THE VAGINA - A Guide


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The female genital anatomy and physiology (functioning) are dealt in detail in this document. It contains information on the vulva (external genitals), vagina, hymen, pubic hair development, the internal organs of the pelvis (including the ovaries and uterus), and common diseases of the female reproductive tract.

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The Vulva and Internal Genitalia
The external sexual organs of the crotch as part of the woman's vulva are included. The vulva includes the vaginal opening, the clitoris, the labia (majora and minora), the urinary opening (urethra), and the area over the pelvic bone that gets covered with pubic hair at puberty (called the mons veneris).
1: Mons veneris
2: Hood of Clitoris
3: Clitoris
4: Labia minora
5: Labia majora
6: Anus
8: Perineum (aka ‘taint‘)
10: Opening of Vagina
11: Opening of Urethra
The adult woman's pubic hair is the most obvious feature in this region. The pubic hair grows from the soft tissue above the pubic bone and is called the mons veneris. In mature unshaven women, the pubic hair extends all the way down and around the vulva to the anus (6). The anus is the opening of the rectum and colon. The pubic hair covers the area between the mons and the anus and is also made of soft fatty tissue (like the mons). The outer lips of the vagina are very much visible known as labia majora (5). The labia majora are prominent in some women and minimal in others. The outer lip skin is darker for some people. The outer lips (labia majora) surround some hairless soft flaps of skin. The inner lips are also clearly visible and are called the labia minora (4). With sexual stimulation, they swell and turn darker as they get filled with blood. The space between the inner lips and the anus is known as the Perineum. If the inner lips are spread apart, one can see that they protect a delicate area between them. This area is called the vestibule. At the top of the vestibule, right below the mons area, the inner lips are joined to form a soft fold of skin or hood (2) that covers the clitoris (3). The clitoris is the most sensitive spot in the entire genital area. Clitoris is made up of erectile tissue which visibly swells during sexual arousal. Below the clitoris is a small slit called the urethra (11) opening. Connected to the bladder is the urethra which is a thin tube about an inch and a half long. This is where urine comes out. Below the urethra opening is the larger opening of the vagina (10). The vagina is the birth canal and connects the outside world of the vulva to the womb (or uterus).

THE VAGINA
The vagina connects the exterior of the vulva to the internal organs of reproduction and it is a muscular tube-like structure (i.e., the cervix and uterus, fallopian tubes, and ovaries which are the internal organs). The vagina is tucked between the urinary bladder in the front and the rectum in the back. If nothing is in between the vaginal walls touch each other. The vaginal walls spread and hug or cling to the objects contained (e.g., tampon, finger, penis, baby).
The walls of the vagina are actually composed of 3 tissues. The inside wall is called mucosa and is similar to the inside of your mouth. Just below the mucosa is a layer of tissue that fills with blood. This is the erectile tissue and it swells when a woman is sexually aroused. The deepest layer is a coat of muscle, and this muscular coat is a wrap of tissue that can relax or constrict.
The vagina varies in length from woman to woman but is generally 2.5 to 4 inches long (from vulva to the cervix). In addition, the vagina has the ability to stretch quite a bit, thus allowing an erect penis in and a baby out (see our Male Genitalia Kit for details on average erection size and shape).

THE HYMEN
Girls are generally born with a thin membrane that covers the vaginal opening. This is called a hymen. Intact hymens vary widely in shape from woman to woman. For most women, the hymen stretches easily, but even after being stretched, little folds of hymen tissue remain (below, right).
It was the popular belief that the absence of a hymen meant past history of sexual intercourse had occurred (i.e., the woman was not a virgin), which need not be true. The hymen is a delicate piece of skin that can stretch and break from sexual intercourse, the use of a tampon, or even vigorous exercise. The stretching and tearing of the hymen are what causes bleeding to sometimes occur after intercourse. "Popped her cherry" is slang describing the breaking of the hymen.

GENITAL DEVELOPMENT
During the pubertal years (usually between ages of 8 and 13, the average age is 11), the vulva and internal genitals grow and change to their adult size. Just as breast development is staged, the medical way to gauge development is  Tanner's Sexual Maturity Rating. Tanner's classification of sexual maturity looks at pubic hair growth to determine development level.
In Stage 2, along with the labia, there is the sparse growth of long, slightly darkened, downy hair. You find straight or only slightly curled in this area generally.
In Stage 3, the pubic hair becomes darker, coarser, and curlier. It now grows sparsely over the mons veneris area.
In Stage 4, the growth of hair is dense, It becomes as coarse and curly as in the adult.
The mature adult, Stage 5, has the classic coarse and curly pubic hair that extends onto the inner thighs.
The final amount, colour, and distribution of pubic hair surrounding the vagina are quite variable. About 90% of the woman aged 18 and older have a "horizontal" pattern. Other hair patterns are also depicted.

