tampon for the first time, or perhaps during our first sexual encounter. However, the vulva often gets breezed right over or is not discussed at all until there is some sort of issue. Many women are not aware that the vulva consists of the external structures of the female genitalia, while the vagina is the canal that leads up to the cervix.

There are many different areas of the vulva, which we will outline below in hopes of improving understanding for not just when there is an issue or things go wrong, but for when we want things to go right! 

Luckily, our education prepares us to investigate further to get a sense of exactly where you may be experiencing pain or changes. However, it can be extremely empowering to be able to go to a medical appointment of any kind and be able to describe and pinpoint exactly where you are noticing any discomfort or changes to ensure you received adequate answers and care. While we are not saying that teaching proper anatomical terminology from a young age is the golden ticket to getting around this (we wish it was that simple), we are however saying that as we grow it can be helpful to become more familiar with the different areas of our bodies. This can be incredibly helpful for our self-awareness in general, understanding our pleasure preferences for ourselves and for communication with our partners, and to track any changes during different phases of life, such as pregnancy, postpartum, perimenopause, etc. Let us be your guide! 

The Vulva & All of Its Wonder! 

The vulva is the entire external structure, which comprises the other areas we will discuss, such as the labia majora and minora, clitoris, urethra, vagina, etc. The vagina is actually only 3.5" in length on average. It tents or enlarges upon arousal, which may help you to understand how penetrative intercourse is possible despite the limited length of the vagina at rest. The opening of the vagina may be referred to as the “introitus.” The vagina extends from the external opening up to the cervix. The urethral opening, or “urethral meatus,” is often learned as “the other hole.” This is where urine comes out after leaving the bladder. 

The tissue surrounding the vaginal opening and including the urethral meatus is called the vestibule. This area is particularly important when it comes to pelvic pain and is sensitive to hormonal changes. The tissue or “skin” around this area looks different from the rest, as it is actually the same type of tissue found internally, such as the tissue of our intestines. We won’t get into the long reason of why this is the case due to our development in utero, but we think it is pretty fascinating to know! 

Monitoring changes in coloration of this area can be helpful as your body undergoes these changes. For instance, sometimes we will notice as pelvic floor therapists that this area looks either pale in color or very red, which would warrant us to facilitate communication with our client’s gynecologist to see if that person may benefit from medical management, such as using a hormone topical or alternative to support the integrity of the vestibule. During times of hormone deficiencies, such as when postpartum women are lactating, this is often an area that is quite irritated. When our clients are getting back to wearing a tampon again or returning to sex postpartum, it is important for us to rule out that contributor. Oftentimes there are pelvic floor muscle tension issues as play and there is general postpartum healing taking place. However, these changes in hormones can dramatically impact pelvic pain as well. By being more aware of your “normal” before these changes take place, it can help you to better identify if this is ever an issue rather than accepting this as your new normal!

Misconceptions About the Hymen

The hymen is a sheath of tissue that may cover or surround the vaginal opening. Even if the hymen is not "intact," it does not indicate if someone is sexually active or not. This is a common misconception. There are different variants of hymen that could be responsible for pain with sex or difficulty with tampon use. This is where the hymen does not open up entirely with only one or several small openings or or there is a band of tissue down the middle. Hymenectomies are a procedure used in some of these cases when removing some of the hymen may be helpful to decrease pain. 

Why Do My Inner Lips Look Different?

There are inner and outer lips that surround the vaginal opening. The labia minora are the inner lips. There is a wide range of "normal" for appearance and length of inner lips. It can be helpful to know that your labia minora should be like sisters, not twins! It is normal for one side to be longer or larger than the other! You may notice changes in size and coloration of this area as your body undergoes hormonal changes, such as during pregnancy, birth, or the different stages of menopause.The labia majora are the outer lips or outer skin folds, made of skin entirely different from the labia minora. These outer lips also vary in size from person to person and change as we age. During pregnancy, many women report they feel swollen or puffy in this area. 

Tracking any changes in size of your inner lips during these changes can be helpful, especially if you notice it becomes difficult to peel away your inner lip from outer lip or it seems like the inner lips are starting to fade away or be reabsorbed. Changes in coloration are also important to note, such as if you notice areas that look white or red. This is important to communicate with your medical team as it could be a sign of a vulvar dermatoses that would warrant further diagnostics. 

The Mysterious Clitoris!

Did you know the glans (visible part) of the clitoris is the female equivalent to the penis? The clitoris is a unique structure in women in that its only job is for pleasure. No wonder this is understudied, under-discussed, and often misunderstood!

The clitoris is also much larger than people usually think! It is not just the small pencil-eraser-sized-part that is visible externally. That is the glans, which is covered by the clitoral hood. You should be able to retract the clitoral hood to visibly see the glans. Think of this like your eyelid moving to open your eye, except manually needing to move your eyelid to do so. If you cannot retract your clitoral hood, notice any shrinking of the visible part of your clitoris, discoloration, or small deposits the size of a grain of sand in this area that won’t easily come off, talk with your medical team. There could be keratin pearls or adhesions that you may need support in removing to ensure your clitoral hood can adequately retract. Sometimes if there are issues in this area's function, it can cause pain that you may not realize is tied to the clitoris itself. 

The legs of the clitoris are called crura. They form a “V” and extend internally under labia majora as they surround the urethra and vagina. The bulbs of the clitoris can be seen in the picture below. They surround the vagina and increase in size with arousal and increased blood flow.

PSA!! Vaginal orgasms or hitting the “G-spot” is really from stimulating the clitoris through the vagina as the bulbs of the clitoris extend on either side of the vaginal canal (underneath labia majora). See the picture for reference! While we are on that topic, the majority of women do not orgasm from vaginal penetration alone – Say it louder for the people in the back!!! Clitoral stimulation during masturbation, foreplay, or intercourse does not need to be only at the visible part of the clitoris! For some folks, this provides too much direct stimulation – almost like too much of a good thing! If that is too much for you, consider stimulation further along the legs or crura of the clitoris, which again underlie the labia majora! In other words, you could be stimulating the clitoris by being inches away from it! 

What Is All the Hype With the Perineum?

The perineum is the area between the vaginal opening & anus. This is the area that gets a lot of social media presence when it comes to “perineal massage” in pregnancy. This is something we help our clients better understand how to incorporate and how it can help. Sometimes if there is pelvic floor muscle tension present, this area seems to be what we called “retracted,” or lifted higher up than your sit bones rather than in line with them. Some of your pelvic floor muscles run right underneath the skin of this area, pretty close to the surface, and extend to the left and right sides over to your sit bones. 

We hope you learned even just one thing from this that will help you along your pelvic health journey! Follow along for more information!