“Vagina.” For some women, the word still carries a twinge of embarrassment, especially if it calls to mind a memory of uncomfortable giggling in middle-school health class. And unless you work in health care or are just really open about women’s health, “vagina” still might not be something you say very often or have talked about in the past. In this installment of our FAM Basics series, we will be going over the basics of where and what the vagina is, as well as its main functions. Our goal is to provide you with the knowledge and language to be able to care for your vaginal health.
What is the vagina?
Essentially, the vagina is an opening made up of very strong muscle that extends up to the cervix and serves as a passageway for the menstrual flow, semen, and childbirth. The vagina lies between the rectum and the bladder and is typically around four inches long. According to Encyclopedia Britannica, the vagina itself is made up of two muscle layers and a layer with blood vessels, nerves, and connective tissue [1].
While we use the term to refer to a woman’s genitalia, “vagina” really only refers to a woman’s internal genitalia, while vulva refers to all of the external components of the female urogenital system including the vaginal opening, labia, clitoris, and urethra [2]. The vagina is also surrounded or partially covered by a thin membrane called the hymen, which has traditionally been thought of as a sign of virginity. But while it can stretch or may be injured during sex or exercise, the hymen doesn’t “break” and can heal from injuries like most other tissue in the body [3].
So, what does the vagina actually do?
During sex
Most of the vagina’s role in your body is to serve as an entrance for some things and an exit for others. The vagina serves as an entrance during sexual intercourse to receive sperm to potentially fertilize an egg. In an aroused state, blood flow increases to the vagina, and to the surrounding structures like the labia and clitoris. To make sex a more comfortable and pleasurable experience, vaginal lubrication (produced by the Bartholin glands) also increases during arousal, and the muscles that make up the vagina relax to increase its diameter [3].
During menstruation
The vagina plays a role in your menstrual cycle by allowing the blood and tissue from menstruation to exit the body. The vagina also responds to changes in hormone levels throughout the month, especially estrogen. When estrogen levels are high, during ovulation and during pregnancy, the lining of the vagina is particularly thick and elastic [1].
During childbirth
In childbirth, the vagina, often referred to as the birth canal, is how a baby exits its former home of the womb to come into the world. The vagina expands to many times its usual diameter to accommodate the baby during birth. How? This is partly thanks to ridges called the vaginal rugae. These ridges help the vagina to expand similarly to how the folds of an accordion expand [1].
When the vagina is not serving as an entrance or exit, it functions as a gatekeeper to prevent pathogens from entering the body. The vagina is home to “good” bacteria that produce lactic acid. Lactic acid lowers the pH of the vagina and prevents other “bad” bacteria from setting up shop.
Vaginal health 101: Is vaginal discharge just the mucus I track when cycle charting?
Vaginal discharge can refer to any secretions that exit the body via the vagina. Cervical mucus is one component of vaginal discharge that changes in quality and amount depending on a woman’s estrogen levels. High estrogen levels create fertile-type mucus that is clear, slippery, stretchy, and essential for nourishing and helping sperm reach the fallopian tubes for possible conception. After estrogen levels drop following ovulation, the mucus may become opaque, tacky, or unnoticeable.
What else could vaginal discharge be besides cervical mucus?
The other components of vaginal discharge include fluid that seeps into the vagina from the cells of the vaginal lining, plus cells and bacteria that get swept down by these secretions [1]. Vaginal discharge helps keep the vagina clean, moist, and free from infection. This discharge should be clear or whitish color, free from strong odor, and either sticky or stretchy, depending on where you are at in your menstrual cycle. Tracking your cervical mucus can help you become familiar with what your normal discharge looks like and can quickly alert you if something is wrong.
How can I support good vaginal health?
To help support vaginal health, do not douche. Remember, the vagina cleans itself and douching can disrupt the good microflora that keeps the vagina at the right pH to prevent bacterial infections or yeast overgrowth. Other habits for vaginal health include fertility awareness charting to be familiar with what is and isn’t normal for you. Schedule an annual visit with your OB/GYN or midwife visit. Wear breathable underwear made of natural fibers and change clothes after swimming, intense workouts, and pelvic floor exercises (like Kegels).
Common diseases related to the vagina include:
- Vaginal yeast infections: A yeast infection is caused when candida yeast, a normal part of the vaginal microbiome, becomes more prominent than it should. This imbalance can cause inflammation, an itching/burning sensation, and thick, chunky discharge. A yeast infection can be treated with antifungal medication. A weakened immune system, unmanaged diabetes, and conditions that impact your hormones, such as pregnancy or taking hormonal birth control, are all risk factors for yeast infections.
- Bacterial vaginosis (BV): BV is basically the bacterial version of a yeast infection. Instead of the microbiome becoming unbalanced because of too much yeast, it becomes unbalanced because of an overgrowth of certain bacteria–resulting in the characteristic “fishy” smelling discharge. Sometimes bacterial vaginosis occurs after taking antibiotics, since the “good” bacteria can grow back unevenly after antibiotics kill them off. Other risk factors include sexual activity–especially with new or multiple partners. While BV is not a sexually transmitted infection (STI), the normal “good” bacteria that lives on your partner’s genitals can potentially disrupt your microbiome. Douching, pregnancy, and having an IUD are other potential causes of BV overgrowth.
- Trichomoniasis (trich): Trich is the most common STI, even more so than chlamydia and gonorrhea. It’s caused by a small parasite. Women who contract trich are more likely to develop cervical cancer. Symptoms of trich include foul smelling vaginal discharge, vaginal inflammation, and pain during intercourse or urination; it is treated with antibiotics.
In general, any irregular bleeding, strange-looking or smelling discharge, itching, burning, or pain during sex or while peeing should prompt a call to a doctor’s office for further investigation in case treatment is needed.
Talking about vaginal health
Talking about vaginal health, or sexual health in general, can feel taboo. However, the vagina is an essential anatomical structure for sex, conception, birth, and in the day-to-day task of keeping your reproductive organs safe from infection. Hopefully, learning a little more about your reproductive organs and knowing when to get help for troubling symptoms can help you to build confidence in taking charge of your vaginal health specifically and your sexual health overall, and in appreciating the wonderful way your body is made.
References:
[1] Britannica, The Editors of Encyclopaedia. “vagina”. Encyclopedia Britannica, 29 Jun. 2023, https://www.britannica.com/science/vagina. Accessed 1 August 2023. [2] Nguyen JD, Duong H. Anatomy, Abdomen and Pelvis: Female External Genitalia. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547703/ [3]Munarriz, Ricardo et al. “Biology of female sexual function.” The Urologic clinics of North America vol. 29,3 (2002): 685-93. doi:10.1016/s0094-0143(02)00069-1Additional Reading:
FAM Basics (series)
How fertility awareness helps detect vaginal infections before they get worse