PELVIC ORGANS
The internal organs that make up the female pelvis are the vagina, uterus (womb), fallopian tubes, and ovaries. Only the opening of the vagina is part of the external genitalia and hence the vagina is considered one of the internal organs. The uterus in a non-pregnant woman is about the size of an orange. It has thick muscular walls that are needed during pregnancy to push the baby through the vagina and out into the world. ("Contractions" refer to the tightening of the uterus during delivery.) Like the walls of the vagina, the inside walls of the uterus touch unless pushed apart by a fetus or abnormal growth. These inside walls grow thick and rich each month; this growth peters off with menstruation (the period). The uterus is connected to the inside end of the vagina through the cervix. The cervix has the consistency of your nose and is the tissue that is checked by a pap smear.
The ovaries are about the size and shape of unshelled almonds and are held in place by ligaments that attach to the pubic bone. A layer of fat surrounds and protects these precious organs. Each ovary itself contains hundreds of eggs, one of which is released each month during ovulation. The egg travels down the four inches long fallopian tube where it is fertilized by a sperm (if a sperm happens to be present). A fertilized egg will become buried in the rich tissue of the uterus (endometrium) and develop into a foetus.

PELVIC DISEASE
Many different types of diseases affect the female genitals. Some of the most common diseases are caught from a partner during sexual contact (e.g., Chlamydia, Herpes, Vaginal Warts, AIDS, etc.). A detailed look at these diseases transcends the scope of this guide and is available in our Sexually Transmitted Disease (STD) Online Guide. The guide shows photographs and gives detailed information on detecting, curing, and preventing the ten most common sexually transmitted diseases. Female genitalia is susceptible to different illness including STDs. These can be grouped depending on whether they affect the external genitalia (vulva) or the internal organs.

COMMON DISEASES OF THE VULVA
Sexually Transmitted Diseases (STD) commonly cause infection and damage to the vulva area. Condyloma (vaginal warts) is a common STD caused by the Human Papilloma Virus (or HPV for short). The photo to the left shows a woman with vaginal warts (arrows) on her labia majora. (The patient is also in her period and has a tampon in the vagina.)
Bartholin's Cysts are infectious lumps that appear if the Bartholin's glands get clogged up. The opening of these glands is located on either side of the vagina. Both sexually transmitted diseases and non-STDs can cause swelling that leads to this abscess. The photo shows yellow pus being expressed from a woman with an infected Bartholin's gland. The swollen gland is very tender and warm to touch. Treatment is with antibiotics and often requires an incision to allow the infected gland to drain.
Vulvar Cancer usually affects a woman in their 60s and is often triggered by HPV (Human Papilloma Virus). Any non-healing area around the vagina or vulva must be checked by a doctor to be sure it is not cancerous.


COMMON DISEASES OF THE INTERNAL ORGANS
Many of the STDs also cause infection and damage to the internal organs. These infections can sometimes lead to sterility (the inability to ever get pregnant) if undiagnosed and treated. Much more information on this and other causes of pelvic inflammatory disease is in our STD online guide.
The entrance to the uterus from the vagina is called the cervix and is considered a part of the uterus. Cervicitis (inflammation and swelling of the cervix) can be caused by many things, including infections (e.g., chlamydia, HPV) and cancer. A Pap smear should be done regularly in woman 18 and older or whenever sexual relations start because it has been proven that HPV can lead to cervical dysplasia (precancerous changes) and cervical cancer. Risk factors for cervical cancer thus include first intercourse at an early age and multiple sex partners. As expected, studies have shown that there is a much lower rate of cervical cancer in nuns and virgins. With the exception of sexual abstinence, the regular and correct use of condoms is the best way to avoid this and many other sexually transmitted diseases.
The inner lining of the uterus (endometrium) can also get infections and cancers. Endometritis is the inflammation and disease of this tissue. Again, the most common culprits are often the STDs (Chlamydia and Gonorrhea) but other things can also cause this serious infection. Endometriosis (not to be confused with endometritis) is a disease where the endometrium inappropriately ends up on the ovaries, fallopian tubes, and other places in the pelvis. It is unclear how and why it ends up outside the uterus. This tissue thickens and experiences significant pain and cramping during the hormonally-driven menstrual cycle. Certain medicines that affect hormone levels (like the birth control pill) can often be used to treat this problem.