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If you sat down, spread open your legs, and pulled out a hand mirror, would you be able to name what you saw? Seems like a silly question — but there’s a common mistake most people make.
“99% of the time, if someone says ‘my vagina,’ they actually mean their vulva,” says board-certified OB/GYN Dr. Staci Tanouye.
Do you think you know the difference? And why does it matter? Dr. Tanouye helps us understand.
What is the vulva?
“Everything you can see, touch, externally is the vulva,” says Dr. Tanouye.
The vulva is the external genital area for people assigned female at birth. The vulva encompasses:
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The mons pubis: Rounded area at the public bones and covered in hair at puberty
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The labia majora: Outer folds of skin in the genital area
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The labia minora: Inner folds of skin in the genital area
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The clitoris: Sensitive tissue beneath the mons pubis that swells up when stimulated
Inside the labia minora is the vestibule, which is the tissue that connects the vulva to the vagina and urethra.
What is the vagina?
“Everything internal, that gets inserted in any way, shape, or form, everything internal is vagina,” explains Dr. Tanouye.
The vagina is a tube-like structure that leads from the uterus to the outside of the body. The cervix is a small organ that connects the vagina to the uterus.
Vulva vs. vagina: Why does knowing the difference matter?
“Although [the vulva and vagina] are part of the same reproductive system, they are treated a bit differently in terms of how we care for them, and the health, and what they can do for themselves, and the environment that we have to maintain,” explains Dr. Tanouye. “We have to add in vulva so we know both [terms], and we know the differences between the two.”
7 things to know to stay on top of your vulvovaginal health
1. The vagina is self-cleaning.
“The vagina is completely self-cleaning,” says Dr. Tanouye, “so you need nothing to clean or maintain your vaginal health if you're doing fine at baseline.”
Vaginal discharge enables the vagina to shed vaginal mucus, cervical mucus, and exfoliated cells. “That’s your cleaning mechanism,” explains Dr. Tanouye. You don’t need to do anything to clean your vagina, including douching or using other inserted hygiene products.
The vulva is a little different. The vulva “needs some gentle cleaning, but it doesn't need any fancy products,” says Dr. Tanouye. “It really just needs water.” For those who want to use an extra cleanser, use a mild, unscented cleanser — not a fancy soap or wash. Even the ones that market themselves as made for vulvas. Like Dr. Tanouye tells us: “You don't need to smell like a piña colada.”
2. Changes in vaginal discharge are worth paying attention to.
Vaginal discharge doesn’t look just one way, but certain changes might indicate something’s up with your vulvovaginal health.
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Color
The color of “normal” vaginal discharge can be:
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Clear
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White
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Slightly yellow
Talk to your healthcare provider if your vaginal discharge is bright yellow or bright green, which could be signs of infection. It’s also good to bring up pinkish or reddish discharge, which happens when there’s unexpected bleeding between periods.
Amount
The amount of “normal” vaginal discharge can range from 1-5 milliliters per day.
“If you ever take a little panty liner and pour five milliliters of water onto it, it's quite a bit,” says Dr. Tanouye. “If you have more discharge than your best friend, you guys are both probably very much in the normal range.”
However, if the amount of discharge significantly increases or it’s really thick, you should talk to a healthcare provider.
Odor
No one’s vaginal discharge is completely odorless. Let’s nip that myth right in the bud. However, vaginal odor that’s more than mild might indicate an issue.
“The basic rule of thumb is if you have your underwear and in order to smell your discharge, you have to bring it right up to your nose,” says Dr. Tanouye. “If there's an odor that's overwhelming, that you can smell without doing that … that might be something that you need to check out.”
Other vaginal symptoms that might suggest an infection or other vaginal health condition include itching and burning, often in combination with thick, cottage cheese-like vaginal discharge.
4. People with vaginas are more prone to UTIs.
Urinary tract infections (UTIs) are infections in the urinary system, which includes the kidneys, the bladder, and the urethra. UTIs happen when bacteria — typically from poop — make their way into the urethra and begin spreading toward the bladder.
