Journal

10 things you need to know about vulvas and vaginas

Let’s undo the taboo and chat about it

Written by Abigail Swoap

You know what’s crazy? How infrequently people talk about vaginas!

Over 50 percent of us have them, but they don’t get nearly enough attention outside the bedroom. The lack of proper sex education in the United States and throughout the rest of the world has created a societal knowledge desert when it comes to understanding vulvar and vaginal health and anatomy. From anatomical myth-busting to common vaginal health issues, we could all benefit from normalizing candid conversation about what’s happening down there. That’s why we’ve rounded up the top ten facts about vaginas that everyone should know, regardless of whether or not you have one. 

The vulva and the vagina are not one and the same.

We wish this was made more clear in sex education programs throughout the world, but unfortunately, that’s just not the case. Let’s clear it up once and for all: the vagina is the tube that connects the vulva to the cervix and uterus. 

The vulva is the part of the genitals outside the body; it includes the labia minora (inner lips) and majora (outer lips), the clitoris, the vaginal opening, and the urethra opening.

For more information, check out Coral’s introduction to vulva and vaginal anatomy.

Not all vulvas look the same, either

There is no “normal” vulva. Vulvas vary in shape, size and color, and labias can be smooth or wrinkled. For some vulva-havers, the inner labia are longer than the outer labia. For others, the outer labia are longer and conceal the inner labia.

It’s normal for vaginal discharge to change over the course of a menstrual cycle

Vaginal discharge can be a great guide to where you are at in your menstrual cycle. It tends to increase as your cycle progresses. Just after your period, discharge is very minimal, mostly dry. Leading up to ovulation, it is white and creamy. Around ovulation, it feels more like egg whites - slippery and clear. You’re most likely no notice a change once ovulation is over, that’s when you’ll really notice a change, as that is when it will become more sticky and dry.

If you’re on the pill or another hormonal contraceptive, discharge is less likely to noticeably change throughout the month. 

However, abnormal changes in discharge can be indications of a vaginal infection (which are way more common than you might think!)

Over 50 percent of vagina-havers will experience vulvovaginal candidiasis (yeast infection) at some point in their lives. The tell-tale signs are itch around the vulva, thick discharge with the consistency of cottage cheese, burning sensations during sex, and redness or swelling of the vulva. Luckily, over-the-counter treatments like Monistat are available at most drug stores. If you’re experiencing a year infection for the first time, make an appointment with your gynecologist to get tested for it. Your doctor may also prescribe a one-time pill to get rid of the infection.

About one in three people with vaginas will experience bacterial vaginosis at some point in their lives. Even though it’s the most common vaginal infection for people ages 15-44, its symptoms are often confused with a yeast infection. BV comes with a thin, gray discharge, pain or itching inside or outside the vagina, and a strong, fishy odor (especially after penetrative sex). When left untreated, it can increase your risk for STIs and can lead to premature delivery for pregnant people.

UTIs account for nearly 25% of all vaginal infections, and about 50-60 percent of vagina-havers will experience one during their lifetime. Most UTIs are infections in the lower tract of the urinary system (which includes your bladder and urethra). Vagina-havers are more likely to get UTIs than penis havers, but all people can experience them. They sometimes present asymptomatically, but when they do come with symptoms, you might experience an almost constant urge to urinate, a burning sensation while urinating, cloudy urine, and/or pelvic pain. If a UTI is left untreated for too long, it can develop into an upper urinary tract infection and cause damage to the kidneys. 

It’s normal (but nonetheless annoying!) for vaginal infections to recur once you’ve had them 

Although yeast infections recur at a rate of less than 5%, nearly 50-70% of all BV cases end up recurring within a year. About 25-40% of UTIs are recurrent

Having recurrent vaginal infections does NOT mean you are dirty or unhygienic

It just means your PH balance has been thrown out of wack. Part of the reason that recurrent vaginal infections are so common is that by treating one infection with antibiotics, you might be inciting another. The vaginal microbiome needs both “good” and “bad” bacteria in order to function properly. The problem is, antibiotics that treat the bad bacteria that UTIs (like E. coli) also get rid of the good bacteria (like lactobacillus acidophilus). This series of unfortunate events can set off a cycle of vaginal health issues that, for some vagina-havers, can last months or even years. 

