The Anatomy of the Vulva (2024)

The vulva includes the external female genital structures. Vulvar anatomy contains several structures, such as the labia, vaginal and urethral openings, and clitoris. Sometimes, the external genitalia are also called the pudendum.

The vulva has several functions and can look different from person to person. Additionally, it can be subject to a range of health issues, including vulvar cancer, bacterial infections, and sexually transmitted infections (STIs).

Where Is Your Vulva Located?

People often refer to the vagina for most things related to female genitals. However, the external genital structures are all part of the vulva, including the opening to the vaginal canal. The vulva begins at the mons pubis, the fleshy covering over your pubic bone where your pubic hair grows.

It extends downwards to include structures such as your clitoris, urethral opening (where pee comes out of), vaginal opening, and perineum. The perineum is the skin before the anus. The vulva ends at the anus, and your anus is not considered part of the vulva.

Parts and Function of the Vulva

Anatomically speaking, the vulva is a blanket term for many structures of the external female genitals. While each part plays a specific role, the overall function of the vulva is to allow your body to pee, give birth, menstruate, and experience sexual pleasure.

Structures included in the vulva include:

• Mons pubis
• Labia majora
• Labia minora
• Clitoris
• Vaginal opening
• Urethral opening
• Vestibular bulbs
• Vulva vestibule
• Bartholin glands
• Skene glands
• Perineum

Mons Pubis

The mons pubis is made up of fatty tissue and is the V-shape that lies directly to the front of the pubic bones. It’s usually prominent, visible from the exterior, and where the pubic hair grows.

The mons pubis helps cushion the area during sexual intercourse and houses the sebaceous glands, which secrete hormones associated with sexual attraction.

Labia Majora

The labia majora, or outer lips, come from the Latin terminology for “larger lips." They consist of two prominent folds of skin that cover other parts of the reproductive system, including:

• Labia minora
• Clitoris
• Vulva vestibule
• Vestibular bulbs
• Bartholin’s glands
• Skene’s glands
• Urethra
• Vagina

The front-facing (anterior) part of the labia majora forms a fold just beneath the mons pubis called the labial commissure.

Labia Minora

The “smaller lips” of the vulva are also known as the labia minora. This pair of skin folds arise at the clitoris. The front portions form a clitoral hood before moving downward. In doing so, they also create the borders of the vulva vestibule.

The back portions of the labia minora link together, separating them from the labia majora.

As these folds link together, they form the frenulum of the labia minora. This part of the body becomes engorged during sexual arousal.

Clitoris

This clitoris is an essential sex organ for people with vaginas. On average, it is innervated by over 10,000 nerve endings. Its primary purpose is pleasure.

There are several parts to the clitoris, and it extends into your body. Externally, the glans clitoris, which is covered by the clitoral hood, are the main anatomical parts you can visualize as part of the vulva.

Vaginal Opening

The vagina is a muscular, elastic tube that runs from the vaginal opening to the cervix. The vagina allows for the passage of menstrual blood and childbirth through the cervix.

Urethral Opening

The urethra is a tube that connects to the bladder to allow urine to exit the bladder. The urethral opening is where urine comes out.

Vestibular Bulbs

These two bulbs are formed of erectile tissue and arise near the back side of the body of the clitoris. They run along the middle edge of the crus (legs) of the clitoris towards the urethra and the vagina.

Vulva Vestibule

The word "vestibule" means a lobby. In the female anatomy, the vulva vestibule is the area between the bottom of the clitoris and the bottom of the labia minora. The openings to both the urethra and vagina are in the vulva vestibule.

Bartholin’s Glands

Sometimes referred to as the greater vestibular glands, these are two pea-sized structures that are found at the back and slightly to the side of the opening of the vagina.

They are involved in fluid secretion during sexual activity.

Skene’s Glands

Also known as the lesser vestibular glands, these sit on either side of the urethra and urethral opening. The Skene's glands are thought to help lubricate the urethra and vagina.

Perineum

The perineum is the skin that runs between the vaginal opening and the anus. It stops at the anus, which is also where the vulva ends.

Function of the Vulva

The vulva is primarily associated with sexual function but has additional roles:

• The vulva allows urine excretion. It houses the urethra, which delivers urine from the bladder out of the body.
• The vulva is crucial to sexual activity. During arousal, several parts become flushed with blood, including the labia minora and majora, the clitoris, and the vestibular bulbs. This stimulates sexual pleasure and works to bolster lubrication for sexual intercourse.
• Lubrication from the vulva can also promote conception—physiological changes during sexual arousal produce lubricating fluids that help the sperm reach the egg.
• During menstruation, your period (the endometrial lining that sheds when conception does not occur) exits through the vaginal opening.
• During vaginal childbirth, the vaginal canal stretches to allow the baby to move out of the vaginal opening.