“People with vaginas have shorter urethras, and depending on anatomically the angle of your urethra, sometimes bacteria can get in there more easily,” explains Dr. Tanouye.
Sex can also make people more susceptible to UTIs because of friction. “We like friction and we don't like friction,” says Dr. Tanouye. “We don't like friction because it can rub against the urethra and cause tiny, tiny little micro-abrasions and bacteria can get up into the urethra from that, and that's why some people get sex-related urinary tract infections.”
Common UTI symptoms include:
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Urgent need to pee
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Sharp pain or burning while peeing
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Increased urination frequency
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Soreness in the lower abdomen, back, or sides
Talk to your healthcare provider if you think you’re having UTI symptoms. Antibiotics should clear the infection.
You can try to prevent future UTIs by washing the skin around the anus and genital with water, drinking lots of fluids, and peeing as soon as you need to.
5. Vaginas love balance.
There are a lot of products on the market that deal with the vaginal microbiome. So, what is it exactly?
“Every part of our body has its own microbiome,” explains Dr. Tanouye. “Microbiome just means the normal flora bacteria that lives in that normally and creates this nice normal homeostasis.”
Vaginas are happiest when there’s a good balance of bacterial flora. If the environment is thrown off, it can lead to overgrowth of bacteria or yeast and infections:
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Gardnerella overgrowth can cause bacterial vaginosis (BV).
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Yeast overgrowth can cause yeast infections.
However, says Dr. Tanouye, the vagina is super smart. Many things “throw off” the vaginal environment, including menstrual blood and semen. But because the vagina is self-cleaning, “it creates this discharge and exfoliates and kind of washes that out on its own,” she explains. “Your vagina is built to return itself back to its stable, normal environment on its own.”
When the vagina isn’t able to normalize the environment on its own, that’s when issues like BV can arise.
6. Treating STIs is important.
Sexually transmitted infections (STIs) are very treatable, and some are even curable. But if STIs like gonorrhea or chlamydia are left untreated, that can lead to a condition called pelvic inflammatory disease (PID). PID can cause inflammation in the reproductive system and impact fertility.
“We want to try to prevent [STIs] as much as possible with condom use because we don't want any inflammatory process getting to our fallopian tubes and causing damage to those tissues,” explains Dr. Tanouye. If someone does get PID, antibiotics can help. Hospitalization and surgery may also be recommended in some cases.
How can you find out if you have an STI? Annual STI testing is your best bet. Though people with vulvas may not experience symptoms even if they have gonorrhea or chlamydia, you should talk to your healthcare provider if you experience any of the following:
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Gonorrhea: Pain or burning while peeing, increased vaginal discharge, and/or vaginal bleeding between periods.
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Chlamydia: “Abnormal” vaginal discharge and/or burning while peeing.
7. Pain during sex is not “normal.”
Some people experience involuntary contractions of the vaginal muscular walls during penetrative sex, or while trying to insert a tampon or sex toy. This is a condition called vaginismus, which up to 17% of people who are seen for sexual dysfunction may have.
You can have enjoyable sex if you want to. Talk to your healthcare provider about your symptoms. They should be able to connect you with a pelvic floor physical therapist who can help you understand where the pain is coming from (sometimes physical or emotional trauma) and how best to treat it. Pelvic floor physical therapists are “the gynecologist’s best friend,” says Dr. Tanouye.
Rescripting vulvovaginal health
“We have an entire hygiene industry that is based around stigma, that is marketing and making money off of how you feel about your body, and that's just, to me, so absolutely wrong,” says Dr. Tanouye.
“I wish people could understand that a lot of that marketing is shame-based. And we need to get away from that and realize what is ‘normal,’ and normal is good and healthy.”
Listen to the “Dear (In)Fertility” episode with Dr. Tanouye for a deeper dive into all things vulvovaginal health!
Sarah duRivage-Jacobs is a sexual and reproductive health writer, educator, and communicator. In addition to Rescripted, her words can be found on the blogs of reproductive health and mental health companies like Modern Fertility, Hey Jane, Millie, Carrot, Origin, O.school, and Charlie Health. You can visit her website here.