We thought about calling this newsletter “The Happy Vagina,” but wondered if people would be too embarrassed to read it. This prompted a discussion of how difficult it is to talk about vaginal health in today’s society. Even with all the strides we’ve made in women’s health, most women are still uncomfortable talking about problems “down there” and can’t even bring themselves to say the word “vagina,” much less celebrate that part of our anatomy that makes us distinctly female.
This reluctance partially stems from the lack of good, reliable medical information available about the female genitalia. In The V Book, Dr. Elizabeth Stewart states that “popular thinking has mirrored the medical community’s indifference. For much of the twentieth century, women’s genitals remained mired in ignorance and shame, as had been the case for hundreds of years.” But that is beginning to change and we intend to encourage that change.
Most women refer to everything between their legs as their “vagina,” but this is not really accurate. The vagina is inside the body cavity and cannot be seen (except for the vaginal opening) without special equipment. The parts we can see (the external genitalia) make up the vulva. Hence the term, vulvovaginal, which refers to both the vulva and vagina because it is difficult to talk about the health of one without also including the other.
Dr. Stewart, one of the first vulvovaginal specialists, encourages women to look at their genital area, using a mirror, to identify what’s there and to know what it should look like. She emphasizes that while “private parts are meant to stay private,” your private parts shouldn’t be foreign to you. You should be intimately familiar with them so that you can detect when there’s a problem and communicate the symptoms effectively with your practitioner. Dr. Stewart notes that “Using a precise vocabulary is the first step to better care.”
The figures below depict the external female genital anatomy; don’t be alarmed if yours doesn’t look exactly like the drawings. Just as our ears and toes are all slightly different, our genitalia also has variations that make each of us unique.
The vagina is a tube-like cavity with its opening (the introitus) in the vulva and terminating with a “blind pouch” that wraps around the cervix, as shown in the figure below. A thin wall separates the vagina from the bladder and rectum. The size of the vagina varies from one woman to the next, but the average length is about 2 1⁄2 to 3 inches.
Vaginal tissue is different than that found in the vulva and is most similar to the tissue found inside the mouth. The tissue around the opening of the vagina is like the tissue of the urethra, with lots of receptors for testosterone and the estrogen hormones. The vaginal walls contain muscles that allow the vagina to expand and contract to accommodate something as slender as a tampon during menstruation or as large as a baby during childbirth. In its relaxed state, with nothing inside it, the vaginal walls collapse against each other. The vaginal muscles are not within your control, but the pelvic muscles around the vaginal opening are. They hold the pelvic organs in place, help control urinary flow, and can affect sexual enjoyment.
The main functions of the vagina are to:
- provide a passageway for menstrual flow
- accommodate the penis during sexual intercourse
- serve as the birth canal for delivery of a baby
- prevent bacteria from entering the body.
This last function is critical to maintaining vaginal health. In Dr. Stewart’s words, “The vagina is a uniquely specialized thoroughfare. It performs more specialized functions than most organs of the body. Penises, tampons, and doctors’ speculums go in. Babies and menstrual flow pass out. Yet for all this traffic, the vagina is as delicate as it is hardy.” Vaginal health depends on a “precarious biological balance among the many bacteria that dwell naturally within. It’s the disruption of this balance that often leads to vaginitis.”
Vaginal Health Conditions
Vaginitis is an infection, irritation, or inflammation of the vagina or vulva. It can be caused by a multitude of things, including bacteria, parasites, yeast, an irritant, a hormone imbalance, or a foreign object (see Primary Factors). Lifestyle factors such as wearing tight pants or nylon pantyhose, using spermicides or douches, having poor dietary habits, or being under constant stress can also contribute to vaginitis.
The symptoms of vaginitis are usually described as itching, burning, or both, and are often accompanied by abnormal, foul-smelling discharge. The itching and burning may occur at any time but are usually most troublesome at night. The burning sometimes feels like a bladder infection, becoming worse during urination or sexual intercourse. The vulva may take on a bright reddish color.
Even though vaginitis accounts for millions of office visits each year, many women are reluctant to seek help or, once they get to their appointment, too embarrassed to discuss their symptoms. That can be a dangerous and life-altering decision.
If left untreated, vaginitis can lead to more serious problems such as pelvic inflammatory disease (PID), which can scar the fallopian tubes and lead to infertility or an ectopic pregnancy where a fertilized egg becomes implanted outside the uterus. Therefore, it is best to seek help from your healthcare practitioner to determine the cause of your vaginitis. Over-the-counter remedies might make the problem worse, especially if they simply mask the symptoms but do not treat the underlying cause.
The most common causes of vaginitis are infectious organisms such as Gardnerella vaginalis (a bacterium that doesn’t like oxygen), Candida (a yeast fungus), or the parasite Trichomonas vaginalis, of which the last two are sexually transmitted. Other sexually transmitted causes include bacteria such as Neisseria gonorrhea and Chlamydia trachomatis, genital warts, and the herpes virus.
Your healthcare practitioner will most likely perform a physical examination and one or more tests to determine the appropriate treatment for your specific type of vaginitis. Tests may include an acid-base balance (pH test), a whiff test, a vaginal smear, a yeast culture or skin scraping. If you have a lump, rash or ulcer, biopsy of a small sample of skin may be necessary. A Pap test is used for evaluating cervical cells, not for diagnosing vaginitis.
Vulvodynia is another health problem that may affect the genitalia. It is described as a spontaneous, generalized pain in the vulvar area, characterized by a stinging, burning, or raw sensation, which may or may not be associated with a form of vaginitis. For some women, the pain is chronic.
Some researchers and practitioners believe that vulvodynia may be related to or caused by a chronic yeast infection. In The Yeast Connection Handbook, Dr. William Crook states that vulvodynia may be similar to other chronic health conditions, such as endometriosis and chronic fatigue syndrome, in that it probably has multiple causes. He poses the possibility that “Candida overgrowth in the gut may so disturb the intestinal membranes that food antigens, endotoxins, and enterotoxins present in the gut are absorbed, and they, in turn, adversely affect the urogenital system. Or … Candida itself may form potent toxins which cause immune system disturbances.”