In mammals, the vulva (: vulvas or vulvae) comprises mostly external, visible structures of the female sex organ leading into the interior of the female reproductive tract. For humans, it includes the mons pubis, labia majora, labia minora, clitoris, vulval vestibule, urinary meatus, vaginal introitus, hymen, and openings of the vestibular glands (Bartholin's and Skene's). The folds of the outer and inner labia provide a double layer of protection for the vagina (which leads to the uterus). Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.
Blood supply to the vulva comes from the three pudendal arteries. The internal pudendal veins give drainage. Afferent lymph vessels carry lymph away from the vulva to the inguinal lymph nodes. The nerves that supply the vulva are the pudendal nerve, perineal nerve, ilioinguinal nerve and their branches. Blood and nerve supply to the vulva contribute to the stages of sexual arousal that are helpful in the reproduction process.
Following the development of the vulva, changes take place at birth, childhood, puberty, menopause and post-menopause. There is a great deal of variation in the appearance of the vulva, particularly in relation to the labia minora. The vulva can be affected by many disorders, which may often result in irritation. Vulvovaginal health measures can prevent many of these. Other disorders include a number of infections and vulvar cancer. There are several vulval restorative surgeries known as genitoplasty, and some of these are also used as cosmetic surgery procedures.
Different cultures have held different views of the vulva. Some ancient religions and societies have worshipped the vulva and revered the female as a goddess. Major traditions in Hinduism continue this. In Western societies, there has been a largely negative attitude typified by the medical terminology of pudenda membra, meaning parts to be ashamed of. There has been an artistic reaction to this in various attempts to bring about a more positive and natural outlook. While the vagina is a separate part of the anatomy, it has often been used synonymously with vulva.
The grooves between the labia majora and minora are called the interlabial sulci, or interlabial folds. The labia minora meet posteriorly as the frenulum (fourchette).
The ilioinguinal nerve originates from the first lumbar nerve and gives branches that include the anterior labial nerves, which supply the skin of the mons pubis and the labia majora.
Researchers from the Elizabeth Garret Anderson Hospital, London, measured multiple genital dimensions of 50 women between the ages of 18 and 50, with a mean age of 35.6:
Clitoris length (mm) | 5.0–35.0 | 19.1 8.7 |
Clitoral glans width (mm) | 3.0–10.0 | 5.5 1.7 |
Clitoris to urethra (mm) | 16.0–45.0 | 28.5 7.1 |
Labia majora length (cm) | 7.0–12.0 | 9.3 1.3 |
Labia minora length (mm) | 20–100 | 60.6 17.2 |
Labia minora width (mm) | 7.0–50.0 | 21.8 9.4 |
Perineum length (mm) | 15.0–55.0 | 31.3 8.5 |
length (cm) | 6.5–12.5 | 9.6 1.5 |
Tanner scale ( n) | IV | 4.0 (8%) |
V | 46 (92%) | |
Color of the genital area compared to the surrounding skin ( n) | Same color | 9 (18%) |
Darker color | 41 (82%) | |
Rugosity of the labia ( n) | Smooth (unwrinkled) | 14 (28%) |
Moderately wrinkled | 34 (68%) | |
Markedly wrinkled | 2 (4%) |
At the same time, a pair of swellings on either side of the urethral folds known as the genital swellings develop into the labioscrotal swellings. Sexual differentiation takes place, and at the end of week six in the female, hormones stimulate further development and the genital tubercle bends and forms the clitoris. The urogenital sinus persists as the vulval vestibule, vestibular glands and urethra. The Urogenital folds form the labia minora and the labioscrotal swellings form the labia majora.
The uterovaginal canal or genital canal, forms in the third month of the development of the urogenital system. The lower part of the canal is blocked off by a plate of tissue, the vaginal plate. This tissue develops and lengthens during the third to fifth months and the lower part of the vaginal canal is formed by a process of desquamation or cell shedding. The end of the vaginal canal is blocked off by an endodermal membrane, which separates the opening from the vestibule. In the fifth month, the membrane degenerates but leaves a remnant called the hymen.