Conditions Affecting the Vulva

Among the many diseases or conditions that can impact the vulva, many are STIs, including chlamydia, syphilis, HPV, and others.

Infections

• Chlamydia arises due to a bacterial STI. It can be asymptomatic but also may lead to symptoms of burning discharges, pain, and inflammation in the urethra and cervix. If untreated (typically with antibiotics), this can lead to pelvic inflammatory disease (PID) and potential complications of ectopic pregnancy or infertility in people with vaginas.
• Gonorrhea is often present alongside chlamydia. Symptoms of the Neisseria gonorrhoeae bacterial infection are similar, as is the risk of PID. Antibiotics can be used to treat this condition.
• Syphilis is the result of infection by Treponema pallidum bacteria. Symptoms may not immediately emerge but include fever, skin rashes and sores, and genital lesions (similar to warts). Inflammation and swelling of the lymph nodes can also occur. Brain lesions and neurological problems can arise if left untreated (usually with penicillin).
• Herpes Simplex 1 & 2 is known as genital herpes and can lead to lesions on the vulva. There is no cure, but symptoms come and go, and flare-ups can be managed.
• Human Papillomavirus (HPV) flares up noticeably as cauliflower-shaped lesions—genital warts—on the vulva or genital region. These arise due to a viral infection and typically resolve on their own. In some cases, the warts become chronic and can lead to cancer.
• Human Immunodeficiency Virus (HIV) This viral infection attacks and can compromise the immune system. HIV can progress to acquired immunodeficiency syndrome (AIDS), a condition characterized by the presence of other opportunistic infections, many of which impact the vulva. There is no cure for HIV. However, pharmaceutical therapies can keep the virus in check.
• are inflammations of the liver that can lead to cirrhosis or other dangerous conditions. While a vaccine for hepatitis B exists, there is none for the other form. There is also no cure for this class of disease. Sexual contact is a common cause of infection.
• Urinary tract infections (UTIs)are common bacterial urethra infections. They lead to symptoms like an increased need to urinate, pain during urination, and cloudy and foul-smelling urine. Highly treatable, they are often caused by the bacteriaEscherichia coli.
• Vaginal candidiasis, also known as vaginal yeast infection, this fungal infection causes vaginal itching and soreness, pain during sexual intercourse, pain or discomfort during urination, and/or abnormal discharges from the vagina. While most cases are mild, some can develop into more serious infections, leading to cracking, bleeding, and inflammation.
• Bacterial vaginosis (BV) is an overgrowth of bacteria in your vagina. It can cause increased discharge, itching, and a fishy smell. Sex can increase your risk for BV, but it can also happen without sexual activity. It is treated with antibiotics.

Skin Conditions

Some skin conditions can affect the vulva, with pain and itching the most common symptoms. These conditions include:

• Lichen sclerosisis an uncomfortable condition characterized by chronic itchiness of the vulva due to irritation. Scratching can lead to a thickening (or lichenification) of the underlying tissues of the vulva and a thinning of the skin. Steroids can treat it.
• Vulvitis, or vulvar itching, is a condition that allergies can cause (but also injury or infection). Symptoms include vaginal discharge, inflammation, itchiness, burning sensations, redness, swelling, and blisters on the vulva. Treatment involves wearing looser clothing or taking sitz baths to ease discomfort. Healthcare providers may also prescribe topical estrogen cream or cortisone ointment.
• Vulvular dermatitis can have varied causes, including heat and moisture, contact allergies to fabrics, menstrual care products, condoms, or irritants like vaginal discharge. Symptoms of vulvular dermatitis feel like other allergies, with itching and inflammation.
• Vulvular psoriasis is the diagnosis of persistent vulva itching and related symptoms in about 5% of people with vaginas, especially on the mons pubis and labia majora. The plaque-like lesions are treated with topical corticosteroids or, in severe cases, drugs like methotrexate.
• Pubic lice (crabs) affect pubic hair on the vulva, and sexual contact is the most common transmission mode. These tiny, crab-like creatures cause severe itchiness, blood spotting on underwear, and small white dots in the pubic hair. Treatment involves washing the area with a specialized soap and abstaining from sexual activity for about 14 days.

Other Vulvar Conditions

In addition, a range of other conditions can affect this part of the body, including the following:

• Bartholin cysts and abscessesarise from cysts that form in the Bartholin’s glands, affecting its ability to secrete necessary hormones. If the cyst becomes infected, it can continue to grow to form an abscess.
• Imperforate hymen is rare and characterized by the hymen not allowing substances through. In girls who have started menstruating, this causes blood and other substances excreted during periods to get caught. Treatment involves perforating the region to drain it.
• Atrophic vulvovaginitis is known as genitourinary syndrome of menopause, with skin and other changes affecting the vulva due to changes in estrogen levels. Estrogen creams can help.
• Vulvar carcinoma is rare, with the most common form being squamous cell carcinoma. One risk factor is HPV. The condition can cause itching and skin changes.
• Vulvar Crohn's disease can occur with or without intestinal symptoms. In some cases, it presents before intestinal disease. It is rare and marked by genital inflammation. Complications such as lymphedema, abscesses, cellulitis, and other genital issues can occur.
• Vulvodynia is chronic, vulvar pain. The cause of the pain often remains unknown.
• Dyspareunia is pain during or after sex.

