V is for Vulva

Welcome to the A to Z of Sex. I’m Dr Lori Beth and I am your host.  We are working our way through the erotic alphabet one letter at a time.  Just a reminder this podcast deals with adult content, so if you don’t have total privacy, you might want to put on your headphones.  Today the letter is V and V is for Vulva.

Vulva comes from the Latin and means wrapping or outer covering.  Fittingly, vulva is the word for the external female sex organs.  Many people improperly refer to this as the vagina but the vagina is actually the internal canal.

The vulva actually includes many parts.   Vulva includes the mons which is the external mound.  It includes labia majora and minora – both sets of lips.   It includes the clitoris and the vestibular bulbs which are the bulbs of the clitoris.    Finally there are some glands in the area that are included as well as pubic hair (when there is any).

In many cultures, shame remains around the vulva.  So much so that many women are embarrassed as to how they look and undertake surgery to change the shape and look of the vulva.  Vulvas come in many shapes and sizes with many configurations.  Normal is really equally to heathy when we talk about vulvas rather than size or shape.  Despite this, many women feel incredibly uncomfortable looking at their own anatomy and so have a warped idea as to whether they are normal or not.  Given that in the west, the medical terminology used is pudenda membra which literally means ‘parts to be ashamed of’, it is no wonder that women find it hard to think about their vulva without shame.

In other cultures, the vulva has been and still is, worshipped as a symbol of the goddess.  In the Hindu religion, the vulva continues to be revered.

In Eastern and Southern Africa, labia stretching is practiced and it is believed to bring greater sexual satisfaction to both partners.   In some cultures, removal of pubic hair is seen as most attractive or necessary for hygiene.

Some people enjoy a variety of genital piercings for enjoyment. Some piercings can cause lots of enjoyment as the nerves are stimulated by the piercing as well.

Why is it important to distinguish between vagina and vulva?  Knowing the right terms for body parts enables women to take full ownership of their bodies.   If we don’t know the right terms, how do we express ourselves clearly with partners and our doctors?   It is essential to remember that many people need clitoral stimulation to reach orgasm and the clitoris is part of the vulva but not of the vagina.

Let’s talk a bit  about vulvar pain.  Pain can include burning, stinging, itching, stabbing and throbbing.  It can include rawness and irritation, problems with pressure.    Pain can be in one spot or come and go.   Sometimes it arises on it’s own and other times as a result of touch including: sexual activity, insertion of a tampon, rubbing from tight or form fitting clothing, sitting and even walking.

Causes of pain include: Infections:  Yeast and bacterial are most common and the pain can range from mild itching to severe throbbing and burning.  Herpes can also cause severe pain and itching.   

Pain can also be caused by damage to nerve endings which can happen in childbirth, sexual activity or by riding a bicycle or a horse.  Menopause can also cause swelling, inflammation, dryness and discomfort.

There is lots of treatment available for various of these conditions.  You have to feel comfortable talking with your doctor about any discomfort or pain that you have in and around your vulva.  For some women, tightness and chronic pain are an issue and physical therapy and sexual therapy can be extremely helpful.  Biofeedback has been used for vulvar pain to teach women to control the body’s response to pain triggers and also how to relax the pelvic floor.

Topical anaesthetics can be applied about 30 minutes before sexual activity will make the sore area numb so that pain is not experienced.  Of course if you cannot figure out where the pain is coming from or the whole area is painful, this will not work.

Pelvic floor therapy can help to relax the pelvis and relieve pain and tension.

Nerve blocks can be effective for someone who has so much pain that it is interfering with daily life. 

It’s also useful to consider avoiding fragranced products around the vulvar area.  Some women develop allergies that lead to itching and pain.   

When pain is not from a specific cause and it has lasted more than three months, it is considered vulvodynia. 

The advice about vulvar pain and itching in menopause can be conflicting.  Sources are clear that the drop in oestrogen causes the changes in the vulva.  Some suggest that dryness is the main cause and suggest lots of lubrication during sexual activity but also on a daily basis.    