Apocrine sweat glands secrete sweat into the pubic hair follicles. This is broken down by bacteria on the skin and produces an odor, which some consider to act as an attractant sex pheromone. The labia minora may grow more prominent and undergo changes in color. At puberty, the first monthly period known as menarche marks the onset of menstruation.
A number of different secretions are associated with the vulva, including urine (from the urethral opening during urination through control of the external sphincter muscle), sweat (from the apocrine glands), Menstruation (leaving from the vagina via the introitus), sebum (from the ), alkaline fluid (from the Bartholin's glands), mucus (from the Skene's glands), vaginal lubrication from the vaginal wall and smegma. Smegma is a white substance formed from a combination of dead cells, skin oils, moisture and naturally occurring bacteria, that forms in the genitalia. In females, this thickened secretion collects around the clitoris and labial folds. It can cause discomfort during sexual activity as it can cause the clitoral glans to stick to the hood, and is easily removed by bathing. Aliphatic acids known as copulins are also secreted in the vagina. These are believed to act as . Their fatty acid composition, and consequently their odor changes in relation to the stages of the menstrual cycle.
Sexual arousal results in a number of physical changes in the vulva. During arousal, the Bartholin's glands produce more vaginal lubrication. Vulval tissue is highly blood vessel; arterioles dilate in response to sexual arousal and the smaller veins will compress after arousal, so that the clitoris and labia minora increase in size. Increased vasocongestion in the vagina causes it to swell, decreasing the size of the vaginal opening by about 30%. Clitoral erection takes place, which retracts the clitoral hood, causing the glans to appear. The labia majora have swollen from blood flow, and slightly separated, revealing a thick and engorged labia minora.
During orgasm, rhythmic muscle contractions occur in the outer third of the vagina, as well as the uterus and anus. Contractions become less intense and more randomly spaced as the orgasm continues. The number of contractions that accompany an orgasm vary depending on its intensity. An orgasm may be accompanied by female ejaculation, causing liquid from the Skene's glands to be expelled through the urethra. The pooled blood begins to dissipate, although at a much slower rate if an orgasm has not occurred. The vagina and its opening return to their normal relaxed state, and the rest of the vulva returns to its normal size, position and color.
Bacterial infections include: chancroid – characterised by known as ; granuloma inguinale showing as inflammatory often described as nodules; syphilis –the primary stage classically presents with a single chancre, a firm, painless, non-itchy ulcer, but there may be multiple sores; and gonorrhea that very often presents no symptoms but can result in discharge.
include human papillomavirus infection (HPV) – this is the most common STI and has many types. Genital HPV can cause . There have been links made between HPV and vulvar cancer, though HPV most often causes cervical cancer. Genital herpes is mostly asymptomatic but can present with small that break open into . HIV/AIDS is mostly transmitted through sexual activity, and the vulva in some cases can be affected by sores.
A highly contagious viral infection is molluscum contagiosum, which is transmissible on close contact and causes water .
Parasitic infections include trichomoniasis, pediculosis pubis, and scabies. Trichomoniasis is transmitted by a parasitism protozoan and is the most common non-viral STI. Most cases are asymptomatic but may present symptoms of irritation and a discharge of unusual odor. Pediculosis pubis, commonly called crabs, is a disease caused by the crab louse an ectoparasite. When the pubic hair is infested, the irritation produced can be intense. Scabies, also known as the "seven year itch", is caused by another ectoparasite, the mite Sarcoptes scabiei, giving intense irritation.
Medical sign and symptoms of vulvar cancer can include: pruritis, or hemmorage; skin changes including rashes, sores, lumps or ulcers, and changes in vulvar skin coloration. Pelvic pain might also occur especially during urination and sex. However, a significant proportion remains asymptomatic in early disease stages, often delaying its diagnosis. As such, 32% of women with vulvar melanoma already have regional involvement or distant metastases at the time of diagnosis, which significantly impacts prognosis.
Surgery (with or without removal of regional lymph nodes) is usually the primary treatment modality. Typically, a wide-local excision is performed, in which the tumor is excised including a safety-margin of healthy tissue to ensure its entire removal, which is confirmed by a pathologist. In more advanced disease, a (partial) vulvectomy may need to be performed in order to remove some or all of the vulva. Advanced-stage melanomas can be treated with checkpoint inhibitors.
