mammal Mammals () are a group of vertebrate animals constituting the class Mammalia (), characterized by the presence of mammary glands which in females produce milk for feeding (nursing) their young, a neocortex (a region of the brain), fur or ...

s, the vagina is the elastic, muscular part of the

female genital tract The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. In humans, the female reproductive system is immature at birth and develops to maturity at puberty to be able ...

. In humans, it extends from the

vestibule Vestibule or Vestibulum can have the following meanings, each primarily based upon a common origin, from early 17th century French, derived from Latin ''vestibulum, -i n.'' "entrance court". Anatomy In general, vestibule is a small space or cavity ...

to the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. At the deep end, the cervix (neck of the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

) bulges into the vagina. The vagina allows for

sexual intercourse Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal penetrat ...

and birth. It also channels

menstrual flow Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of ho ...

, which occurs in humans and closely related

primate Primates are a diverse order of mammals. They are divided into the strepsirrhines, which include the lemurs, galagos, and lorisids, and the haplorhines, which include the tarsiers and the simians (monkeys and apes, the latter including huma ...

s as part of the

menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs a ...

. Although research on the vagina is especially lacking for different animals, its location, structure and size are documented as varying among species. Female mammals usually have two external openings in the

vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external sex organ, female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, bulb of vestibu ...

; these are the urethral opening for the urinary tract and the vaginal opening for the genital tract. This is different from male mammals, who usually have a single urethral opening for both urination and

reproduction Reproduction (or procreation or breeding) is the biological process by which new individual organisms – "offspring" – are produced from their "parent" or parents. Reproduction is a fundamental feature of all known life; each individual or ...

. The vaginal opening is much larger than the nearby urethral opening, and both are protected by the labia in humans. In

amphibian Amphibians are tetrapod, four-limbed and ectothermic vertebrates of the Class (biology), class Amphibia. All living amphibians belong to the group Lissamphibia. They inhabit a wide variety of habitats, with most species living within terres ...

bird Birds are a group of warm-blooded vertebrates constituting the class Aves (), characterised by feathers, toothless beaked jaws, the laying of hard-shelled eggs, a high metabolic rate, a four-chambered heart, and a strong yet lightweigh ...

reptile Reptiles, as most commonly defined are the animals in the class Reptilia ( ), a paraphyletic grouping comprising all sauropsids except birds. Living reptiles comprise turtles, crocodilians, squamates (lizards and snakes) and rhynchocephalians ( ...

s and

monotreme Monotremes () are prototherian mammals of the order Monotremata. They are one of the three groups of living mammals, along with placentals (Eutheria), and marsupials (Metatheria). Monotremes are typified by structural differences in their brain ...

s, the

cloaca In animal anatomy, a cloaca ( ), plural cloacae ( or ), is the posterior orifice that serves as the only opening for the digestive, reproductive, and urinary tracts (if present) of many vertebrate animals. All amphibians, reptiles and birds, a ...

is the single external opening for the gastrointestinal, urinary, and reproductive tracts. To accommodate smoother penetration of the vagina during sexual intercourse or other

sexual activity Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts, ranging from activities done alone (e.g., masturbation) ...

, vaginal moisture increases during

sexual arousal Sexual arousal (also known as sexual excitement) describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind as ...

in human females and other female mammals. This increase in moisture provides

vaginal lubrication Vaginal lubrication is a naturally produced fluid that lubricates a vagina. Vaginal lubrication is always present, but production increases significantly near ovulation and during sexual arousal in anticipation of sexual intercourse. Vaginal dr ...

, which reduces friction. The texture of the vaginal walls creates friction for the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...

during sexual intercourse and stimulates it toward

ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential componen ...

, enabling

fertilization Fertilisation or fertilization (see spelling differences), also known as generative fertilisation, syngamy and impregnation, is the fusion of gametes to give rise to a new individual organism or offspring and initiate its development. Proce ...

. Along with pleasure and bonding, women's sexual behavior with others (which can include heterosexual or

lesbian A lesbian is a Homosexuality, homosexual woman.Zimmerman, p. 453. The word is also used for women in relation to their sexual identity or sexual behavior, regardless of sexual orientation, or as an adjective to characterize or associate n ...

sexual activity) can result in sexually transmitted infections (STIs), the risk of which can be reduced by recommended

safe sex Safe sex is sexual activity using methods or contraceptive devices (such as condoms) to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer se ...

practices. Other health issues may also affect the human vagina. The vagina and vulva have evoked strong reactions in societies throughout history, including negative perceptions and language, cultural

taboo A taboo or tabu is a social group's ban, prohibition, or avoidance of something (usually an utterance or behavior) based on the group's sense that it is excessively repulsive, sacred, or allowed only for certain persons.''Encyclopædia Britannica ...

s, and their use as symbols for

female sexuality Human female sexuality encompasses a broad range of behaviors and processes, including female sexual identity and sexual behavior, the physiological, psychological, social, cultural, political, and spiritual or religious aspects of sexual ac ...

, spirituality, or regeneration of life. In common speech, the word ''vagina'' is often used to refer to the vulva or to the female genitals in general. By its dictionary and anatomical definitions, however, ''vagina'' refers exclusively to the specific internal structure, and understanding the distinction can improve knowledge of the female genitalia and aid in healthcare communication.

Etymology and definition

The term ''vagina'' is from

Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...

meaning "sheath" or " scabbard"; the plural of ''vagina'' is either ''vaginae'', or ''vaginas''. The vagina may also be referred to as the birth canal in the context of

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

and

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...

. Although by its dictionary and anatomical definitions, the term ''vagina'' refers exclusively to the specific internal structure, it is colloquially used to refer to the

or to both the vagina and vulva. Using the term ''vagina'' to mean "vulva" can pose medical or legal confusion; for example, a person's interpretation of its location might not match another's interpretation of the location. Medically, one description of the vagina is that it is the canal between the hymen (or remnants of the hymen) and the

, while a legal description is that it begins at the vulva (between the labia). It may be that the incorrect use of the term ''vagina'' is due to not as much thought going into the anatomy of the female genitals as has gone into the study of male genitals, and that this has contributed to an absence of correct vocabulary for the external female genitalia among both the general public and health professionals. Because a better understanding of female genitalia can help combat sexual and psychological harm with regard to female development, researchers endorse correct terminology for the vulva.

Structure

Gross anatomy

The human vagina is an elastic, muscular canal that extends from the vulva to the cervix. The opening of the vagina lies in the

urogenital triangle The urogenital triangle is the anterior part of the perineum. In female mammals, it contains the vagina and associated parts of the internal genitalia. Structure The urogenital triangle is the area bound by a triangle with one vertex at the pubi ...

. The urogenital triangle is the front triangle of the perineum and also consists of the urethral opening and associated parts of the external genitalia. The vaginal canal travels upwards and backwards, between the urethra at the front, and the rectum at the back. Near the upper vagina, the cervix protrudes into the vagina on its front surface at approximately a 90 degree angle. The vaginal and urethral openings are protected by the labia. When not

sexually aroused Sexual arousal (also known as sexual excitement) describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind ...