Pain can be caused by shrinkage in the tissues and less flexibility.  This will not resolve with lubrication.  This can resolve by careful stretches, work on pelvic floor muscles for relaxation.  Gentle sex can help over time but if it is too painful to endure any kind of penetration, alternatives to penetrative sex need to be built into your sexual life if they are not already present.

In parts of Africa and the Middle East, female genital mutilation is performed.  One form of FGM is a clitoridectomy which is partial or total removal of the clitoris.  A second form involves the partial or total removal of the clitoris and the labia minora.  The third form is infibulation which involves narrowing the vaginal opening.  This is done by cutting and repositioning the inner or outer labia and often also involves removal of the clitoris.  These procedures are often not done medically and have a wide variety of devastating effects including haemorrhage and sepsis which can lead to death.  Long term women can become infertile or find that labour is incredibly difficult or suffer from fistula and other conditions.

FGM is used to curb sexual desire in these cultures though it is acknowledged that even doing this does not always eliminate sexual desire.  Many communities have a specific time during the year when girls who have reached the age undergo these rituals which they are told transform them into women and prepare them for marriage.

Labiaplasty and other forms of cosmetic surgery have become far more popular in the past 10 years.  Though many people see this as extremely different from FGM, in fact there are some similarities. 

The biggest difference is that FGM is non-consensual – usually performed on girls who are too young to consent and cosmetic surgery is performed on adults who give informed consent.  Modern surgery is also done safely in a sterile environment where as FGM is usually not done this way.

The similarity is that they are both the result of cultural pressure about how female genitalia should look, operate, feel.  There is lots of social pressure to undergo surgery that is similar to the social pressure for FGM. 

Surgery in the west is done to improve sexual desirability.  The norms being sought are entirely cultural.   Often the possible complications are not considered.  The area is rich with nerves and there is a risk of nerve damage.  It is a small risk but having no feeling in that area can cause significant ongoing upset. 

Angie wrote in and said ‘My partner and I watch lots of pornography together and we enjoy it very much.  Recently I have become worried about the way my vulva looks as all the actresses seem to have a much tidier look to their lady parts.   Should I consider surgery?’ 

Thanks for writing in Angie.  As I said earlier, there is no one normal size or shape for a vulva.    If you are concerned that your partner is finding you less attractive because of your size and shape, have a full and frank conversation with them before even considering undergoing a surgical procedure.    There are always risks with surgery including ones to do infection, nerve damage, anaesthesia reaction, and slow healing. 

If you are unable to increase your confidence by talking with your partner and exploring this area with a coach, then carefully consider all the pros and cons of surgery.  Sometimes people rely on surgery as the cure to feeling unattractive or a lack of self-confidence.  In my experience, surgery on its own  rarely resolves these issues so think carefully and take advice before undergoing surgery.

Robin wrote in ‘I am 60 years old and sex now hurts.  I have tried all sorts of creams, ointments, lubes but nothing has worked.  What can you advise?’ 

Thanks for writing in Robin.  Painful sex can arise for a variety of reasons.  You didn’t say how long your problem has been going on.  If you have been having painful sex for more than a month, it would be worthwhile to have an appointment with your doctor to try to diagnose what is causing the painful sex.    There are a variety of treatments available that can help a lot depending upon the cause of the pain. 

If talking to the doctor feels embarrassing,  take a deep breath and focus on the problem.  Your doctor has heard many different problems and should treat you with respect and care.   

As for self-help, consider engaging in non-penetrative sex and see if that is less painful. 

Leo wrote in and said ‘My girlfriend gets embarrassed when I stroke her vulva and all the parts of her vulva.  She always seems to want to quickly move me on to penetration.   Is there anyway I can slow her down?’ 

Thanks for writing in Leo.   First talk with your girlfriend about her embarrassment.  Reassure her that you find all of her exciting.  Make sure that the reason that she is moving you away isn’t that your touch is feeling painful, or tickling and not in a good way.  Once she agrees, start slowly and ask what feels good and what does not.  You might even ask her to show you how she touches herself.    If you show her how much you want to please her and how much you enjoy her, you are likely to be successful.

Thanks for joining me for the A to Z of Sex this week. Write to me with suggestions for the show, questions you want answered at drloribeth@atozofsex.com , follow me on twitter, Instagram and Facebook.

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