Clitoromegaly is an enlarged clitoris caused by either or an intersex condition.
Vulvodynia is chronic pain in the vulvar region. There is no single identifiable cause. A subtype of this is vulvar vestibulitis but since this is not thought to be an inflammatory condition it is more usually referred to as vestibulodynia. Vulvar vestibulitis usually affects pre-menopausal women.
Pudendal nerve entrapment can cause sharp pain or numbness in the vulva. This condition can be caused by activities such as cycling, giving birth, or prolonged sitting.
A number of skin disorders such as lichen sclerosus, and lichen simplex chronicus can affect the vulva. Crohn's disease of the vulva is an uncommon form of metastasis Crohn's disease, which manifests as a skin condition showing as hypertrophy lesions or vulvar . Papillary hidradenomas are nodules that can ulcerate and are mostly found on the skin of the labia or of the interlabial folds. Another more complex ulcerative condition is hidradenitis suppurativa, which is characterised by painful cysts that can ulcerate, and recur, and can become chronic lasting for many years. Chronic cases can develop into squamous cell carcinomas. An asymptomatic skin disorder of the vulval vestibule is vestibular papillomatosis, which is characterised by fine, pink projections from either the epithelium of the vulva or from the labia minora. Dermatoscopy can distinguish this condition from genital warts. A subtype of psoriasis, an autoimmune disease, is inverse psoriasis in which red patches can appear in the of the labia.
The use of cosmetic surgeries has been criticized by clinicians. The American College of Obstetricians and Gynecologists recommends that women be informed of the risks of these surgeries. They refer to the lack of data relevant to their safety and effectiveness and to the potential associated risks such as infection, altered sensation, dyspareunia, adhesions, and . There is also a percentage of people seeking cosmetic surgery who may be suffering from body dysmorphic disorder and surgery in these cases can be counterproductive.
In some cultures, including modern Western culture, women have shaved or otherwise hair removal from part or all of the vulva. When high-cut swimsuits became fashionable, women who wished to wear them would remove the hair on either side of their pubic triangles, to avoid exhibiting pubic hair. Other women prefer to retain their vulva hair. The removal of hair from the vulva is a fairly recent phenomenon in the United States, Canada, and Western Europe, usually in the form of bikini waxing or Brazilian waxing, but has been prevalent in many Eastern European and Middle Eastern cultures for centuries, usually due to the idea that it may be more hygienic, or originating in prostitution and pornography. Hair removal may include all, most, or some of the hair.Helen Bickmore; Milady's Hair Removal Techniques: A Comprehensive Manual; Thomson Delmar Learning; 2003; French waxing leaves a small amount of hair on either side of the labia or a strip directly above and in line with the pudendal cleft called a landing strip. Islam teaching includes Muslim hygienical jurisprudence a sunnah of which is the removal of pubic hair.
Several forms of can be made in the vulva, and include the Christina, Princess Albertina, Isabella, Nefertiti, fourchette, and . Piercings are usually performed for aesthetic purposes, but some forms like the clitoral hood piercing (or rarely glans piercing) might also enhance pleasure during sex. Though they are common in traditional cultures, intimate piercings are a fairly recent trend in Western society. Other forms of permanent modifications of the vulva for cultural, decorative or aesthetic reasons are genital tattoos or scarification (so-called "Hanabira").
Female genital surgery includes laser resurfacing of the labia to remove wrinkles, labiaplasty (reducing the size of the labia) and vaginoplasty. In September 2007, the American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion on these and other female genital surgeries, including "vaginal rejuvenation", "designer vaginoplasty", "revirgination", and "G-spot amplification". This opinion states that the safety of these procedures has not been documented. The ACOG and the ISSVD recommend that women seeking these surgeries need to be informed about the lack of data supporting these procedures and the potential associated risks such as infection, altered sensation, dyspareunia, adhesions, and scarring.