Luckily, scientists are beginning to understand the efficacy of suppository and oral probiotics in helping treat recurrent vaginal infections. An Italian study found that taking the two in conjunction is an effective treatment. 

If you’re experiencing recurrent vaginal infections and have been on multiple rounds of antibiotics, talk to your gynecologist about using a suppository probiotic like BIOM.

If you do experience recurrent vaginal infections, it can help to understand what might be triggering them 

It’s not always easy to get down to the bottom of what’s causing recurring vaginal infections, and that can be really frustrating (particularly if they are uncomfortable or if they are preventing you from having sex). If you’re not sure what’s causing them to keep coming back, it might help to start keeping track for yourself. Coral’s Pulse feature would be a great place to start. Over time, you might notice patterns in your recurrent infections that could clue you in to potential fixes. 

Some common triggers of vaginal infections (besides antibiotics) are:
  • Semen and period blood, both of which are more basic on the ph scale. 
  • Hormone Replacement Therapy (HRT), which can influence the balance of the vaginal microbiome.
  • Increases in sexual activity, or having sex with a new partner

In addition to peeing before and after sex, if sex is a trigger for you, the withdrawal (or pull-out) method can also help reduce the onset of recurrent vaginal infections.

There isn’t enough research out there about partner transmission of vaginal infections (but we’re getting there!)

The CDC has concluded that “there is no research to show that treating a sex partner affects whether or not a woman gets BV.” However, one recent study found that some penis-havers carry a natural bacteria on the skin of their penis that might trigger BV in some vagina-havers. 

Unfortunately, there is not much to be done about this as there is little to no research about the efficacy of partner treatment for BV. However, Coral looks forward to a world in which research about vaginas and other female health issues is prioritized in research since we could all benefit from knowing how to prevent recurring infections.

When it comes to sexual transmission of yeast infections, we do know that about 15% of penis-havers will develop an itchy rash on their penis after having sex with a woman with a yeast infection. It’s also possible for partners to pass yeast infections back and forth, so make sure you allow enough time for treatment to kick in before hopping back in the sack. 

There are many causes of painful sex, and you should know about them!

More mild painful penetrative sex is usually a result of lack of lubrication or adequate arousal response. Less commonly, it is caused by an STI, vaginal inflammation, postpartum issues, dips in estrogen, constipation, or endometriosis. More intense pain is typically due to infection, endometriosis or vaginal atrophy. 

Painful penetrative sex that persists for over six months is diagnosable by the DSM-5 and is categorized as a genito-pelvic pain disorder. Its cause is complex: it can be physical, psychological, or a combination of both. Genito-pelvic pain disorder is usually classified as either “lifelong” or “acquired,” meaning you’ve either always had pain or the pain came about at a certain point, respectively. This classification is important because the root cause is easier to determine after your doctor knows whether your pain is lifelong or acquired. 

The psychological element results from the anticipation of sex being the driver of the pain. Once anxiety builds up, muscles contract in the vaginal opening and walls. Over time, this can result in an intense phobia of pain resulting from tightening of the vaginal muscles and making penetration near impossible.

Over time, the pain becomes so intense that the problem tends to get worse unless treatment is sought. 

Aging affects the vagina in a variety of ways

Decreases in estrogen production as aging increases tend to result in a decrease in elasticity and thinner vaginal walls, which means a decrease in lubrication. But never fear: lube is always there for you. Lubricants like those from Cake can help with arousal as people with vaginas age. 

It’s possible for the color of your vulva to change as you get older. Vulvas vary in color from pinkish to dark brown, and UTIs can also increase with age.


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