Page 5 2011 Winter
Vulval health and hygiene
Vulva or vagina?
Many women and girls refer to their genitals as their 'vagina' which is not technically correct. The correct term for the external female genitals is 'vulva'. The vagina is the muscular, internal cavity extending from the neck of the uterus (the cervix) to the external genitals.
Parts of the vulva include:
- mons pubis (pad of fatty tissue covered with pubic hair)
- labia majora (outer lips - covered with pubic hair)
- labia minora (inner lips - hairless)
- clitoris and its hood or covering (at the front of the genital area)
- vestibule (surrounds the vaginal opening and the urethral or urinary opening), containing the Skene's glands and Bartholin's glands
- urinary (urethral) opening
- vaginal opening (introitus)
- perineum (area of skin between vagina and anus)
- hymen (membrane of tissue around the vaginal opening)
Diagram of the parts of the vulva
Many women don't even know what their vulva looks like, because it is more hidden than the male genitals and can only be viewed clearly using a mirror. It's important that you know what your vulva looks and feels like normally, so that you can detect any changes early.
Each woman's vulva is unique in size, shape and appearance; variation between women is completely normal. You might notice a difference between the left and right sides of your vulva or your labia minora may protrude out further than your labia majora – this too is considered normal. The appearance of the vulva may change at different times throughout your life such as puberty, pregnancy and menopause.
The colour of a healthy vulva can vary from pink to brownish black, depending on ethnicity and skin tone. The pubic hair, which covers the mons pubis and labia majora and sometimes the inner thigh, perineum and anus, also varies in colour and thickness between individuals.
All women experience some vaginal discharge or secretions which help keep the vagina and vulva moist and remove bacteria and dead cells. Normal secretions vary throughout the menstrual cycle, from thin and slippery during ovulation to thick and white just before or after your period. It's common for discharge to be discoloured red or brown a day or two after your period.
It's normal for your vulva to have a scent that may vary at different times in your menstrual cycle. There are a number of different fluids and secretions associated with the vulva, including urine, sweat, menstrual blood, skin oils and vaginal and gland secretions.
What's not normal?
When you know what your vulva looks and feels like normally, it's easier to recognise when something is wrong. If you notice any changes, it is important to see a health professional for advice – don't let embarrassment or awkwardness hold you back.
Because the vulva's appearance changes during your life, it can be difficult to know which changes are normal and which are not. Changes in colour and texture of the vulval skin can indicate infections or irritations, especially if combined with symptoms such as itching, tenderness, swelling, burning, odour or unusual discharge. In particular, look for redness or whitening of the skin and changes in the skin texture (e.g. cracking, ulceration or scaly patches) as these are signs of a skin infection. Blistering or small lumps on the skin may be signs of a sexually transmissible infection (STI) such as genital herpes or genital warts. If in doubt, see your health professional.
Some vulval and vaginal infections cause a change in the colour, consistency and odour of secretions or discharge. Vaginal 'thrush' is an infection with the yeast Candida, which affects up to 75% of women at some point in their lives. It is characterised by itching, burning and stinging on urination and a thick white discharge with a lumpy 'cottage-cheese' appearance and a yeasty smell. Other types of discharge needing investigation include any foul-smelling or fishy discharge, or discharge that is green, yellow, or contains blood (apart from your period).
Although some vulval odour is normal, it should not be unpleasant, yeasty or fishy, as this is a sign of infection. Other causes of unpleasant odour may be STIs, a forgotten tampon, or the presence of urine or faeces. Sweat glands around the vulva can also affect genital odour.
Itching, burning, irritation, soreness, painful sex or urination, or abnormal bleeding should not be self-treated; they need to be correctly diagnosed by a health professional. If these symptoms persist after three months of treatment, you may need to be referred to a dermatologist or specialist gynaecologist.
Many women worry about vulval hygiene, and being 'clean and dry'. It is important to understand that some amount of vulval discharge is normal and necessary to maintain the slightly acidic environment of the healthy vagina which helps to prevent infections. Women should therefore avoid using soaps, shower gels or perfumed bath products on their vulva as these products can upset the natural acidic environment and can cause irritation. Douching (squirting soapy liquid into your vagina) is never recommended. Only wash your vulva in plain water or use a soap substitute. If you have a vulval irritation, you may find bathing in water with bicarbonate soda added (2 tablespoons in a basin/1 cup in a bath) offers relief. This can be used together with a treatment prescribed by your health professional.
Vulval hygiene tips
Women generally know they should check their breasts regularly but how many have done a vulval self-examination? A monthly check can help identify any changes to your vulva early, so you can seek medical advice sooner rather than later.
How and when to self-examine
What should I look for?
Q & A
Jean Hailes gynaecologists
I get a yellow discharge in between my periods - what is it?
During ovulation, you may notice an increase in secretions with a thin slippery consistency, like uncooked egg-white. This secretion will turn yellowy-brown when exposed to the air so it's normal to notice yellow stains on your underwear during the middle of your cycle.
I hate the way my vagina looks – can I have cosmetic surgery? What are the risks?
Many women worry that their vulva looks unattractive. Often this anxiety is caused by what they see in the media or social pressures to have a 'childlike' vulva. Remember, your vulva is unique – no two are alike, so it's unhelpful to compare yourself to (often digitally altered) images in the media or pornography. Whilst cosmetic surgery is an option, you should remember that surgical procedures have risks including infection, bleeding and scarring – and there's no guarantee that you will be happy with the result. Talk to your health professional, a counsellor and your partner (if you have one) before considering cosmetic surgery.
Are there any health risks or benefits to full Brazillian waxing? (removing all pubic hair) What about laser removal?
There are no medical reasons why you should or shouldn't remove your pubic hair – it's a personal decision. Waxing in general poses some potential risks including:
- Redness, bumps, inflamed skin
- Ingrown hairs
- Allergic reactions
- Sun sensitivity
- Burning, darkening, scarring
- Folliculitis (bacterial infection)
Laser hair removal is a medical procedure that removes unwanted hair using an intense, pulsating beam of light. Repeated treatments aim to permanently damage the hair follicle to stop hair regrowth. Risks include temporary irritation, scabbing or crusting and pigment changes to the skin.
If you choose to remove some or all of your pubic hair, ensure the practitioner follows proper hygiene practices and is accredited. For laser hair removal, choose a dermatologist or cosmetic surgeon with experience in laser hair removal, rather than a beauty therapist or other nonmedical personnel.
What's better for vulval health, tampons or pads?
Some women may experience irritation from wearing pads but in general, the choice to use pads or tampons is up to the individual. The important thing is to remember to change your pad or tampon regularly, every four hours or more frequently if needed.
The Australia and New Zealand Vulvovaginal Society www.anzvs.org
Better Health Channel www.betterhealth.vic.gov.au