With the growing popularity of female cosmetic genital surgeries, the practice increasingly draws criticism from an opposition movement of Cyberfeminism activist groups and platforms, called the labia pride movement. The major point of contention is that heavy advertising for these procedures, in combination with a lack of public education, fosters body insecurities in women with larger labia in spite of the fact that there is normal and pronounced individual variation in the size of labia. The preference for smaller labia is a matter of a fashion fad and is without clinical or functional significance.
FGM/C can have harmful effects on their physical and mental health. Various official and unofficial research reports also confirm these complications. In its various reports, the World Health Organization has considered FGM/C as an action that endangers women's health in various ways. This organization stated in a report published in January 2023 that FGM/C has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and it interferes with the natural functions of girls' and women's bodies. Although all forms of FGM/C are associated with increased risk of health complications, the risk is greater with more severe forms of FGM/C.
The American National Library of Medicine also stated in an article in 2018 that the consequences of FGM/C have both physiological and psychological complications, including short- and long-term complications. The method in which the procedure is performed may determine the extent of the short-term complications. If the process was completed using unsterile equipment, no antiseptics, and no antibiotics, the victim may have increased risk of complications. Primary infections include staphylococcus infections, urinary tract infections, excessive and uncontrollable pain, and hemorrhaging. Infections such as human immunodeficiency virus (HIV), Chlamydia trachomatis, Clostridium tetani, and herpes simplex virus (HSV) 2 are significantly more common among women who underwent Type 3 mutilation compared with other categories.
Some major Hindu traditions such as Shaktism, a goddess-centered tradition, revere the vulva and vagina under the name yoni.
Sheela na gigs are figurative carvings of naked women displaying an exaggerated vulva. They are found in ancient and medieval European contexts. They are displayed on many churches, but their origin and significance is debatable. A main line of thinking is that they were used to ward off evil spirits. Another view is that the sheela na gig was a divine assistant in childbirth.
L'Origine du monde ( Origin of the World), painted by Gustave Courbet in 1866, was an early Realist painting of a vulva that only became exhibited many years later. The painting was commissioned by Ottoman Empire diplomat Halil Şerif Paşa. The woman used as the model for the painting was probably Halil's lover Constance Quéniaux. However, another potential model is Marie-Anne Detourbay, who was also a lover of Halil Şerif Pasha.
Japanese sculptor and manga artist Megumi Igarashi has focused much of her work on painting and modelling vulvas and vulva-themed works. She has used molds to create – three-dimensional models of her vulva with the hope of demystifying the female genitals.
An Installation art called The Dinner Party by , Judy Chicago, portrays a symbolic history of famous women. The dinner plates each depict an elaborate vulval form and they are arranged in a triangular vulva shape. Another installation was made by British artist Jamie McCartney who used the casts of four hundred vulvas to create The Great Wall of Vagina in 2011. The casts are life-size. Explanations written by the project's sexual health adviser accompany these. The purpose of the artist was to "address some of the stigmas and misconceptions that are commonplace".
As a rule, only the external female genitals of placental mammals are referred to as the "vulva", although the term is also used in the scientific literature for functionally comparable structures in other animal groups such as marsupials and roundworms (Nematoda).E. Szabó, B. Hargitai, A. Regos u. a.: "TRA-1/GLI controls the expression of the Hox gene lin-39 during C. elegans vulval development". In: Developmental Biology. Vol. 330, no. 2, 2009, pp. 339–348. .
For comparison, , , , and have a cloaca. An organ system like a vulva does not exist.
The vulva of a placental consists of the following along with its variations:
During estrus, the clitoris of a mare (female horse) everts as the labia contracts by opening and closing. This is colloquially known as "winking". Throughout the menstrual cycle, some female ' vulvar and anal regions will swell (sexual swelling) to attract a male, though the fundamental reason for this function is up for debate.
The vulva of a spotted hyena has a large clitoris known as a pseudo-penis for copulating, giving birth and urinating, as well as fused labia (pseudo-scrotum). This can make it difficult to correctly Sexing the species.
==Additional images==
Clinical significance
Irritation
Sexually transmitted infections
Cancer
Other
Childbirth
Surgery
Society and culture
Altering the female genitalia
Female genital mutilation
Etymology
Terminology
Religion and art
Other animals
See also
External links
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