It wasn’t always easy to talk about vaginas and I never thought I would make a career out of it, but here I am, Dr. Courtney Seacat, vagina doctor. Growing up, I literally thought it was actually called, “a vachina.” Look how far I’ve come.
In all seriousness, the vagina and all that it includes is still somewhat of a taboo subject. I wanted to write an article to address questions I get on a daily basis about what is “normal,” common myths, and hopefully make women more comfortable with the area, “down there,” I mean, their VAGINA. There are several different types of cancer that can occur in this area, so knowing what is normal and what needs to be addressed by your doctor is important. Get to know your vagina.
The pubic bone area or where most of the pubic hair is located, is called the mons pubis.
There are two openings of the vulva. The urethra (where you pee from) and the vaginal opening (where period blood and babies come out of and the insertion point for intercourse). I know that is anatomy 101, but you would be shocked at the number of people who may not know there are two openings there. Of course, there is the anus which is separated from the vagina by what we call the perineum. After delivering a baby, this is the area that usually needs repair after a laceration or tear. 
So is this drawing what your vulva/vagina is supposed to look exactly like? That is a big “NO”! The location of the anatomical parts are accurate, but this is not what most real life vulvas ad vaginas look like. Every woman is unique. There is no right way your labia are supposed to look. This is a common concern for most women. There are times when the inner labia are much longer than the outer or when one side is larger or longer than the other. Some people have full outer labia and some are thin. With age, the vulva and vagina change and you better believe it changes after having a a baby.
Vaginas are not something people see daily and can easily compare, to know if there is "normal". Just like other body parts, everyone is different. I know this can cause distress to some girls and women. When the vulva causes discomfort physically and emotionally, there are procedures that can be done to try and rectify this. Labiaplasty and vaginoplasty are becoming common procedures. There are good reasons for these procedures when it comes to issues with discomfort or hygiene, but the truth is…there is no perfect vagina, because no one knows what perfect is supposed to be. I will be honest, I examine about 10-15 vulvas a day and would not be able to tell you this.
I found this great little article by an anonymous bikini waxer who details the several different types of vulvas she sees in her practice.
http://www.dailymail.co.uk/femail/article-4391136/Bikini-waxer-reveals-five-different-types-vagina.html
I found this great little article by an anonymous bikini waxer who details the several different types of vulvas she sees in her practice.
http://www.dailymail.co.uk/femail/article-4391136/Bikini-waxer-reveals-five-different-types-vagina.html
I NEED this collage in my office.
Now to address questions most people have, but are too embarrassed to sometimes ask...
- Is discharge normal? The answer is yes, but with exceptions. Discharge is basically what is released from the cervix and vaginal glands daily. It changes depending on where you are on your menstrual cycle and is basically hormonal dependent. During ovulation (when you are most fertile), the discharge is pretty slick and slimy, almost like egg whites. I think of it as a slip and slid for sperm (sperm can make it to an ovulated egg the easiest) in this environment). Did you just picture sperm with big smiles on their face as they slide through the uterus? Yeah, me neither.
Other times of the month, the discharge is thicker and white. Right after your period, you may notice a smaller amount.
Everyone is different in the amount of discharge they have.
Signs when something may not be right would include any irritation, foul odor (like a strong fish smell), yellow or greenish color, or excessive itching. These could be signs of an infection such as bacterial vaginosis (also known as BV), a yeast infection, or a sexually transmitted disease (STD). Speaking of STDs, most infections such as gonorrhea and chlamydia (the most common ones) don’t have any symptoms. Be sure to get tested if you have unprotected intercourse. Better to be safe than sorry.
2. Is an odor normal? Yes and no. The vagina is made up of a lot of bacteria in perfect balance to keep things normal. We call this the vaginal flora. There is always a slight odor as this enviroment is slightly acidic. When there is overgrowth of a certain bacteria or an imbalance of the flora, this can cause a foul odor. Most associate this foul odor with a fishy like smell.
3. Why do I get yeast infections? A yeast infection is an overgrowth of a fungus, not a bacteria. Yeast infections can happen when the vaginal flora gets unbalanced. This can happen with poor hygiene, but also with over-cleaning. Sometimes, taking antibiotics can get rid of the good bacteria and allow yeast to overgrow. Symptoms usually include itching and a thick, white, cottage cheese like discharge (hope you are not eating cottage cheese right now). You will need an anti-fungal to treat this.
4. Can you get cold sores on your vagina? Yes! There are two types of herpes. Herpes Type I usually involves cold sores on the lips, which can be transmitted very easily by just getting kissed by a grandparent when you were a baby. There is also type II, which is the one you usually see develop on the genitals. Herpes type I can also be transfer to the genital via oral sex, so it is possible to develop vaginal lesions.
5. Is it normal to have pain with sex? No. This is not an uncommon issue I see. There are several things that can cause this, such as an infection or some structural issue like an ovarian cyst, endometriosis, or uterine fibroids. As women go through menopause, the vaginal tissue gets thin and drier, which can also cause discomfort with intercourse. This can be treated with an estrogen cream. There are other common problems that many have never heard of and are not always easily treated. They are vulvodynia and vaginismus. Sounds like something super exciting to have, right?
