More often than not, euphemisms are used to describe female genitals. I won’t list them, but they are numerous and, let’s say, colourful.
Some are babyish terms parents use when talking to children. Others are schoolyard slang that, oddly, remain in common usage.
I’ve lost count of the times people have come into my busy north London surgery telling me they’re itchy or sore ‘down there’. And even doctors I know will end up using the catch-all ‘private parts’.
While these words may feel more palatable, or perhaps less embarrassing than ‘vulva’ and ‘vagina’, they’re not really helpful.
A case in point – an astonishing 73 per cent of women don’t actually know the difference between these two distinct anatomical areas, according to one recent survey.
And if we can’t name things properly, accurately and without shame, it only adds to the stigma and misunderstanding around women’s most intimate health issues.
And things do go wrong. This is because down there everything is close together – urethras (the tube that passes urine out from the bladder) are short and in close proximity to our vulvas and rectums. This means that, sometimes, the female anatomy can be its own worst enemy. It can be hard to know where the symptoms are coming from, particularly if they include pain or itching.
More often than not, euphemisms are used to describe female genitals, such as flower or petal. I won’t list them all, but they are numerous and, let’s say, colourful
Dr Philippa Kaye, author and GP with a particular interest in women’s and sexual health, puts together her ultimate guide for what could go wrong with your reproductive system and how you can sort it
Yet women all too often put up with it – enduring everything from painful sex to recurring infections or bleeding.
I’m here to tell you there is no need for this. There’s usually a straightforward solution, so read on for my ultimate guide…
PAINFUL SEX DOES NOT HAVE TO BE ENDURED
Up to 80 per cent of all women will develop a condition known as genitourinary syndrome of the menopause, or GSM, as they reach mid-life – causing symptoms such as itching, dryness and painful sex.
Also known as vaginal atrophy, it happens when levels of the hormone oestrogen reduce, causing the tissues of the vagina and vulva to become thinner and drier.
It can cause a burning sensation that makes even sitting down painful, a stinging or burning pain when urinating.
It can also diminish libido because sex becomes more difficult and increases the risk of urinary tract infections.
But it is NOT an inevitable part of ageing or something you should just accept.
Using vaginal oestrogen can be life-changing. It acts only on the local tissues and is not absorbed into the rest of the body like HRT, which means it can be used safely by most women, including those who have had breast cancer.
YOU CAN GET VARICOSE VEINS IN YOUR VULVA
Like the swollen blue or purple veins that can protrude in legs, varicose veins can also form on the outer surface of the vulva.
Known as vulvar varicosities, they are more likely to occur if you are pregnant, as hormone changes can relax the walls of the veins, making them more susceptible to twisting. They can cause discomfort if you are standing for long periods of time, or during penetrative sex.
Being overweight, or sitting down for long periods, can also increase the risk.
They largely resolve by themselves within six weeks after giving birth, but you can relieve symptoms by putting your feet up, wearing compression stockings or applying a cool compress to the area.
YES, YOUR CLITORIS CAN SHRINK, BUT DON’T PANIC
Clitoral atrophy is when the clitoris – a button-like sensitive area – stops responding to stimulation and begins to shrink.
This can be caused by hormonal changes linked to the menopause, lichen sclerosus (see below), a lack of blood flow to the area and a lack of use.
So this is your sign to engage in regular stimulation to preserve it, which will improve blood flow to the area. You could try using toys, which can be bought discreetly online, or vaginal oestrogen, which can be applied not just in the vagina but all over the vulva too.
Anything that will improve your blood supply around the body more generally will also help – so exercise more and don’t smoke.
WHITE PATCHES LINKED TO VULVAl CANCER
If you find white patches on your genitals it might be lichen sclerosus – an inflammatory condition that causes tremendous itching and discomfort. It isn’t contagious or sexually transmitted, but the pain it causes when urinating or having sex can have a huge impact on daily lives and relationships.
The skin might look very smooth, almost shiny, and may even bleed when touched. It can also cause the entrance to the vagina to narrow due to the chronic inflammation triggering the formation of scar tissue.
Treatment involves high-strength steroids and emollient creams, but if skin changes don’t improve, or any thickening or ulceration lasts for more than two weeks, you should go back to your GP, as a referral to a specialist dermatologist may be needed.
Aside from the impact on quality of life, one in 20 cases develops into vulval cancer.
Why this happens isn’t clear – lichen sclerosus is thought to be an autoimmune condition, in which the body mistakes the skin for foreign tissue and attacks it.
Things do go wrong. This is because down there everything is close together – urethras are short and in close proximity to our vulvas and rectums. This means sometimes the female anatomy can be its own worst enemy
Around one in five women with the condition is likely to also have another autoimmune disease.
But 60 per cent of cases of vulval cancer occur in women with lichen sclerosus – so it’s important to get it treated, and to get any lingering issues checked out.
THE MYSTERY PAIN WITHOUT A CAUSE
Sometimes women have a chronic pain in the vulva that doctors can’t explain and has no obvious cause. Called vulvodynia, it is thought to affect around 16 per cent of women at some point in their lives and might feel like a burning or throbbing sensation. It can be chronic or intermittent.
For some women, it means they struggle to have sex, use tampons, cycle or even sit down for too long.
There are no official figures on how many are affected because few seek help and there are no obvious outward signs.
But symptoms can be managed, and treatment might include pelvic floor exercises, painkillers and talking therapies.
Vulvodynia can also trigger another condition called vaginismus, which causes the vagina to tighten or spasm when attempting penetrative sex or inserting a tampon. Other triggers include painful conditions such as thrush or lichen sclerosus, or previous sexual abuse.
