Understanding the Vaginal Introitus

The vaginal opening sits in the rear portion of the vulva (the external female genitalia). The vulva is covered by fleshy layers of skin called labia that help cushion and protect the vagina. The vulva also houses the clitoris, urinary canal, and the pubic bone.

The vaginal introitus is the opening to the vagina. The vagina is a muscular canal that extends to the cervix, the opening of the uterus. During penetration, the vaginal canal stretches. After penetration, the vagina and introitus shrink back to their original size.

A variety of conditions can impact the vaginal introitus. Some cause mild irritation or itching, while others can cause severe pain or discomfort.

Irritation

The skin in and around the vagina is very sensitive. Scented personal care products, such as soaps, bubble bath, and body wash, can easily irritate the skin surrounding the introitus.

Tight clothing or underwear made from synthetic materials, such as nylon, often trap moisture and rub against the vagina, leading to irritation.

To avoid irritation, stop using any products around your introitus. Instead, try rinsing the area with warm water. Opt for underwear made out of breathable, natural fabrics, such as cotton, and pants that give the area room to breathe.

Imperforate hymen

The hymen is a thin membrane that covers the vaginal opening in young girls and women. It usually has at least one opening to allow menstrual blood to flow out of the body. However, some women have an imperforate hymen, which covers the entire vaginal opening without any holes.

This can make both menstruation and penetration very uncomfortable. It’s easily treated with a minor surgical procedure.

Stenosis

Sometimes the introitus and vaginal canal become very narrow, leading to a condition called vaginal stenosis. While some women just naturally have a narrower vagina, surgery, age, and cancer treatments can all cause it as well.

Vaginal stenosis can make common things, including penetration and pelvic exams, extremely painful. If you think you have vaginal stenosis, talk to your doctor. There are several treatment options that can help. They may suggest using a device called a vaginal dilator, which can slowly increase the elasticity of your vaginal muscles, making it easier for them to relax. This often aids in opening up the vaginal canal.

Prolapse

A pelvic organ prolapse or genital prolapse occurs when one or more of the pelvic organs, such as the bladder, uterus, or vagina, loses its structural support inside the body. When this happens, the organ may slip through the introitus.

While it can happen at any age, it’s more common in older women. It can be the result of multiple vaginal births, an injury, a previous surgery, abdominal pressure, or repeated heavy lifting.

In mild cases, pelvic floor exercises can help. In other cases, you may need surgery to secure the organs to their proper place. Your doctor might also suggest using a pessary, which is a flexible, removable device that you place in your vagina to support your uterus.

Lichen sclerosis

This condition causes the tissue in and around the vaginal introitus to turn thin and crinkly. It can also lead to the development of white patches.

These lesions are more common in women with psoriasis, but any woman can develop them. In addition to the changes to the skin, other symptoms include itching and pain. Most cases respond well to topical corticosteroids.

In rare instances, scarring from these spots can turn into cancer. So your doctor will continue to watch the skin in and around the introitus for any signs of change.

Infections

Several common infections can affect the vulva and introitus. These infections are caused by a variety of things, from yeast to bacteria.

Some of the most common infections include:

• Yeast infection. An overgrowth of yeast in the vagina can lead to an itchy, burning infection. It’s treated with over-the-counter or prescription medication.
• Genital herpes. The herpes simplex virus causes this common sexually transmitted infection. Herpes is spread by direct skin-to-skin contact, including intercourse. It can be spread even when a sore isn’t visible. Genital herpes sores appear as blisters or bumps in and around the vaginal opening. The blisters can break and leave painful stores that may heal slowly.
• Genital warts. The human papillomavirus (HPV) causes this common sexually transmitted infection. Genital warts can form in clusters or small groups of bumps. They appear several weeks or months after contact with the virus.
• Bacterial vaginosis. The vagina naturally balances the growth of bacteria. However, certain types of bacteria can grow too rapidly, disrupting this natural balance. This leads to itching, unusual odors, and vaginal discharge. This can be treated with antibiotics either taken by mouth or applied vaginally.

Cysts

Several types of cysts can form in the skin surrounding the introitus. If these cysts grow large, they may block the opening of the vagina entirely. Smaller cysts may only partially block the entrance.

These cysts include:

• Bartholin’s cyst. On either side of the vaginal opening are glands that secrete fluids to help lubricate the vagina. Occasionally, those glands can become blocked. This causes a buildup of fluid that leads to a large cyst that’s sometimes painful and tender.
• Inclusion cyst. This type of cyst is made of skin cells and fat. While they’re generally harmless, large ones can partially block the vaginal introitus.
• Epidermal cysts. This cyst is the result of unusual growth, often due to a blocked hair follicle or damaged oil gland.

Vulvodynia

Vulvodynia refers to ongoing pain or discomfort of the vulvar area, including the introitus. Many women with vulvodynia report being extremely sensitive to pressure and touch, while others feel an intense burning sensation. These symptoms can last for weeks, months, or even years.

Experts aren’t sure what causes vulvodynia, but there are several treatment options that can help, including medication, surgery, and nerve blocks.

When it comes to the introitus and vagina, less is often more. They’re designed to clean themselves naturally and tend to be very sensitive to personal care products.

Follow these tips to reduce your risk of irritation:

• Wash carefully. Use only warm water to rinse around your vagina. If you do use soap, make sure it’s mild and doesn’t contain any fragrance. Follow up by drying the whole area with a clean cotton towel.
• Wash new underwear. Most new clothing, including underwear, contains a layer of chemicals from the manufacturing process. This usually doesn’t cause any problems on the rest of your body, but the skin around your introitus is extra sensitive. Run new underwear through a cycle or two in the washing machine before wearing it.
• Wear natural fabrics. Stick with cotton underwear, which is breathable. Synthetic materials, such as nylon or polyester, trap moisture. This can lead to chafing or an infection.
• Don’t scratch. If the skin around your introitus is itchy, try to avoid scratching the area, which just leads to more irritation. You also run the risk of cutting yourself, leaving the skin around your vagina vulnerable to infection.