Would it surprise you to know that over 50% of women lack knowledge about the structure and functions of the vulva and vagina? 

We have a huge array of nicknames for our genitalia – our V, fanny, foof, downstairs, lady bits, vajajay and dozens more – and it’s rare to hear people say it as it is.

There remains a discomfort talking about this which is deeply rooted in societal norms, gender health and educational gaps which leads to personal embarrassment. When The Vagina Monologues first premiered in 1996, it had a certain shock value.

But surely in midlife, it’s time for us to educate ourselves about our anatomy and use the correct terminology? Having open discussions about our intimate health with friends, family and healthcare providers can enhance our quality of life and help us embrace our bodies. 

The difference between the vulva and the vagina.

The vulva refers to the external part of the female genitalia, consisting of various areas such as the labia majora, labia minora, clitoris, vestibule and perineum. It includes the urethra (where we pass urine), the vaginal opening, and the anus below this area.

The vagina, so often used to describe female genitalia in general, is just the passage between the vulva and the womb. It is a muscular cylindrical structure, approximately 7-8cm long. It has its own vaginal microbiome and plays a vital role in sensation and creating pleasure. Additionally, the vagina is crucial for pregnancy and childbirth. 

Using the right terminology (healthcare providers, please note too!) isn’t just an exercise in biological correctness, it’s important to ensure effective communication regarding any issues that may arise... no more 'down there' please! 

Regularly self-examine.

You should regularly self-examine with a mirror to understand what is normal for you. Remember – there is no normal, everyone’s body is different. Changes in the vulva can occur due to various factors, so being aware of your normal helps in identifying and addressing any changes promptly. 

Itching, soreness or dryness?

Educate yourself about the conditions that can occur. Itching, for example, may not always indicate thrush. If you experience persistent itching, dryness, soreness, burning, pain during sex, or any other unusual symptoms, consult your healthcare provider for a check-up. 

There are a variety of skin conditions, infections and cancers that can occur at the vulva and vagina, so it is crucial to seek medical attention if you have persistent symptoms. Please do not ignore any symptoms and schedule a check-up. 

How our genitalia can change

Our vulval and vaginal health can change at different stages of life, from childhood to beyond menopause. These changes can not only impact our daily activities but also our relationships, careers and self-confidence.

During menopause, the vagina, for example, can become shorter and narrower and the tissue of the vulva can become thinner and less elastic or flexible.

In fact, during midlife, at least 50% of women may experience Genitourinary Syndrome of Menopause (GSM), which is caused by reduced oestrogen in the vulval, vaginal  and urethral tissues. This can lead to dryness, itching, painful sex, frequent urination, or discomfort.

Effective treatments are available - discuss your symptoms with a healthcare provider to explore suitable options. These can range from something as simple as using water alone for washing, avoiding soaps and perfumed products through to using emollients, pH balanced lubricants or topical oestrogens. Pelvic floor exercises, dilators and vibrators can also help to manage certain aspects of GSM too.

Fortunately, we are entering an era where more novel treatments are available to prevent or address the functional changes experienced by women. Private treatments like Radiofrequency vaginal or vulval treatments, fillers, PRP (platelet-rich plasma) and polynucleotides are examples of what is available. Make sure you conduct your own thorough research with these and consult a qualified medical practitioner before trying any new treatments. 

Now is a prime time to educate and empower ourselves about our intimate health – take care of your vulva and vagina as a key part of improving your well-being.

Smita Sinha, Founder and Consultant Gynaecologist, Serenity Women’s Clinic


Instagram: serenitywomensclinic

Written by Smita Sinha
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