All About the Vulva

The clinical term for the vaginal opening is the introitus. This inner part of the labia leads to the cervical opening of the uterus. It is the entry point of the penis during coital sex and for tampons and menstrual cups during a woman's period. With the help of the perineum, the space between the bottom of the vulva and the anus, the introitus also facilitates childbirth.

Despite the terms sometimes being used interchangeably, the vulva and the vagina are different. The vagina is the internal part of the female genitalia, from the introitus up to the cervix, the opening to the uterus. The vulva is the area around the vagina. While the vagina is self-cleaning, the vulva needs regular cleansing or it may introduce infections into the vagina.

The labia are lips that cover the opening of the vagina that can swell with increased bloodflow. The labia majora are the fleshy outer lips with pubic hair, while the labia minora are inside the labia majora, between the clitoris and introitus. They vary in shape, size, and color, all of which can change with age.

Located at the top of the vulva, where the labia minora meet, is the tip of the clitoris, whose only purpose is providing pleasure. It can be as large as a thumb or as small as a pea. The full clitoris is a spongy 5-inch organ that traverses both sides of the vagina. It has thousands of nerve endings, making it extremely sensitive.

Also known as mons veneris, the mons pubis is a fleshy, prominent part of the vulva shaped like an upside-down triangle. Its fatty tissue acts as a cushion for the pubic bone. During puberty its texture changes as it becomes covered with hair. The mons pubis has oil-producing glands that play a role in pheromone production.

The urethral meatus is the opening of the urethra that sits above the introitus and behind the clitoris. This is where urine is ejected. The lesser vestibular glands, known as Skene’s glands, are located on either side of the urethral opening. Their job is to lubricate the opening, but not all women have them.

The area that surrounds the opening of the vagina and the urethral meatus is the vestibule of the vulva. In addition to separating the vulva and the vagina, it is home to the greater vestibular glands or Bartholin glands. These pea-sized glands reside on either side of the introitus and secrete mucus to lubricate the vaginal opening, making intercourse more comfortable.

The pudendal nerve starts from the sacral region in the lower back, between S2 and S4. It branches off into the inferior rectal nerve, which innervates part of the anal canal, the perineal nerve, which manages the labia majora and minora, and the dorsal nerve of the clitoris, which innervates the clitoral skin and is partially responsible for orgasms.

Lichen sclerosus is a noncontagious skin disorder that can affect women at any age but is more likely to develop after menopause. Vulvar skin, particularly the labia, becomes itchy with white spots. In more severe cases, women experience blistering and bleeding. Corticosteroids are the most common treatment, and they need to be taken regularly to avoid recurrence.

Some women experience unexplained burning, ache, or pain in the vulvar region, a condition called vulvodynia. While the vulva looks normal, the pain can be triggered by touch, sex, tampon use, or any normal activity. Vulvodynia has no clear cause, and it can go away on its own. While medications can help manage this condition, some women require surgery.