A mom and her 2-year-old daughter are in the grocery store. The mother is a physician, and the father is a biologist, and together they’ve tried to teach their child the body parts – pretty typical information toddlers learn. So why was it so uncomfortable when, from the grocery store cart, among the cereals and canned goods and pasta sauces, the daughter joyously exclaims, “I have a vaginaaa!”?
The mom is conflicted. She wants to praise the girl for knowing her parts, but then again – oh my gosh, she said vagina in public!
Jeanne Conry, president of The American Congress of Obstetricians and Gynecologists says this anecdote she heard from a friend exemplifies a challenge she faces as an OB-GYN. “We’re torn with being scientists, being appropriate and educating, and then facing a Victorian background that says ‘it’s not proper to talk about this.’” Cue the OB-GYN exam rooms, where many women let it all out. She talks with patients about their relationships, sex lives, fears, and of course, the ins and outs of their vaginas and vulvas.
Maybe you only really think about (let alone discuss) your vagina in the OB-GYN room. Or maybe, like the aforementioned toddler, you have no qualms about loudly chatting about your vagina in the supermarket. Whatever your thoughts, feelings and comfort level on the topic, the health of the vagina and vulva shouldn’t be ignored. Knowing how to properly care for them on your own will help you be safer, healthier and a more empowered patient.
Below, Conry and Debby Herbenick, co-director of Indiana University’s Center for Sexual Health Promotion, share basic tips for keeping your vagina and vulva healthy.
Learn your lady parts. Not sure what the difference is between the vagina and the vulva? Can you identify the vestibule and inner and outer labias? It's common for many women to know very little about their genitals, says Herbenick, who is also the co-author of "Read My Lips: A Complete Guide to the Vagina and Vulva."
Understanding the vulva and vagina is not only important for communicating with a sexual partner, but also for communicating with your health care provider, she says. If something down there is in pain or uncomfortable, expressing specifics is more helpful than telling the nurse or doctor that your vagina hurts. For one, she'll have to figure out if you really do mean the vagina, which is often used to describe the vulva. (The vulva is your external genitals, while the vagina is actually the muscular tube connecting the vulva to the cervix of the uterus.) So right off the bat, you'll likely need to answer follow-up questions to clarify where you feel lousy in an OB-GYN exam room – a place where some women may already feel a bit vulnerable. There's nothing wrong with the follow-up questions, and chances are, the doctor or nurse will be able to identify the issue, but Herbenick says it's a barrier, "and why not teach women and girls the right words for their genitals?"
Look up a diagram of the vagina and vulva, and learn your parts if you don't already know them. However, note that everyone's vagina and vulva looks different, as discussed later. Don't expect to look exactly like diagrams.
Examine your vulva. Now that you're a vagina expert (or at least know the difference between the vagina and vulva), take a good look at yourself below the belt. In good lighting, remove your underwear and grab a hand mirror. Squat above the mirror, or prop yourself in front of it on the bed. Make a habit of examining your vulva about once a month, and "check for anything new or different about your genitals that you don't remember seeing before," Herbenick says, such as "new moles, lumps or bumps, or red or white patchy areas." If you notice any of these new developments, bring it up with a health care provider. Chances are, these occurrences don't indicate anything too major, but a health care provider can determine if they're precancerous, cancerous, a skin condition or possibly a sexually transmitted infection or disease, and begin treatment.
Say no to douche. Those prepackaged douches intended to clean the vagina contain water, along with vinegar, baking soda or iodine, according to the U.S. Department of Health and Human Services Office on Women's Health. They're also completely unnecessary. "Vaginas are self-cleaning body parts, and douching can offset the natural balance of them," Herbenick says. She points out that if you're using douche in an attempt to alleviate an existing problem, doing so can possibly cause further irritation and make finding the original issue harder for a health care provider to identify. Instead of douche, simply rinse your vulva with a handful of water.
Groom your own way (but be careful). To each her own when it comes to grooming or not grooming pubic hair, Herbenick says. Though, of course, be careful with that razor blade so close to your genitals. And if you're prone to ingrown hairs, consider waxing, she adds, although Conry says waxing has its own risks: "If someone waxes and everything goes fine, then they're really happy," Conry says. "It's when they start getting the folliculitis [inflammation of hair follicles], and those poor little hair follicles are not really happy with them. Then they're in for a lot of pain."
Be a well woman. Under the Affordable Care Act, annual well-woman exams is a covered benefit. Depending on your risk factors, The American College of Obstetricians and Gynecologists recommends cervical and breast cancer screenings, evaluation and counseling, immunizations and a breast exam. If you show symptoms or risk factors for trouble below the belt, then the health care provider will provide a pelvic exam and internal examination, too. If not, it's up to you if they look under the paper dress. Read more about the well-woman exam here.
If you're over age 21, Pap tests are also recommended to screen for cervical cancer. Make sure to talk to your physician about when you should be tested and how frequently.
Forget about "normal" vulvas. "We have women coming in, asking, 'Are my labia too big? Are my labia too small?'" Conry says, referring to the two folds of skin at the entrance of the vagina. Perhaps the most common questions patients ask her are about the appearance of their vulvas – if they're normal. The fact is there is no "normal" vulva, and while you may only be familiar with your own genitals, Conry sees about 30 a day and can attest that they come in all shapes, sizes and colors.
Not convinced? Conry suggests looking up the art installation named "The Great Wall of Vagina." (If you choose to Google it, consider your surroundings before clicking on the official website's photos tab.) The installation includes plaster casts of 400 different vulvas and aims to show just how unique our genitals are.
"Just as we are very, very diverse in our facial features and in so many other features," Cornry says, "there are a lot of different vulvas out there."