When people talk about the vagina, they’re usually referring to the vulva, which is the outer part of the female genitalia. The vulva includes the:
- vaginal opening
The vaginal opening, also called the vaginal vestibule or introitus, is the opening into the vagina. It’s located between the urethra and the anus. The opening is where menstrual blood leaves the body. It’s also used to birth a baby and for sexual intercourse.
The vaginal wall is made of muscle covered in a mucus membrane, similar to the tissue in your mouth. The wall contains layers of tissue with many elastic fibers. The surface of the wall also contains rugae, which are pleats of extra tissue that allow the vagina to expand during sex or childbirth.
The tissues of the vaginal wall undergo hormone-related changes during the menstrual cycle. The cells in the outer layer of the tissue stores glycogen. During ovulation, this layer is shed. The glycogen is broken down by bacteria and helps maintain a pH level to protect the vagina against potentially harmful bacteria and fungi.
The hymen is a thin membrane that surrounds the opening to the vagina. Though hymens can range in shape and size, most are shaped like a half-moon. This shape allows menstrual blood to leave the vagina.
When someone first has intercourse or inserts something into the vagina, the hymen may tear. This can also happen during vigorous exercise.
Certain hymen shapes and types can interfere with menstrual flow, wearing tampons, or having intercourse. These include:
- Imperforate hymen. An imperforate hymen completely covers the opening to the vagina, blocking menstrual flow. It needs to be repaired with minor surgery.
- Microperforate hymen. A microperforate hymen is a very thin membrane that almost completely covers the vaginal opening. Minor surgery is used to create a larger opening.
- Septate hymen. The membrane of a septate hymen includes an extra band of tissue that creates two openings. It’s treated with minor surgery.
Many conditions can affect the vagina. Here’s a look at some of the main ones.
Vaginitis is an inflammation of the vagina resulting from an infection. It can cause uncomfortable symptoms, such as:
There are different types of vaginitis, depending on the cause. The most common types include:
- Bacterial vaginosis (BV). BV is a bacterial infection that stems from an overgrowth of healthy vaginal bacteria. This can happen when something changes the vagina’s pH level, such as douching. BV isn’t a sexually transmitted infection (STI), but sex with a new partner or multiple partners can increase someone’s risk for developing it. BV may cause white or gray discharge, but it doesn’t always cause symptoms.
- Yeast infection. A vaginal yeast infection happens when there’s an overgrowth of a type of yeast called Candida albicans in the vagina. Vaginal yeast infections are very common. Symptoms may include itching, inflammation, and a thick, white discharge that has the appearance of cottage cheese. Yeast infections can usually be treated using over-the-counter (OTC) antifungal medication.
- Trichomoniasis. Often referred to as “trich,” trichomoniasis is an STI caused by a parasite called Trichomonas vaginalis. It often causes a green or yellow discharge with a fishy odor, as well as burning and redness. It’s treated with antibiotics. To avoid reinfection, both partners should be treated.
Vaginismus causes involuntary contractions of the vaginal muscles. The muscle contractions make penetration painful, if not impossible. It often begins when someone first attempts to have intercourse.
There’s no single cause, but it’s often linked to past sexual trauma or emotional factors. For some, the fear of painful sex due to vaginismus can make the muscles contract even more, leading to more pain.
STIs are transmitted through sexual contact and can affect the vagina and cause symptoms ranging from discharge to genital warts or sores. Some STIs don’t cause any symptoms and are only found during routine screening. Common STIs include:
Vaginal atrophy causes the tissues of the vagina to shrink and thin, which can narrow the canal and reduce its elasticity. It’s more common during menopause. During menopause, estrogen production drops, reducing the amount of vaginal fluids and interfering with the vagina’s pH.
Atrophy can also happen earlier in life due to other causes of decreased estrogen, such as breastfeeding, ovary removal, and certain medications. It can cause vaginal dryness, painful intercourse, and irritation.
Vaginal prolapse happens when the vagina stretches or expands, protruding onto other organs. It’s rare that it involves the vagina alone. The tissue that supports the uterus usually stretches as well, causing it to weaken during straining.
Vaginal childbirth, frequent pressure on the abdomen from obesity or strained bowel movements, and menopause can increase risk for prolapse.
There are different types of prolapse that can involve the vagina, including:
- cystocele, which involves the front of the vagina and the bladder
- rectocele, which involves the back of the vagina and rectum
- enterocele, which involves the front of the vaginal wall and small bowel
Vaginal prolapse doesn’t always cause symptoms. But in some cases, it can cause a sense of fullness or heaviness in the pelvis. Others may feel a pulling sensation in the area.
Symptoms usually go away when someone lies down and might get worse when standing, having a bowel movement, or lifting something. Passing urine when sneezing, laughing, or coughing is also possible.
Vaginal cancer is very rare. There are different types of vaginal cancer, but the most common is squamous cell carcinoma that starts in the lining of the vagina. In its early stages, it may not cause any symptoms. But if it spreads, it can cause unusual vaginal bleeding, discharge, or a lump in the vagina.
Symptoms of a vaginal condition can range from mild to severe and depend on the underlying cause.
The following are some common symptoms:
- a change in the amount, color, or odor of vaginal discharge
- irritation in or around the vagina
- bleeding during or after sex
- bleeding between periods
- bleeding after menopause
- painful intercourse
Vaginal conditions usually respond best to treatment when caught early, so make sure to follow up with a doctor if you notice any of these symptoms.
While several conditions can affect the vagina, you can reduce your risk for developing many of them.
Follow these tips to lower your risk:
- Avoid douching. The vagina naturally cleanses itself. Douching can upset the natural balance of bacteria and fungi, leading to an infection.
- Avoid scented soaps and feminine hygiene products. Perfumes in scented hygiene products, such as soaps, pads, and wipes, can irritate the skin and disrupt the pH balance of the vagina. Opt for unscented products instead.
- Be sexually responsible. Always use protection with new partners and make sure to follow up with regular STI testing.
- Do Kegel exercises. These help to strengthen the pelvic floor muscles, which can help reduce your risk for vaginal prolapse and pelvic floor weakness. Learn how to do them.
- Get vaccinated. Speak to your doctor about vaccinations to protect against HPV and hepatitis B, which can be transmitted through sex.
- Get regular checkups. See your doctor for regular Pap smears and screenings for cervical cancer and HPV. The U.S. Preventive Services Task Force recommends that women ages 21 to 65 have cervical cancer screening with a Pap smear every three years. Women ages 30 to 65 can lengthen the screening interval to five years if they have HPV testing in combination with a Pap smear.