, the vagina is a collapsed tube, with the front and back walls placed together. The lateral walls, especially their middle area, are relatively more rigid. Because of this, the collapsed vagina has an H-shaped cross section. Behind, the upper vagina is separated from the

rectum The rectum is the final straight portion of the large intestine in humans and some other mammals, and the Gastrointestinal tract, gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the s ...

by the recto-uterine pouch, the middle vagina by loose

connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...

, and the lower vagina by the

perineal body The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), includi ...

. Where the vaginal lumen surrounds the cervix of the uterus, it is divided into four continuous regions (

vaginal fornices The fornices of the vagina (sing. fornix of the vagina or fornix vaginae) are the superior portions of the vagina, extending into the recesses created by the vaginal portion of cervix. The word "fornix" is Latin for "arch". Structure There are t ...

); these are the anterior, posterior, right lateral, and left lateral fornices. The posterior fornix is deeper than the anterior fornix. Supporting the vagina are its upper, middle, and lower third muscles and ligaments. The upper third are the levator ani muscles, and the transcervical, pubocervical, and sacrocervical ligaments. It is supported by the upper portions of the cardinal ligaments and the parametrium. The middle third of the vagina involves the urogenital diaphragm. It is supported by the levator ani muscles and the lower portion of the cardinal ligaments. The lower third is supported by the perineal body, or the urogenital and

pelvic diaphragm The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the leva ...

s. The lower third may also be described as being supported by the perineal body and the pubovaginal part of the levator ani muscle.

Vaginal opening and hymen

The vaginal opening is at the posterior end of the

vulval vestibule The vulval vestibule (or vulvar vestibule or vestibule of vagina) is a part of the vulva between the labia minora into which the urinary meatus (urethral opening) and the vaginal opening open. Its edge is marked by Hart's line. It represents the ...

, behind the urethral opening. The opening to the vagina is normally obscured by the labia minora (vaginal lips), but may be exposed after

vaginal delivery A vaginal delivery is the birth of offspring in mammals (baby, babies in humans) through the vagina (also called the "birth canal"). It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, with l ...

. The hymen is a thin layer of mucosal tissue that surrounds or partially covers the vaginal opening. The effects of intercourse and childbirth on the hymen are variable. Where it is broken, it may completely disappear or remnants known as ''carunculae myrtiformes'' may persist. Otherwise, being very elastic, it may return to its normal position. Additionally, the hymen may be lacerated by disease, injury,

medical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient ...

masturbation Masturbation is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrators, or combinatio ...

physical exercise Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...

. For these reasons,

virginity Virginity is the state of a person who has never engaged in sexual intercourse. The term ''virgin'' originally only referred to sexually inexperienced women, but has evolved to encompass a range of definitions, as found in traditional, modern ...

cannot be definitively determined by examining the hymen.

Variations and size

The length of the vagina varies among women of child-bearing age. Because of the presence of the cervix in the front wall of the vagina, there is a difference in length between the front wall, approximately 7.5 cm (2.5 to 3 in) long, and the back wall, approximately 9 cm (3.5 in) long. During sexual arousal, the vagina expands both in length and width. If a woman stands upright, the vaginal canal points in an upward-backward direction and forms an angle of approximately 45 degrees with the uterus. The vaginal opening and hymen also vary in size; in children, although the hymen commonly appears crescent-shaped, many shapes are possible.

Development

The vaginal plate is the precursor to the vagina. During development, the vaginal plate begins to grow where the fused ends of the

paramesonephric duct Paramesonephric ducts (or Müllerian ducts) are paired ducts of the embryo that run down the lateral sides of the genital ridge and terminate at the sinus tubercle in the primitive urogenital sinus. In the female, they will develop to form the fal ...

s (Müllerian ducts) enter the back wall of the

urogenital sinus The urogenital sinus is a part of the human body only present in the development of the urinary and reproductive organs. It is the ventral part of the cloaca, formed after the cloaca separates from the anal canal during the fourth to seventh we ...

as the sinus tubercle. As the plate grows, it significantly separates the cervix and the urogenital sinus; eventually, the central cells of the plate break down to form the vaginal lumen. This usually occurs by the twenty to twenty-fourth week of development. If the lumen does not form, or is incomplete, membranes known as vaginal septae can form across or around the tract, causing obstruction of the outflow tract later in life. During sexual differentiation, without

testosterone Testosterone is the primary sex hormone and anabolic steroid in males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testes and prostate, as well as promoting secondar ...

, the urogenital sinus persists as the vestibule of the vagina. The two

urogenital folds The development of the reproductive system is the part of embryonic growth that results in the sex organs and contributes to sexual differentiation. Due to its large overlap with development of the urinary system, the two systems are typically ...

of the genital tubercle form the labia minora, and the

labioscrotal swelling The labioscrotal swellings (genital swellings or labioscrotal folds) are paired structures in the human embryo that represent the final stage of development of the caudal end of the external genitals before sexual differentiation. In both males a ...

s enlarge to form the

labia majora The labia majora (singular: ''labium majus'') are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum. Together with the labia minora they form the labia of the vulva. The labia majo ...

. There are conflicting views on the embryologic origin of the vagina. The majority view is Koff's 1933 description, which posits that the upper two-thirds of the vagina originate from the caudal part of the Müllerian duct, while the lower part of the vagina develops from the urogenital sinus. Other views are Bulmer's 1957's description that the vaginal epithelium derives solely from the urogenital sinus epithelium, and Witschi's 1970 research, which reexamined Koff's description and concluded that the sinovaginal bulbs are the same as the lower portions of the

Wolffian duct The mesonephric duct (also known as the Wolffian duct, archinephric duct, Leydig's duct or nephric duct) is a paired organ that forms during the embryonic development of humans and other mammals and gives rise to male reproductive organs. Stru ...

s. Witschi's view is supported by research by Acién et al., Bok and Drews. Robboy et al. reviewed Koff and Bulmer's theories, and support Bulmer's description in light of their own research. The debates stem from the complexity of the interrelated tissues and the absence of an animal model that matches human vaginal development. Because of this, study of human vaginal development is ongoing and may help resolve the conflicting data.

Microanatomy

The vaginal wall from the lumen outwards consists firstly of a

mucosa A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...

stratified squamous epithelium A stratified squamous epithelium consists of squamous (flattened) epithelial cells arranged in layers upon a basal membrane. Only one layer is in contact with the basement membrane; the other layers adhere to one another to maintain structural i ...

that is not keratinized, with a

lamina propria The lamina propria is a thin layer of connective tissue that forms part of the moist linings known as mucous membranes or mucosae, which line various tubes in the body, such as the respiratory tract, the gastrointestinal tract, and the urogenita ...