What Are Symptoms of Vulvar Conditions?

The symptoms of conditions that affect the vulva vary according to the cause, but there are a few that are common to more than one condition:

• Pruritis (itching), among the most common complaints
• Dyspareunia (recurring pain during sex)
• Burning sensation, often when urinating
• Difficulty urinating
• Scarring and other skin changes
• Fever, with some infections
• Changes in vaginal discharge and odor

Keep in mind that some people won't have symptoms of a vulvar disorder immediately.

Tips for Keeping the Vulva Healthy

People with vaginas can take steps to prevent conditions that affect the vulva, including decisions about safer sex in order to prevent STIs. Careful hygiene also can help to prevent infection.

Contact with irritants and allergens can contribute to vulvar dermatitis. Consider the following tips:

• Change textiles and fabrics that irritate the vulva (for example, choose cotton).
• Replace personal care products that contain fragrances or other ingredients that lead to allergic responses.
• Check the type of condom you use, as well as tampons and other menstrual care products.
• Avoid douches, which can disrupt the protective vaginal flora that keeps you healthy.
  

Tests

Screening and examination of parts of the vulva are an essential aspect of female health. Prompt detection of health problems can significantly improve outcomes, especially in cases of sexually transmitted infections and cancer.

Providers will typically begin with a physical exam to visualize the vulvar structures. Additional tests may include the following procedures.

Vulvar Biopsy

To test for the presence of vulvar carcinoma, specialists will perform a physical examination of the pelvis and do a vulvar biopsy.

This is a test in which a small portion of tissue is removed and examined under a microscope for the presence of cancer or pre-cancerous cells. Healthcare providers may use a special device called a colposcope to magnify the area they are selecting to examine.

If results come up positive, other tests may be performed to assess for the spread of cancer.

Darkfield Microscopy

Though most syphilis cases are tested using blood samples, the definitive option is an assessment of a sample using a special darkfield microscope.

If an open sore is found on the vulva, healthcare providers may collect a sample and use that for testing.

HPV Testing

In cases of suspected HPV that arise as genital warts on the vulva, a healthcare provider may perform HPV testing to look for the presence of the virus in cell samples from the area.

Herpes Testing

If the sores from genital herpes appear on the vulva, they can be swabbed and tested. This condition can be hard to diagnose between outbreaks.

Urinalysis

Urine samples are used to assess a wide range of health conditions, including diabetes, liver health, and pregnancy.

People with female anatomy will need to spread the labia open and use a sterile wipe to clean the area, as well as a separate wipe for the urethral opening, before providing a urine sample. This is to ensure that an uncontaminated sample is assessed.

Anatomical Variations

Female external genitalia—particularly the sizes and colors of the mon pubis, clitoris, labia majora and minora, as well as the vaginal opening—can vary a great deal from person to person.

The greatest differences are seen in the size, color, and structure of the labia majora and minora, with some people displaying more prominent folds. In other cases, the clitoris and clitoral hood are larger and more prominent.

These variations are associated with the amount of estrogen activity during puberty. Larger, thicker features are associated with increased presence of this hormone during this time.

Largely, though, functionality is unaffected by these differences.

Congenital Variations

In addition, there are more rare cases of congenital variations of the vulva, involving the physiology of the uterus and vagina. There are four classes of these variations:

• Class I: This is an abnormal development of ducts in the uterus and vagina. The most common such issue is Mayer-Rokinatsky-Kuster-Hauser syndrome, in which the uterus, cervix, and upper portion of the vagina do not develop properly.
• Class II: This class refers to disorders of vertical fusion leading to malformation of the cervix, as well as either obstructive or nonobstructive transverse vaginal septa (walls). This can impact the function of the vulva.
• Class III: Lateral fusion disorders of this class describe situations where there is a doubling of anatomical features of the vulva. Oftentimes, this will lead to the formation of multiple uteri and can be obstructive (affecting function) or non-obstructive.
• Class IV: The final category represents those that are combinations of the above conditions.

Summary

The vulva, and the external organs that make up the female reproductive system, play key functions in sexual and reproductive health and urinary function. A number of conditions can affect the vulva, including sexually transmitted infections and age-related structural changes (like menopause).

Allergies, and autoimmune conditions like psoriasis, also can affect the vulva. Most conditions can be treated, even when there is not yet a cure (for example, with HIV infection).

Be aware of itching, pain, and related symptoms of conditions that can affect the vulva. Talk to your healthcare provider about your vulvar health and any concerns you have.