Again, there are things we can do to help ease the symptoms, including the use of vaginal dilators and sexual counselling.
COMMON INFECTIONS You SHOULDN’T IGNORE
IT’S completely normal to have vaginal discharge, and it doesn’t mean you’re dirty, smelly or disgusting. In fact, it’s all part of your vagina’s self-cleaning mechanism, which helps protect against infection.
Generally it’s clear or milky and can be thinner and more ‘elastic’ – slippery and stretchy – around ovulation, and thicker and stickier as your period approaches.
But if it changes colour or develops a smell – anything that is not normal for you – then it might indicate a problem.
If it starts looking like cottage cheese, causes an intense itch and smells yeast-like, it may be a sign of thrush – an overgrowth of a fungus called candida.
Three in four women will experience thrush in their lifetimes, and six per cent suffer repeatedly. Over-the-counter creams, pessaries and tablets can treat it, but see your GP if it doesn’t improve.
If it turns green and frothy you might need antibiotics to treat a sexually transmitted infection (STI) called trichomonas vaginalis, which is caused by a tiny parasite. Green or yellow discharge can also indicate other STIs such as gonorrhoea and chlamydia, which require antibiotics.
A strong fishy smell and thin, grey discharge could indicate an overgrowth of bacteria called bacterial vaginosis, which is very common. You can treat it by inserting a gel, or take a one-off dose of antibiotic metronidazole.
DON’T DISMISS UNUSUAL BLEEDING
Blood-stained discharge can be a sign of an STI such as chlamydia or gonorrhoea, and might also indicate a cervical polyp – a common and benign growth on the wall of the cervix.
But if you are bleeding between periods, or after the menopause, this should always be checked out because of the risk of cancer.
Womb cancer, which affects about 10,000 women a year in the UK and is most commonly diagnosed between the ages of 50 and 74, is usually picked up because it causes abnormal bleeding. And both vulval cancer – which is rarer, affecting 1,400 women a year – and vaginal cancer lead to bleeding as one of the early symptoms.
Vulval cancer can cause persistent itching and changes to the skin, including patches that are redder, paler or darker than usual, or a sore and ulcerated area.
Vaginal cancer may also cause itching, alongside skin changes or ulcers in or around the vagina.
Having these symptoms does not necessarily mean you have cancer, but it does mean you should get them checked out.
LUMPS AND BUMPS THAT MIGHT NEED SURGERY
There are lots of causes of lumps or bumps on the vulva, and most of them are harmless or easy to treat.
Fordyce spots are very small clusters of white, creamy or yellowish spots that can occur on the vulva and inside the labia – these are benign, and are simply visible sebaceous glands that produce an oily substance called sebum to lubricate the skin and hair.
Sometimes these, and ingrown hairs in and around the genitals, can turn into sebaceous cysts, which may need draining and antibiotics if they become infected or swollen.
Other lumps can be caused by STIs. Genital warts – small lumps that group together to look a bit like cauliflower – can feel rough and might be the same colour as the surrounding skin or slightly darker.
Caused by the human papillomavirus (HPV) – which is also linked to cervical cancer – they sometimes disappear on their own, but may need treatment including prescription creams or cryotherapy to freeze them off.
Herpes infection leads to small, fluid-filled blisters that cause a tingling sensation, itching or burning pain and, while there is no cure, antiviral medication can treat outbreaks and prevent recurrences.
But an infection in the Bartholin’s glands can prove more problematic. These glands are pea-sized nubs found on either side of the vulva near the vaginal opening which produce secretions to help lubricate it.
Sometimes a fluid-filled cyst called a Bartholin’s cyst can develop in the gland. This causes a soft lump which might make the labia look more asymmetrical than usual and could cause pain when sitting down.
Soaking in a warm bath every day may help it drain, but if it becomes infected it can cause a Bartholin’s abscess – a very painful swelling that can also make you feel unwell.
See your GP – it will need antibiotics and possibly surgical treatment to drain it and prevent it from returning.
A USER’S GUIDE – WITH HELP FROM A MIRROR – AS TO WHAT’S ‘DOWN THERE’
A few years back, Gwyneth Paltrow discovered she didn’t know what a vagina is.
Given that the Oscar-winning actress turned wellness guru famously sold a scented candle in her Goop store called This Smells Like My Vagina, this was something of a shock.
But in an episode of her TV show The Goop Lab, entitled The Pleasure Is Hers, she’s corrected by the late feminist sex educator Betty Dodson for incorrectly referring to the vulva as ‘the vagina’.
A few years back, Gwyneth Paltrow discovered she didn’t know what a vagina is (Pictured in January at a screening for her show The Goop Lab)
Given that the wellness guru famously sold a scented candle in her Goop store called This Smells Like My Vagina (pictured), this was something of a shock
Gwynnie is taken aback: ‘I thought the vagina was the whole thing?’ Well, it’s not. The vulva is the external female genitalia, while the vagina is the muscular internal tube inside (to help you remember the difference, it contains the word ‘in’).
The vulva includes the labia, two sets of skin folds that protect the opening of the vagina, which is below the urethral opening (where urine comes out).
The labia majora are the fatty outer lips that have hair on them, while the labia minora are the thinner, inner lips that encapsulate the clitoris.
No two vulvas look the same – from asymmetric labia to inner lips that hang down further than the outer set, it’s all normal.
None of this is particularly visible if a woman is standing and you’re looking front on, although you can see the mons pubis – a pad of soft, hair-covered skin that covers the pubic bone.
The easiest way to look at your genitals is by using a mirror (you might also need a light)– and I recommend you do.
After all, if you don’t know what they look like normally, you won’t be able to recognise if something changes.