(a thin layer of

) underneath it. Secondly, there is a layer of

smooth muscle Smooth muscle is an involuntary non-striated muscle, so-called because it has no sarcomeres and therefore no striations (''bands'' or ''stripes''). It is divided into two subgroups, single-unit and multiunit smooth muscle. Within single-unit mus ...

with bundles of circular fibers internal to longitudinal fibers (those that run lengthwise). Lastly, is an outer layer of connective tissue called the adventitia. Some texts list four layers by counting the two sublayers of the mucosa (epithelium and lamina propria) separately. The smooth muscular layer within the vagina has a weak contractive force that can create some pressure in the lumen of the vagina; much stronger contractive force, such as during childbirth, comes from muscles in the

pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the lev ...

that are attached to the adventitia around the vagina. The lamina propria is rich in blood vessels and lymphatic channels. The muscular layer is composed of smooth muscle fibers, with an outer layer of longitudinal muscle, an inner layer of circular muscle, and oblique muscle fibers between. The outer layer, the adventitia, is a thin dense layer of connective tissue and it blends with loose connective tissue containing blood vessels,

lymphatic vessel The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph vess ...

s and nerve fibers that are between pelvic organs. The vaginal mucosa is absent of glands. It forms folds (transverse ridges or

rugae In anatomy, rugae are a series of ridges produced by folding of the wall of an organ. Most commonly rugae refers to the gastric rugae of the internal surface of the stomach. Function A purpose of the gastric rugae is to allow for expansion of ...

), which are more prominent in the outer third of the vagina; their function is to provide the vagina with increased surface area for extension and stretching. Rugae vaginales

The epithelium of the ectocervix (the portion the uterine cervix extending into the vagina) is an extension of, and shares a border with, the vaginal epithelium. The vaginal epithelium is made up of layers of cells, including the

basal cells The ''stratum basale'' (basal layer, sometimes referred to as ''stratum germinativum'') is the deepest layer of the five layers of the epidermis, the external covering of skin in mammals. The ''stratum basale'' is a single layer of columnar or ...

, the parabasal cells, the superficial squamous flat cells, and the intermediate cells. The basal layer of the epithelium is the most mitotically active and reproduces new cells. The superficial cells

shed A shed is typically a simple, single-story roofed structure that is used for hobbies, or as a workshop in a back garden or on an allotment. Sheds vary considerably in their size and complexity of construction, from simple open-sided ones de ...

continuously and basal cells replace them.

Estrogen Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal acti ...

induces the intermediate and superficial cells to fill with

glycogen Glycogen is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals, fungi, and bacteria. The polysaccharide structure represents the main storage form of glucose in the body. Glycogen functions as one o ...

. Cells from the lower basal layer transition from active metabolic activity to death (

apoptosis Apoptosis (from grc, ἀπόπτωσις, apóptōsis, 'falling off') is a form of programmed cell death that occurs in multicellular organisms. Biochemical events lead to characteristic cell changes (morphology) and death. These changes incl ...

). In these mid-layers of the epithelia, the cells begin to lose their

mitochondria A mitochondrion (; ) is an organelle found in the Cell (biology), cells of most Eukaryotes, such as animals, plants and Fungus, fungi. Mitochondria have a double lipid bilayer, membrane structure and use aerobic respiration to generate adenosi ...

and other

organelle In cell biology, an organelle is a specialized subunit, usually within a cell, that has a specific function. The name ''organelle'' comes from the idea that these structures are parts of cells, as organs are to the body, hence ''organelle,'' the ...

s. The cells retain a usually high level of glycogen compared to other epithelial tissue in the body. Under the influence of maternal estrogen, the vagina of a newborn is lined by thick stratified squamous epithelium (or mucosa) for two to four weeks after birth. Between then to

puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a boy. ...

, the epithelium remains thin with only a few layers of cuboidal cells without glycogen. The epithelium also has few rugae and is red in color before puberty. When puberty begins, the mucosa thickens and again becomes stratified squamous epithelium with glycogen containing cells, under the influence of the girl's rising estrogen levels. Finally, the epithelium thins out from

menopause Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...

onward and eventually ceases to contain glycogen, because of the lack of estrogen. Flattened squamous cells are more resistant to both abrasion and infection. The permeability of the epithelium allows for an effective response from the

immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...

since

antibodies An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the ...

and other immune components can easily reach the surface. The vaginal epithelium differs from the similar tissue of the skin. The

epidermis The epidermis is the outermost of the three layers that comprise the skin, the inner layers being the dermis and hypodermis. The epidermis layer provides a barrier to infection from environmental pathogens and regulates the amount of water rele ...

of the skin is relatively resistant to water because it contains high levels of lipids. The vaginal epithelium contains lower levels of lipids. This allows the passage of water and water-soluble substances through the tissue. Keratinization happens when the epithelium is exposed to the dry external atmosphere. In abnormal circumstances, such as in pelvic organ prolapse, the mucosa may be exposed to air, becoming dry and keratinized.

Blood and nerve supply

Blood is supplied to the vagina mainly via the vaginal artery, which emerges from a branch of the

internal iliac artery The internal iliac artery (formerly known as the hypogastric artery) is the main artery of the pelvis. Structure The internal iliac artery supplies the walls and viscera of the pelvis, the buttock, the reproductive organs, and the medial compart ...

or the uterine artery. The vaginal arteries anastamose (are joined) along the side of the vagina with the cervical branch of the uterine artery; this forms the azygos artery, which lies on the midline of the anterior and posterior vagina. Other arteries which supply the vagina include the middle rectal artery and the internal pudendal artery, all branches of the internal iliac artery. Three groups of lymphatic vessels accompany these arteries; the upper group accompanies the vaginal branches of the uterine artery; a middle group accompanies the vaginal arteries; and the lower group, draining lymph from the area outside the hymen, drain to the inguinal lymph nodes. Ninety-five percent of the lymphatic channels of the vagina are within 3 mm of the surface of the vagina. Two main veins drain blood from the vagina, one on the left and one on the right. These form a network of smaller veins, the

vaginal venous plexus The vaginal venous plexus is a group of veins draining blood from the vagina. It lies around the sides of the vagina. Its blood is eventually into the internal iliac veins. Structure The vaginal venous plexus lies around the sides of the vagi ...

, on the sides of the vagina, connecting with similar venous plexuses of the

bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

, and

. These ultimately drain into the internal iliac veins. The nerve supply of the upper vagina is provided by the sympathetic and

parasympathetic The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of t ...

areas of the

pelvic plexus The inferior hypogastric plexus (pelvic plexus in some texts) is a network () of nerves that supplies the organs of the pelvic cavity. The inferior hypogastric plexus gives rise to the prostatic plexus in males and the uterovaginal plexus in female ...

. The lower vagina is supplied by the pudendal nerve.

Function

Secretions

Vaginal secretions are primarily from the

, cervix, and vaginal epithelium in addition to minuscule

from the

Bartholin's gland The Bartholin's glands (named after Caspar Bartholin the Younger; also called Bartholin glands or greater vestibular glands) are two pea sized compound alveolar glandsManual of Obstetrics. (3rd ed.). Elsevier. pp. 1-16. . located slightly poster ...

s upon sexual arousal. It takes little vaginal secretion to make the vagina moist; secretions may increase during sexual arousal, the middle of or a little prior to

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hor ...

