Down Below
Am I normal?
One question many women ask is whether they are normal down below. However, many women are unaware of what is normal, what is not, the basic anatomy of female genitalia and reproductive system. Here is a basic overview of a woman’s anatomy, written in plain language. However, we are all individuals, and there will be some variation between women.
Clitoris
The clitoris is the female equivalent of the head of the penis. It is made up of bundles of nerve cells and rather than being a button, or a knob is a shaft which extends back into the woman’s body. The nerves in the clitoris make it extremely sensitive. When a woman becomes sexually aroused, it becomes erect much in the same way a man does under the same circumstances.
Labia Minora and Majora
The labia minora (or ‘little’ or ‘inner’ lips) are found either side of the clitoris, urethral and vaginal openings and are an extension of the clitoral hood. The size of labia differs between women. Sometimes the labia minora are tucked away and entirely enclosed by the labia majora. Sometimes they may hang out a little bit. The labia majora are the ‘outer’ or ‘big lips’ that are what we see on the outside. These labia act to protect the sensitive areas and openings in the genital region. In most women, the two sides of both sets of labia are different, and one sits a little lower than the other. If they are clean and healthy, it is all within the range of normal.
Urethral Opening
This opening is the hole where your wee comes out. It is the exit end of the tube that comes from your bladder, where your wee is stored until you need to go to the toilet. We typically find this below the clitoris and above the vaginal opening. Still, there is variation in exactly what position it sits from woman to woman.
Vaginal Opening
The vaginal opening is the outer end of the muscular tube that is your vagina. This orifice is the hole than a penis goes in during sex and where you bleed from when you have your period. This exit is also where your baby comes out in a vaginal birth. The other end of your vagina ends in a tightly closed circular structure called the cervix.
Perineum
The perineum is the name for the area between the vagina and the anus. It consists of several layers of muscle as well as the skin that covers them.
Anus
This orifice is where your poo comes out. It is the exit end of the rectum, the final part of your intestines.
Cervix
Your cervix (or the neck of the womb) is the structure found at the inside end of your vagina. Most of the time, it stays tightly closed and should only open up to give birth. The cervix also has some nerves in it and can play a pleasurable role during sex. However, it can also be painful if treated too roughly. Hence, if you have pain during sex at full penetration, this is likely what’s happening.
Uterus
The uterus has a few different components. The body of the uterus is the part in which a baby will grow. It consists of a few layers with different functions. The endometrium is the layer that builds up during your cycle. It then sheds during your period (the blood of your period is discarded endometrium).
The myometrium is the muscular component and is responsible for rhythmic contraction. When you aren’t pregnant, this assists in shedding the endometrium, when you are pregnant, it is the muscle layer responsible for your contractions. The fundus of the uterus is the very top part. If you are pregnant, your care provider will measure the fundus to keep an eye on how your baby is growing.
Fallopian tubes
These are the tubes that eggs (and embryos) travel down on the way to your uterus.
Ovaries
Your ovaries have a couple of functions. They produce and release eggs and hormones during each cycle. They also release hormones that sustain a pregnancy if necessary.
Pap Smears
A Pap smear is the test of a sample of cells taken from a woman’s cervix. The test looks for changes in these cells that show cancer or conditions that may develop into cancer. If detected early, cervical cancer can be cured. A traditional pap smear is recommended every two years from the age of 18 or the time you become sexually active (8).
In 2017 cancer screening practice in Australia changed from the Pap test to the cervical screening program. We recommend this test every five years if your previous test results are normal. The new test is performed and feels the same as the Pap test but looks for the Human Papilloma Virus (HPV), the virus responsible for most cervical cancer. It is more accurate and anticipated to protect up to 30% more women (8).
To do a pap test, a doctor or nurse uses a device called a speculum to widen the opening of the vagina—this enables us to see the cervix. We then use a plastic spatula and small brush to collect cells from the cervix. This sample is then sent to the lab for testing. A Pap test should not be painful but will likely be uncomfortable. Pap smear results take about a week to come back to your doctor, so if you haven’t heard from them in a few weeks, give them a call and chase them up. However, no news is good news in this situation. Abnormal results will usually prompt a phone call from your nurse or doctor.
What do results mean?
A normal Pap smear means the cells from the cervix look healthy and are not showing any signs of unusual changes. An abnormal Pap smear means the cells do not look normal.
This result may prompt a repeat pap smear, or some follow up tests to perform an accurate diagnosis or determine what treatment you may need. An abnormal smear does not always mean that cancer or pre-cancerous cells were present in the sample. There are many causes for abnormal Pap test results, including infection, inflammation related to using a diaphragm or sex, and changes related to your menstrual cycle. Your doctor will evaluate the results to determine if further testing is necessary.
A repeat Pap test may also be necessary if enough cells weren’t collected during your initial examination to allow proper evaluation. Women with certain risk factors, such as a history of abnormal Pap smears, should be screened more frequently. Please speak to your doctor about what frequency of Pap smears is most beneficial to you.
Hygiene
Your vagina has a self-cleaning mechanism which makes it quite easy to look after. However, there are a few maintenance issues that will help with your vaginal health and keep bacteria balanced and under control.
- Shower at least once a day. If you have two or more showers daily, try to limit how much soap or body wash you use as it dries out your skin and can create an imbalance in the healthy bacteria that live there.
- Keep your vulva clean, using mild, unscented soap and water. Don’t attempt to wash the inside and rinse with warm water.
- After using the toilet, wipe from front to back. Wiping the other way can introduce gut bacteria into your reproductive system and cause infection.
- Wear cotton underwear. Cotton lets the airflow and keeps you dry.
- Minimise how often you wear tight-fitting clothing, such as pantyhose, and tight-fitting jeans.
- Change out of wet swimsuits as soon as possible. All these clothes may increase body heat and moisture in your genital area, promoting bacterial overgrowth.
- Change pads or tampons often.
- Don’t douche or use deodorant tampons or feminine sprays, powders, or perfumes. These items can change the healthy balance of organisms in your vagina.
Dr Janelle McAlpine (PhD), Clinical Midwife
Photo by Bangkoker, used under license from Shutterstock.com