Five questions about your vulva you're too embarrassed to ask your doctor

24 July 2018

Many women can’t necessarily identify the different parts of their female anatomy, with many referring to their external sexual organ as their vagina. In fact, the external organs are known collectively as the vulva which includes the labia, clitoris and the opening of the vagina. The vagina itself is an internal flexible tube, about 8cm in length leading from the vulva to the cervix.

Consultant Gynaecologist, Miss Claire Bailey warns “women should be self-aware of their own female anatomy, especially as no two are the same.

"Women need to be aware of what is normal for them and to examine themselves regularly in order to spot any changes and know when something is not normal.”

Claire Bailey says “the main parts of the external genitalia that women should be aware of is their labia majora, labia minora, clitoris and the hood over the clitoris so they can be aware of any changes to the area.”

Here, she answers the questions that you may be too embarrassed or nervous to ask:

1. What is a normal size for the labia? 

The labia are the lips that sit around the outside of the vaginal opening. Just as the shape of our nose and ears varies from person to person, so do the size of our labia’s. 'Normal' labia's encompass a huge range in size and shape of labia minora. If my patients want reassurance I direct them to 'The Great Wall of Vaginas' which is a sculpture by Jamie McCartney of hundreds of real women's vulvas. Women can always find a vulva that looks similar to their own!

The only time it may be a cause for concern is if the size of your labia affects you from enjoying your normal activities, for example a larger labia may cause discomfort for a cyclist or horse rider.

Many NHS Trusts will no longer fund the surgery to reduce the size of the labia minora (called a labioplasty) as it is a cosmetic procedure so you will usually have to pay for the operation. I would not recommend labioplasty for teenagers because their bodies are still developing; both physically and psychologically.

2. Is it normal to have an itchy vagina/vulva? 

Itching of the vulva and vagina is a common complaint and is usually nothing to worry about. There are simple measures that can be taken that can help reduce vulval itching and irritation. These include;

  • avoiding soap and perfume products in the area, including feminine wipes
  • wear cotton underwear
  • loose clothing (avoid tight trousers and pyjamas)
  • avoid biological washing powders to underwear
  • where possible, avoid panty liners and pads.

If, despite these measures, your symptoms persist then see your doctor for advice.

Sometimes, a skin condition of the vulva can be the cause and it is important to self-examine so that you can identify any skin lesions, lumps or bumps. Should you notice any of these skin changes, you should get these checked out by your own doctor to exclude any skin disorders such as eczema and lichen sclerosis or, more rarely, a precancer of the vulva.

3. I think I have got thrush, what should I do?

Thrush is a yeast infection, usually caused by a fungal organism called Candida albicans. It is a common condition and both men and women can be affected. Thrush infections occur when the acid balance in the vagina alters. Signs of thrush infection are vulval and vaginal itching which is usually associated with a ‘cottage cheese-like’ vaginal discharge. There can be associated soreness, especially during sex.

Although thrush can occur at any time, it is particularly common if you are diabetic, pregnant or if you have taken a course of antibiotics. It is usually easily treated with anti-fungal cream and pessaries which can be bought over the counter. If your symptoms do not improve, despite the treatment, you should see your own doctor for advice. If you experience recurrent infections, your GP can take a swab from the lower vagina to confirm the cause of your symptoms is a thrush infection and ensure that you are prescribed the correct treatment.

4. I am worried about my vaginal discharge

Vaginal discharge is a common complaint, primarily because women do not like having a discharge as it makes them feel dirty. The fact is that producing vaginal discharge is normal (physiological) and is your body’s way of keeping the vagina clean and healthy.

Discharge is simply the mucus produced by the cervix and vagina. Discharge typically increases when you are pregnant, taking contraceptive hormones or when you ovulate (mid-cycle). Discharge can be sticky or runny but as long as it is white/clear and not foul-smelling it is nothing to worry about. It is worth noting though, that a rare cause of vaginal discharge is cervical cancer and you should ensure that you are up to date with your cervical smear tests.

If your discharge has changed and is green and offensive it should be assessed by your doctor or sexual health clinic. Chlamydia and gonorrhoea are common sexually transmitted infections that present with discharge that need treating with antibiotics. The discharge can be associated with pelvic pain, irregular vaginal bleeding and feeling generally unwell. Bacterial vaginosis is an infection that classically causes a discharge that has a ‘fishy’ smell.

If a sexually transmitted infection screening test is negative then your doctor can look for other causes of discharge. Sometimes, the mucus-producing cells from the lining of the cervix appear on the outer surface of the cervix. This is called an ectropion and is a normal finding in women, but can account for increased discharge as well as bleeding after sex. The only way to know whether you have an ectropion is to have a speculum examination (like when you have a smear test) so that your doctor can see the cervix. It is possible to treat an ectropion with a simple procedure in the outpatient setting.

Vaginal discharge usually (but not always) reduces after the menopause. Consequently, women feel dry and sore in the vagina and many older ladies have reported missing having a discharge!

5. Is it normal to experience vulval pain?

 Vulval pain can form part of a variety of disorders including skin conditions, pre-cancer of the vulva and neuralgia. Vulval pain is not normal and should be assessed by your doctor.

In the absence of any abnormalities on examination, vulval pain is termed vulvodynia. Pain is classically described as burning in nature and seems to be due to overactive nerve fibres in the vulva sending inappropriate messages to the brain.

Vulvodynia can be categorised according to when the pain occurs. If there is pain only when the area is touched e.g. During intercourse, inserting a tampon or riding a bike, then it is termed provoked vulvodynia. If the pain can occur at any time and without the vulva being touched then it is called unprovoked vulvodynia.

Vulval pain syndromes like vulvodynia should be referred to a specialist. Treatment will vary according to the type of vulvodynia but can include medicines (tablets and creams), physiotherapy, local injections and psychosexual counselling. Surgery to remove the skin around the opening of the vagina (a vestibulectomy) is rarely an appropriate option but has a role in managing some women with provoked vulvodynia.

As a rule of thumb, don’t be embarrassed, if you notice any lumps, bumps or changes to your vuvla then get checked out by your GP.

Q: How quickly could I have a consultation, and how much would it cost? 

A: It depends on the availability of the consultant you wanted to see, but we pride ourselves on getting you fast access to diagnosis and you can often get a consultation within 24/48 hours.

Q: If I need surgery, how quickly could I have it?

A: We have no waiting lists at Spire Parkway Hospital, but again it depends on the availability of the consultant you wanted, but as a guide, and subject to your pre-operation assessment, between one and two weeks. 

Q: I don’t have health insurance, can I self-pay? 

A: Yes, you can. Our self-pay team can talk you through this and explain the finance options that are available, should you wish to explore them. Click here to submit an enquiry online.

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