, or during

. Menstruation (also known as a "period" or "monthly") is the regular discharge of blood and mucosal tissue (known as menses) from the inner lining of the uterus through the vagina. The vaginal mucous membrane varies in thickness and composition during the

, which is the regular, natural change that occurs in the female reproductive system (specifically the uterus and

ovaries The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. T ...

) that makes pregnancy possible. Different hygiene products such as tampons, menstrual cups, and sanitary napkins are available to absorb or capture menstrual blood. The Bartholin's glands, located near the vaginal opening, were originally considered the primary source for vaginal lubrication, but further examination showed that they provide only a few drops of

mucus Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is ...

. Vaginal lubrication is mostly provided by plasma seepage known as

transudate Transudate is extravascular fluid with low protein content and a low specific gravity (< 1.012). It has low nucleated cell counts (less than 500 to 1000 /microliter) and the primary cell types are vasocongestion), resulting in the release of plasma as transudate from the capillaries through the vaginal epithelium. Before and during ovulation, the mucus glands within the cervix secrete different variations of mucus, which provides an

alkaline In chemistry, an alkali (; from ar, القلوي, al-qaly, lit=ashes of the saltwort) is a base (chemistry), basic, ionic compound, ionic salt (chemistry), salt of an alkali metal or an alkaline earth metal. An alkali can also be defined as ...

fertile Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Fertilit ...

environment in the vaginal canal that is favorable to the survival of

sperm Sperm is the male reproductive cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm with a tail known as a flagellum, whi ...

. Following menopause, vaginal lubrication naturally decreases.

Sexual activity

Nerve endings in the vagina can provide pleasurable sensations when the vagina is stimulated during sexual activity. Women may derive pleasure from one part of the vagina, or from a feeling of closeness and fullness during vaginal penetration. Because the vagina is not rich in nerve endings, women often do not receive sufficient sexual stimulation, or

orgasm Orgasm (from Greek , ; "excitement, swelling") or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region charac ...

, solely from vaginal penetration. Although the literature commonly cites a greater concentration of nerve endings and therefore greater sensitivity near the vaginal entrance (the outer one-third or lower third), some scientific examinations of vaginal wall innervation indicate no single area with a greater density of nerve endings. Other research indicates that only some women have a greater density of nerve endings in the anterior vaginal wall. Because of the fewer nerve endings in the vagina, childbirth pain is significantly more tolerable. Pleasure can be derived from the vagina in a variety of ways. In addition to

penile A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do ...

penetration, pleasure can come from

, fingering, oral sex ( cunnilingus), or specific sex positions (such as the missionary position or the

spoons sex position The spoons position or spooning is both a sexual position and a cuddling technique. The name derives from the way that two spoons may be positioned side by side, with bowls aligned. The sexual spoons position is a form of a rear-entry position, a ...

). Heterosexual couples may engage in cunnilingus or fingering as forms of foreplay to incite sexual arousal or as accompanying acts, or as a type of

birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...

, or to preserve virginity.Se
272
an
page 301
for two different definitions of outercourse (first of the pages for no-penetration definition; second of the pages for no-penile-penetration definition). Less commonly, they may use non penile-vaginal sexual acts as a primary means of sexual pleasure. In contrast,

s and other

women who have sex with women Women who have sex with women (WSW) are women who engage in sexual activities with other women, whether they identify themselves as lesbian, bisexual, or heterosexual, or dispense with sexual identification altogether. The term ''WSW'' is often us ...

commonly engage in cunnilingus or fingering as main forms of sexual activity. Some women and couples use sex toys, such as a vibrator or

dildo A dildo is a sex toy, often explicitly phallic in appearance, intended for sexual penetration or other sexual activity during masturbation or with sex partners. Dildos can be made from a number of materials and shaped like an erect human penis ...

, for vaginal pleasure. The '' Kama Sutra'' – an ancient

Hindu Hindus (; ) are people who religiously adhere to Hinduism.Jeffery D. Long (2007), A Vision for Hinduism, IB Tauris, , pages 35–37 Historically, the term has also been used as a geographical, cultural, and later religious identifier for ...

text written by

Vātsyāyana Vātsyāyana was an ancient Indian philosopher, known for authoring the ''Kama Sutra''. He was a brahmin, and lived in India during the second or third century CE, probably in Pataliputra (modern day Patna in Bihar). He is not to be confused w ...

, which includes a number of sexual positions – may also be used to increase sexual pleasure, with special emphasis on female sexual satisfaction. Most women require direct stimulation of the

clitoris The clitoris ( or ) is a female sex organ present in mammals, ostriches and a limited number of other animals. In humans, the visible portion – the glans – is at the front junction of the labia minora (inner lips), above the ope ...

to orgasm. The clitoris plays a part in vaginal stimulation. It is a sex organ of multiplanar structure containing an abundance of nerve endings, with a broad attachment to the pubic arch and extensive supporting tissue to the labia. Research indicates that it forms a tissue cluster with the vagina. This tissue is perhaps more extensive in some women than in others, which may contribute to orgasms experienced vaginally. * * During sexual arousal, and particularly the stimulation of the clitoris, the walls of the vagina lubricate. This begins after ten to thirty seconds of sexual arousal, and increases in amount the longer the woman is aroused. It reduces friction or injury that can be caused by insertion of the penis into the vagina or other penetration of the vagina during sexual activity. The vagina lengthens during the arousal, and can continue to lengthen in response to pressure; as the woman becomes fully aroused, the vagina expands in length and width, while the cervix retracts. With the upper two-thirds of the vagina expanding and lengthening, the uterus rises into the

greater pelvis The pelvic cavity is a body cavity that is bounded by the bones of the pelvis. Its oblique roof is the pelvic inlet (the superior opening of the pelvis). Its lower boundary is the pelvic floor. The pelvic cavity primarily contains the reproducti ...

, and the cervix is elevated above the vaginal floor, resulting in tenting of the mid-vaginal plane. This is known as the tenting or ballooning effect. As the elastic walls of the vagina stretch or contract, with support from the pelvic muscles, to wrap around the inserted penis (or other object), this creates friction for the penis and helps to cause a man to experience orgasm and

, which in turn enables

. An area in the vagina that may be an

erogenous zone An erogenous zone (from Greek , ''érōs'' "love"; and English ''-genous'' "producing", from Greek , ''-genḗs'' "born") is an area of the human body that has heightened sensitivity, the stimulation of which may generate a sexual response, su ...

is the G-spot. It is typically defined as being located at the anterior wall of the vagina, a couple or few inches in from the entrance, and some women experience intense pleasure, and sometimes an orgasm, if this area is stimulated during sexual activity. A G-spot orgasm may be responsible for

female ejaculation Female ejaculation is characterized as an expulsion of fluid from the Skene's gland at the lower end of the urethra during or before an orgasm. It is also known colloquially as squirting (or gushing), although research indicates that female eja ...