Vulvodynia usually consistent of a burning pain at the opening of the vagina or vulva. Most of the time this is located at the bottom opening of the vulva. It is when the nerves respond inappropriately to touch. Barely touching this area with a q-tip can cause a sharp, burning, or stabbing pain. There are topical and oral creams that treat nerve issues that can be prescribed. If these medications do not help, one may need surgery This involves removing a superficial layer of vulvar skin to stop these nerves from firing inappropriately.
Vaginismus is the other type of vaginal pain commonly seen. This is when the muscles that make up the opening of the vagina and pretty much the whole support of your bottom, contract involuntarily. This can cause painful intercourse, but also pain with placing a tampon and sometimes so severe that a person cannot even tolerate an exam. People with history of sexual abuse, strict religious backgrounds, or shameful views of sex are at increased risk of this. This can also occur regardless of these backgrounds. The more you try to overcome the pain, the worse the muscles spasm and it is a vicious cycle. The best treatment for this is pelvic floor physical therapy. Yes, there are physical therapist for the vagina! They are awesome and this is the treatment where I see the most progress for my patients. They specialize in helping people regain control of their pelvic muscles and learn to relax them again. Luckily, more physical therapists are getting this training. I get that pelvic floor PT may be weird for some people, so there are also vaginal dilators (you can buy them on Amazon) that you can use in the comfort of your own home. These are recommended to use daily for 30 minutes to help gradually allow your muscles to relax as you slowly increase the size of the dilators.
If you have any of these symptoms, talk with your doc. You are not alone and it is not something you should have to be ashamed of or live with.
5) Does everyone shave? What is the trend these days? Honestly, I don’t know. I could not tell you who shaves or doesn’t. Unless you have something very interesting, such as a shaved hair portrait of Barbara Streisand, googly eyes glued to your mons, or a vagazzled masterpiece, chances are your ob/gyn will not remember what your vagina looked liked. My advice is…you do you girl. Go hair free or go native, whichever is most comfortable for you. Frequent shaving can cause irritation, Maybe take a break, every now and then, if you notice frequent razor burn and discomfort. Trends come and go. No one knows the true purpose of pubic hair. Some suggest it helps keep bacteria out and others say it helps trap pheromones that help with sexual desire. There is no great data either way.
6) Is my vagina too big or too small? There is not standard size, but most vaginas are around 3-4 cm in depth and 3 cm in width. The vagina can expand to 200% times its original size, which is what happens with intercourse and of course when a baby makes its way through.
6) Is my vagina too big or too small? There is not standard size, but most vaginas are around 3-4 cm in depth and 3 cm in width. The vagina can expand to 200% times its original size, which is what happens with intercourse and of course when a baby makes its way through.
Aging, weight changes, smoking habits, and genetics can affect the vagina structure over time. Sometimes the vaginal walls can collapse some and even prolapse or sag out of the vaginal opening. This is nothing that can hurt you, but can affect quality of life. Ob/gyns can help with this and there are doctors called, urogynecologist, that specialize in this issue.
Vagina Dos and Don’ts
Don’t douche! The vagina actually cleans itself. Douching gets rid of the good bacteria and can change the pH or balance of the vagina and cause all kinds of issues. Is it any wonder the slang term for a "not so good guy " is a douche?
Do gently clean with a non-harsh soap. RepHresh is a good cleanser that can help balance the pH of the vagina (get it RepHresh with a pH? So clever), but again is not necessary to use, as the vagina is a self cleaning organ. The natural pH of the vagina is acidic (like a fine wine), so allow it to stay that way.
Don’t hang out in a wet bathing suit too long. This can lead to yeast infections and irritation.
Do see a doctor if you feel like you have any new lesions or areas of irritation. There are several dermatological issues that can present primarily on the vagina. Some allergic reactions can occur on this sensitive area.
Don’t leave a tampon in too long. By too long I mean more than 24 hrs. Toxic shock syndrome is rare with how tampons are made, but infection can still occur.
Do wipe front to back. Yes, your mom told you right.
Don’t place a Jade Egg in your vagina! Thanks a lot Gwyneth Paltrow. Really though. Why? Just because some guru says something helps does not mean it is true and that is based on any real research. Western medicine, although not perfect, has the most EVIDENCE-BASED research behind it. Do things change over time? Sure as new research develops. I promise the medical community is not out to get you, though. We do our best to recommend things to keep and make you healthy based on the information we have. A Jade Egg is not one of these. Not to mention they are $50-$60!
Do be careful when shaving or waxing. Ingrown hairs can happen and cause pain and infection, which may even lead to an abscess which needs surgical draining. See your doctor right away if you notice any signs of an abscess. May sure to gently exfoliate before hair removal. People with poorly controlled diabetes are at the highest risk of an abscess or a serious infection requiring surgery, so be careful.
Do Kegels! This is exercise for your vagina. Here is how to do a Kegel: Try to stop your urine mid-stream. These are the muscle you want to work on contracting and relaxing to help strengthen that pelvic floor to help with issues such as incontinence and gaining back the muscle tone after having a vaginal delivery. Also, I hear they may have added a Kegel competition in the next Olympics. Are you Kegeling reading this right now? I hope so!
Don’t wear a vaginal/vulvar wig or merkin. Yes, that is a thing and I have seen it. Talk about irritation in this sensitive area. Don’t believe me? Look it up…Merkin.
Do LOVE YOUR VAGINA!
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