, leading some doctors and researchers to believe that G-spot pleasure comes from the

Skene's gland In female human anatomy, Skene's glands or the Skene glands ( , also known as the lesser vestibular glands, paraurethral glands) are glands located around the lower end of the urethra. The glands are surrounded by tissue that swells with blood ...

s, a female homologue of the prostate, rather than any particular spot on the vaginal wall; other researchers consider the connection between the Skene's glands and the G-spot area to be weak. The G-spot's existence (and existence as a distinct structure) is still under dispute because reports of its location can vary from woman to woman, it appears to be nonexistent in some women, and it is hypothesized to be an extension of the clitoris and therefore the reason for orgasms experienced vaginally.

Childbirth

The vagina is the birth canal for the delivery of a baby. When labor nears, several signs may occur, including vaginal discharge and the rupture of membranes (water breaking). The latter results in a gush or small stream of

amniotic fluid The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products betwee ...

from the vagina. Water breaking most commonly happens at the beginning of labor. It happens before labor if there is a

premature rupture of membranes Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complicati ...

, which occurs in 10% of cases. Among women giving birth for the first time, Braxton Hicks contractions are mistaken for actual contractions, but they are instead a way for the body to prepare for true labor. They do not signal the beginning of labor, but they are usually very strong in the days leading up to labor. As the body prepares for childbirth, the cervix softens,

thins Thins is one of the largest brands of savoury snack potato chips currently available in Australia, and is owned by Snack Brands Australia. The snack food is a thinly-sliced variety of potato chip (crisp) and comes in a variety of flavours, includ ...

, moves forward to face the front, and begins to open. This allows the fetus to settle into the pelvis, a process known as lightening. As the fetus settles into the pelvis, pain from the

sciatic nerve The sciatic nerve, also called the ischiadic nerve, is a large nerve in humans and other vertebrate animals which is the largest branch of the sacral plexus and runs alongside the hip joint and down the lower limb. It is the longest and widest si ...

s, increased vaginal discharge, and increased urinary frequency can occur. While lightening is likelier to happen after labor has begun for women who have given birth before, it may happen ten to fourteen days before labor in women experiencing labor for the first time. The fetus begins to lose the support of the cervix when contractions begin. With cervical dilation reaching 10 cm to accommodate the head of the fetus, the head moves from the uterus to the vagina. The elasticity of the vagina allows it to stretch to many times its normal diameter in order to deliver the child. Vaginal births are more common, but if there is a risk of complications a

caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...

(C-section) may be performed. The vaginal mucosa has an abnormal accumulation of fluid ( edematous) and is thin, with few rugae, a little after birth. The mucosa thickens and rugae return in approximately three weeks once the ovaries regain usual function and estrogen flow is restored. The vaginal opening gapes and is relaxed, until it returns to its approximate pre-pregnant state six to eight weeks after delivery, known as the

postpartum period The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal perio ...

; however, the vagina will continue to be larger in size than it was previously. After giving birth, there is a phase of vaginal discharge called lochia that can vary significantly in the amount of loss and its duration but can go on for up to six weeks.

Vaginal microbiota

The

vaginal flora Vaginal flora, vaginal microbiota or vaginal microbiome are the microorganisms that colonize the vagina. They were discovered by the German gynecologist Albert Döderlein in 1892 and are part of the overall human flora. The amount and type o ...

is a complex

ecosystem An ecosystem (or ecological system) consists of all the organisms and the physical environment with which they interact. These biotic and abiotic components are linked together through nutrient cycles and energy flows. Energy enters the syste ...

that changes throughout life, from birth to menopause. The vaginal microbiota resides in and on the outermost layer of the vaginal epithelium. This microbiome consists of species and genera which typically do not cause symptoms or infections in women with normal immunity. The vaginal microbiome is dominated by '' Lactobacillus'' species. These species

metabolize Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...

glycogen, breaking it down into sugar. ''Lactobacilli'' metabolize the sugar into glucose and lactic acid. Under the influence of hormones, such as estrogen, progesterone and

follicle-stimulating hormone Follicle-stimulating hormone (FSH) is a gonadotropin, a glycoprotein polypeptide hormone. FSH is synthesized and secreted by the gonadotropic cells of the anterior pituitary gland and regulates the development, growth, pubertal maturation, an ...

(FSH), the vaginal ecosystem undergoes cyclic or periodic changes.

Clinical significance

Pelvic examinations

Vaginal health can be assessed during a

pelvic examination A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, dis ...

, along with the health of most of the organs of the female reproductive system. Such exams may include the Pap test (or cervical smear). In the United States, Pap test screening is recommended starting around 21 years of age until the age of 65. However, other countries do not recommend pap testing in non-sexually active women. Guidelines on frequency vary from every three to five years. Routine pelvic examination on adult women who are not pregnant and lack symptoms may be more harmful than beneficial. ree text/ref> A normal finding during the pelvic exam of a pregnant women is a bluish tinge to the vaginal wall. Pelvic exams are most often performed when there are unexplained symptoms of discharge, pain, unexpected bleeding or urinary problems. During a pelvic exam, the vaginal opening is assessed for position,

symmetry Symmetry (from grc, συμμετρία "agreement in dimensions, due proportion, arrangement") in everyday language refers to a sense of harmonious and beautiful proportion and balance. In mathematics, "symmetry" has a more precise definit ...

, presence of the hymen, and shape. The vagina is assessed internally by the examiner with gloved fingers, before the speculum is inserted, to note the presence of any weakness, lumps or

nodules Nodule may refer to: *Nodule (geology), a small rock or mineral cluster *Manganese nodule, a metallic concretion found on the seafloor *Nodule (medicine), a small aggregation of cells *Root nodule Root nodules are found on the roots of plants, p ...

. Inflammation and discharge are noted if present. During this time, the Skene's and Bartolin's glands are palpated to identify abnormalities in these structures. After the digital examination of the vagina is complete, the speculum, an instrument to visualize internal structures, is carefully inserted to make the cervix visible. Examination of the vagina may also be done during a

cavity search A body cavity search, also known simply as a cavity search, is either a visual search or a manual internal inspection of body cavities for prohibited materials (contraband), such as illegal drugs, money, jewelry, or weapons. Body cavities frequen ...

. Lacerations or other injuries to the vagina can occur during

sexual assault Sexual assault is an act in which one intentionally sexually touches another person without that person's consent, or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which ...

or other sexual abuse. These can be tears, bruises, inflammation and abrasions. Sexual assault with objects can damage the vagina and

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

examination may reveal the presence of foreign objects. If consent is given, a pelvic examination is part of the assessment of sexual assault. Pelvic exams are also performed during pregnancy, and women with high risk pregnancies have exams more often.

Medications

Intravaginal administration Intravaginal administration is a route of administration where the substance is applied inside the vagina. Pharmacologically, it has the potential advantage to result in effects primarily in the vagina or nearby structures (such as the vaginal po ...

is a

route of administration A route of administration in pharmacology and toxicology is the way by which a medication, drug, fluid, poison, or other substance is taken into the body. Routes of administration are generally classified by the location at which the substance i ...

where the medication is inserted into the vagina as a creme or tablet. Pharmacologically, this has the potential advantage of promoting

therapeutic effect Therapeutic effect refers to the response(s) after a treatment of any kind, the results of which are judged to be useful or favorable. This is true whether the result was expected, unexpected, or even an unintended consequence. An adverse effect (i ...

s primarily in the vagina or nearby structures (such as the vaginal portion of cervix) with limited systemic

adverse effect An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complica ...

s compared to other routes of administration. Medications used to ripen the cervix and induce labor are commonly administered via this route, as are estrogens, contraceptive agents, propranolol, and

antifungals An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as crypto ...

Vaginal ring Vaginal rings (also known as intravaginal rings, or V-Rings) are polymeric drug delivery devices designed to provide controlled release of drugs for intravaginal administration over extended periods of time. The ring is inserted into the vagina a ...

s can also be used to deliver medication, including

in contraceptive vaginal rings. These are inserted into the vagina and provide continuous, low dose and consistent drug levels in the vagina and throughout the body. Before the baby merges from the womb, an injection for pain control during childbirth may be administered through the vaginal wall and near the pudendal nerve. Because the pudendal nerve carries motor and sensory fibers that innervate the pelvic muscles, a

pudendal nerve block Pudendal anesthesia, also known as a pudendal block, or saddle block, is a form of local anesthesia commonly used in the practice of obstetrics to relieve pain during the delivery of baby by forceps. The pudendal nerve block prevents fainting during ...

relieves birth pain. The medicine does not harm the child, and is without significant complications.

Infections, diseases, and safe sex

Vaginal infections or diseases include yeast infection,

vaginitis Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy. The three main ...

sexually transmitted infection Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are Transmission (medicine), spread by Human sexual activity, sexual activity, especi ...

s (STIs) and

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

. ''Lactobacillus gasseri'' and other ''Lactobacillus'' species in the vaginal flora provide some protection from infections by their secretion of bacteriocins and

hydrogen peroxide Hydrogen peroxide is a chemical compound with the formula . In its pure form, it is a very pale blue liquid that is slightly more viscous than water. It is used as an oxidizer, bleaching agent, and antiseptic, usually as a dilute solution (3%� ...

. The healthy vagina of a woman of child-bearing age is

acid In computer science, ACID ( atomicity, consistency, isolation, durability) is a set of properties of database transactions intended to guarantee data validity despite errors, power failures, and other mishaps. In the context of databases, a sequ ...

ic, with a pH normally ranging between 3.8 and 4.5. The low pH prohibits growth of many strains of

pathogen In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...

ic microbes. The acidic balance of the vagina may also be affected by pregnancy, menstruation,

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

or other illness,

birth control pills Oral contraceptives, abbreviated OCPs, also known as birth control pills, are medications taken by mouth for the purpose of birth control. Female Two types of female oral contraceptive pill, taken once per day, are widely available: * The combin ...

, certain

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

, poor diet, and stress (such as from a lack of sleep). Any of these changes to the acidic balance of the vagina may contribute to yeast infection. An elevated pH (greater than 4.5) of the vaginal fluid can be caused by an overgrowth of bacteria as in

bacterial vaginosis Bacterial vaginosis (BV) is a disease of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination ...

, or in the parasitic infection

trichomoniasis Trichomoniasis (trich) is an infectious disease caused by the parasite ''Trichomonas vaginalis''. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms ca ...

, both of which have vaginitis as a symptom. Vaginal flora populated by a number of different bacteria characteristic of bacterial vaginosis increases the risk of adverse pregnancy outcomes. During a pelvic exam, samples of vaginal fluids may be taken to screen for sexually transmitted infections or other infections. Because the vagina is self-cleansing, it usually does not need special hygiene. Clinicians generally discourage the practice of

douching A douche is a device used to introduce a stream of water into the body for medical or hygienic reasons, or the stream of water itself. Douche usually refers to vaginal irrigation, the rinsing of the vagina, but it can also refer to the rinsing ...

for maintaining vulvovaginal health. Since the vaginal flora gives protection against disease, a disturbance of this balance may lead to infection and abnormal discharge. Vaginal discharge may indicate a vaginal infection by color and odor, or the resulting symptoms of discharge, such as irritation or burning. Abnormal vaginal discharge may be caused by STIs, diabetes, douches, fragranced soaps, bubble baths, birth control pills, yeast infection (commonly as a result of antibiotic use) or another form of vaginitis. While vaginitis is an inflammation of the vagina, and is attributed to infection, hormonal issues, or irritants, vaginismus is an involuntary tightening of the vagina muscles during vaginal penetration that is caused by a

conditioned reflex Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus A stimulus is something that causes a physiological response. It may refer to: *Stimulation **Stimulus ...

or disease. Vaginal discharge due to yeast infection is usually thick, creamy in color and odorless, while discharge due to bacterial vaginosis is gray-white in color, and discharge due to trichomoniasis is usually a gray color, thin in consistency, and has a fishy odor. Discharge in 25% of the trichomoniasis cases is yellow-green.

HIV/AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...

human papillomavirus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and res ...

(HPV), genital herpes and trichomoniasis are some STIs that may affect the vagina, and health sources recommend

(or barrier method) practices to prevent the transmission of these and other STIs. Safe sex commonly involves the use of

condom A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of in ...

s, and sometimes

female condom An internal condom (also known as a femidom or female condom) is a barrier device that is used during sexual intercourse as a barrier contraceptive to reduce the probability of pregnancy or a sexually transmitted infection (STI). Meant as an al ...

s (which give women more control). Both types can help avert pregnancy by preventing semen from coming in contact with the vagina. There is, however, little research on whether female condoms are as effective as male condoms at preventing STIs, and they are slightly less effective than male condoms at preventing pregnancy, which may be because the female condom fits less tightly than the male condom or because it can slip into the vagina and spill semen. The vaginal lymph nodes often trap

ous cells that originate in the vagina. These nodes can be assessed for the presence of disease. Selective surgical removal (rather than total and more invasive removal) of vaginal lymph nodes reduces the risk of complications that can accompany more radical surgeries. These selective nodes act as sentinel lymph nodes. Instead of surgery, the lymph nodes of concern are sometimes treated with

radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...

administered to the patient's pelvic, inguinal lymph nodes, or both.

Vaginal cancer Vaginal cancer is an extraordinarily rare form of cancer that develops in the tissue of the vagina. Primary vaginal cancer originates from the vaginal tissue – most frequently squamous cell carcinoma, but primary vaginal adenocarcinoma, sarcoma ...

and

vulvar cancer Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or vaginal glands are affected. Symptoms include a lump, itchiness, changes in t ...

are very rare, and primarily affect older women.

Cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...

(which is relatively common) increases the risk of vaginal cancer, which is why there is a significant chance for vaginal cancer to occur at the same time as, or after, cervical cancer. It may be that their causes are the same. Cervical cancer may be prevented by pap smear screening and

HPV vaccine Human papillomavirus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus (HPV). Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HP ...

s, but HPV vaccines only cover HPV types 16 and 18, the cause of 70% of cervical cancers. Some symptoms of cervical and vaginal cancer are

dyspareunia Dyspareunia ( ) is painful sexual intercourse due to medical or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the f ...

, and abnormal vaginal bleeding or vaginal discharge, especially after sexual intercourse or menopause. However, most cervical cancers are

asymptomatic In medicine, any disease is classified asymptomatic if a patient tests as carrier for a disease or infection but experiences no symptoms. Whenever a medical condition fails to show noticeable symptoms after a diagnosis it might be considered asy ...

(present no symptoms). Vaginal intracavity brachytherapy (VBT) is used to treat

endometrial The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional layer ...

, vaginal and cervical cancer. An applicator is inserted into the vagina to allow the administration of radiation as close to the site of the cancer as possible. Survival rates increase with VBT when compared to external beam radiation therapy. By using the vagina to place the emitter as close to the cancerous growth as possible, the systemic effects of radiation therapy are reduced and cure rates for vaginal cancer are higher. Research is unclear on whether treating cervical cancer with radiation therapy increases the risk of vaginal cancer.

Effects of aging and childbirth

Age and hormone levels significantly correlate with the pH of the vagina. Estrogen, glycogen and lactobacilli impact these levels. At birth, the vagina is acidic with a pH of approximately 4.5, and ceases to be acidic by three to six weeks of age, becoming alkaline. Average vaginal pH is 7.0 in pre-pubertal girls. Although there is a high degree of variability in timing, girls who are approximately seven to twelve years of age will continue to have labial development as the hymen thickens and the vagina elongates to approximately 8 cm. The vaginal mucosa thickens and the vaginal pH becomes acidic again. Girls may also experience a thin, white vaginal discharge called

leukorrhea Leukorrhea or (leucorrhoea American and British English spelling differences, British English), also known as fluor albus, is a thick, whitish, yellowish or greenish vaginal discharge. It has also been referred to as "the whites". There are many ...

. The vaginal microbiota of adolescent girls aged 13 to 18 years is similar to women of reproductive age, who have an average vaginal pH of 3.8–4.5, but research is not as clear on whether this is the same for premenarcheal or perimenarcheal girls. The vaginal pH during menopause is 6.5–7.0 (without hormone replacement therapy), or 4.5–5.0 with hormone replacement therapy. Vaginal Mucosa Normal vs Menopause

After menopause, the body produces less estrogen. This causes

atrophic vaginitis Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to not enough estrogen. Symptoms may include pain with sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does no ...

(thinning and inflammation of the vaginal walls), which can lead to vaginal itching, burning, bleeding, soreness, or

vaginal dryness Vaginal lubrication is a naturally produced fluid that lubricates a vagina. Vaginal lubrication is always present, but production increases significantly near ovulation and during sexual arousal in anticipation of sexual intercourse. Vaginal ...

(a decrease in lubrication). Vaginal dryness can cause discomfort on its own or discomfort or pain during sexual intercourse.

Hot flash Hot flashes (also known as hot flushes) are a form of flushing, often caused by the changing hormone levels that are characteristic of menopause. They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and ...

es are also characteristic of menopause. Menopause also affects the composition of vaginal support structures. The vascular structures become fewer with advancing age. Specific

collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whole ...

s become altered in composition and ratios. It is thought that the weakening of the support structures of the vagina is due to the physiological changes in this connective tissue. Menopausal symptoms can be eased by estrogen-containing vaginal creams, non-prescription, non-hormonal medications, vaginal estrogen rings such as the

Femring Estradiol acetate (EA), sold under the brand names Femtrace, Femring, and Menoring, is an estrogen medication which is used in hormone therapy for the treatment of menopausal symptoms in women.https://www.accessdata.fda.gov/drugsatfda_docs/label/ ...

, or other hormone replacement therapies, but there are risks (including adverse effects) associated with hormone replacement therapy. Vaginal creams and vaginal estrogen rings may not have the same risks as other hormone replacement treatments. Hormone replacement therapy can treat vaginal dryness, but a personal lubricant may be used to temporarily remedy vaginal dryness specifically for sexual intercourse. Some women have an increase in sexual desire following menopause. It may be that menopausal women who continue to engage in sexual activity regularly experience vaginal lubrication similar to levels in women who have not entered menopause, and can enjoy sexual intercourse fully. They may have less vaginal atrophy and fewer problems concerning sexual intercourse. Vaginal changes that happen with aging and childbirth include mucosal redundancy, rounding of the posterior aspect of the vagina with shortening of the distance from the distal end of the anal canal to the vaginal opening, diastasis or disruption of the

pubococcygeus muscle The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...

s caused by poor repair of an

episiotomy Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening ...

, and blebs that may protrude beyond the area of the vaginal opening. Other vaginal changes related to aging and childbirth are

stress urinary incontinence Stress incontinence, also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the Urinary bladder, bladder outlet by the Urethral sphincters, urethral sphincter. ...

, rectocele, and

cystocele A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complicat ...

. Physical changes resulting from pregnancy, childbirth, and menopause often contribute to stress urinary incontinence. If a woman has weak

muscle support and tissue damage from childbirth or pelvic surgery, a lack of estrogen can further weaken the pelvic muscles and contribute to stress urinary incontinence. Pelvic organ prolapse, such as a rectocele or cystocele, is characterized by the descent of pelvic organs from their normal positions to impinge upon the vagina. A reduction in estrogen does not cause rectocele, cystocele or uterine prolapse, but childbirth and weakness in pelvic support structures can. Prolapse may also occur when the pelvic floor becomes injured during a

hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

, gynecological cancer treatment, or heavy lifting. Pelvic floor exercises such as Kegel exercises can be used to strengthen the pelvic floor muscles, preventing or arresting the progression of prolapse. There is no evidence that doing Kegel exercises isotonically or with some form of weight is superior; there are greater risks with using weights since a foreign object is introduced into the vagina. During the third stage of labor, while the infant is being born, the vagina undergoes significant changes. A gush of blood from the vagina may be seen right before the baby is born. Lacerations to the vagina that can occur during birth vary in depth, severity and the amount of adjacent tissue involvement. The laceration can be so extensive as to involve the rectum and

anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, d ...

. This event can be especially distressing to a new mother. When this occurs, fecal incontinence develops and stool can leave through the vagina. Close to 85% of

spontaneous vaginal birth A vaginal delivery is the birth of offspring in mammals (babies in humans) through the vagina (also called the "birth canal"). It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, with lower m ...

s develop some form of tearing. Out of these, 60–70% require

suturing A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of threa ...

. Lacerations from labor do not always occur.

Surgery

The vagina, including the vaginal opening, may be altered as a result of surgeries such as an episiotomy,

vaginectomy Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender affirmation surgery. ...

, vaginoplasty or labiaplasty. Those who undergo vaginoplasty are usually older and have given birth. A thorough examination of the vagina before a vaginoplasty is standard, as well as a referral to a

urogynecologist Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology. History In 1893, Howard Kelly, a gynecologist and pioneering urogynecologist, invented an air cystoscope which was simply a handheld, hollow tube with a glass ...

to diagnose possible vaginal disorders. With regard to labiaplasty, reduction of the labia minora is quick without hindrance, complications are minor and rare, and can be corrected. Any scarring from the procedure is minimal, and long-term problems have not been identified. During an episiotomy, a surgical incision is made during the second stage of labor to enlarge the vaginal opening for the baby to pass through. Although its routine use is no longer recommended, and not having an episiotomy is found to have better results than an episiotomy, it is one of the most common medical procedures performed on women. The incision is made through the skin, vaginal epithelium, subcutaneous fat, perineal body and superficial transverse perineal muscle and extends from the vagina to the anus. Episiotomies can be painful after delivery. Women often report pain during sexual intercourse up to three months after laceration repair or an episiotomy. Some surgical techniques result in less pain than others. The two types of episiotomies performed are the medial incision and the medio-lateral incision. The median incision is a perpendicular cut between the vagina and the anus and is the most common. The medio-lateral incision is made between the vagina at an angle and is not as likely to tear through to the anus. The medio-lateral cut takes more time to heal than the median cut. Vaginectomy is surgery to remove all or part of the vagina, and is usually used to treat malignancy. Removal of some or all of the reproductive organs and genitalia can result in damage to the nerves and leave behind scarring or adhesions. Sexual function may also be impaired as a result, as in the case of some cervical cancer surgeries. These surgeries can impact pain, elasticity, vaginal lubrication and sexual arousal. This often resolves after one year but may take longer. Women, especially those who are older and have had multiple births, may choose to surgically correct vaginal laxity. This surgery has been described as vaginal tightening or rejuvenation. While a woman may experience an improvement in self-image and sexual pleasure by undergoing vaginal tightening or rejuvenation, there are risks associated with the procedures, including infection, narrowing of the vaginal opening, insufficient tightening, decreased sexual function (such as pain during sexual intercourse), and

rectovaginal fistula A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistulae may be extremely debilitating. If the opening between the rectum and vagina is wide it will allo ...

. Women who undergo this procedure may unknowingly have a medical issue, such as a prolapse, and an attempt to correct this is also made during the surgery. Surgery on the vagina can be elective or cosmetic. Women who seek cosmetic surgery can have

congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

conditions, physical discomfort or wish to alter the appearance of their genitals. Concerns over average genital appearance or measurements are largely unavailable and make defining a successful outcome for such surgery difficult. A number of sex reassignment surgeries are available to

transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through tr ...

people. Although not all

intersex Intersex people are individuals born with any of several sex characteristics including chromosome patterns, gonads, or genitals that, according to the Office of the United Nations High Commissioner for Human Rights, "do not fit typical bina ...

conditions require surgical treatment, some choose genital surgery to correct atypical anatomical conditions.

Anomalies and other health issues

Vaginal anomalies Vaginal anomalies are abnormal structures that are formed (or not formed) during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina. When present, they are often f ...

are defects that result in an abnormal or absent vagina. The most common obstructive vaginal anomaly is an imperforate hymen, a condition in which the hymen obstructs menstrual flow or other vaginal secretions. Another vaginal anomaly is a transverse vaginal septum, which partially or completely blocks the vaginal canal. The precise cause of an obstruction must be determined before it is repaired, since corrective surgery differs depending on the cause. In some cases, such as isolated

vaginal agenesis Vaginal atresia is a condition in which the vagina is abnormally closed or absent. The main causes can either be complete vaginal hypoplasia, or a vaginal obstruction, often caused by an imperforate hymen or, less commonly, a transverse vaginal sep ...

, the external genitalia may appear normal. Abnormal openings known as fistulas can cause

urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra. Cel ...

feces Feces ( or faeces), known colloquially and in slang as poo and poop, are the solid or semi-solid remains of food that was not digested in the small intestine, and has been broken down by bacteria in the large intestine. Feces contain a relati ...

to enter the vagina, resulting in incontinence. The vagina is susceptible to fistula formation because of its proximity to the urinary and gastrointestinal tracts. Specific causes are manifold and include obstructed labor, hysterectomy, malignancy, radiation,

, and bowel disorders. A small number of vaginal fistulas are

. Various surgical methods are employed to repair fistulas. Untreated, fistulas can result in significant

disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be Cognitive disability, cognitive, Developmental disability, dev ...

and have a profound impact on

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

Vaginal evisceration Vaginal evisceration is an evisceration of the small intestine that occurs through the vagina, typically subsequent to vaginal hysterectomy, and following sexual intercourse after the surgery. It is a surgical emergency. Presentation Vaginal evi ...

is a serious complication of a

vaginal hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

and occurs when the

vaginal cuff The vaginal cuff is the upper portion of the vagina that opens up into the peritoneum and is sutured shut after the removal of the cervix and uterus during a hysterectomy. The vaginal cuff is created by suturing together the edges of the surgical ...

ruptures, allowing the

small intestine The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...

to protrude from the vagina. Cysts may also affect the vagina. Various types of vaginal cysts can develop on the surface of the vaginal epithelium or in deeper layers of the vagina and can grow to be as large as 7 cm. Often, they are an incidental finding during a routine pelvic examination. Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. Cysts that can be present include

Müllerian cyst Ciliated cyst of the vulva (also known as "Cutaneous Müllerian cyst," and "Paramesonephric mucinous cyst of the vulva") is a cutaneous condition characterized by a cyst of the vulva. See also * Ceruminoma A ceruminous adenoma is a benign gla ...

Gartner's duct cyst A Gartner's duct cyst (sometimes incorrectly referred to as ''vaginal inclusion cyst'') is a benign vaginal cyst that originates from the Gartner's duct, which is a vestigial remnant of the mesonephric duct (wolffian duct) in females. They are typi ...

s, and epidermoid cysts. A vaginal cyst is most likely to develop in women between the ages of 30 to 40. It is estimated that 1 out of 200 women has a vaginal cyst. The Bartholin's cyst is of vulvar rather than vaginal origin, but it presents as a lump at the vaginal opening. It is more common in younger women and is usually without symptoms, but it can cause pain if an

abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...

forms, block the entrance to the

if large, and impede walking or cause painful sexual intercourse.

Society and culture

Perceptions, symbolism and vulgarity

Various perceptions of the vagina have existed throughout history, including the belief it is the center of sexual desire, a metaphor for life via birth, inferior to the penis, unappealing to sight or smell, or

vulgar Vulgar is a Latin word meaning "common" or "pertaining to ordinary people." Language * Vulgar or common language, the vernacular speech of a region or a people * Language use characterised by vulgarity, see Vulgarism and Other uses *A vul ...

. These views can largely be attributed to

sex differences Sexual dimorphism is the condition where the sexes of the same animal and/or plant species exhibit different morphological characteristics, particularly characteristics not directly involved in reproduction. The condition occurs in most ani ...

, and how they are interpreted. David Buss, an

evolutionary psychologist Evolutionary psychology is a theoretical approach in psychology that examines cognition and behavior from a modern evolutionary perspective. It seeks to identify human psychological adaptations with regards to the ancestral problems they evolv ...

, stated that because a penis is significantly larger than a clitoris and is readily visible while the vagina is not, and males urinate through the penis, boys are taught from childhood to touch their penises while girls are often taught that they should not touch their own genitalia, which implies that there is harm in doing so. Buss attributed this as the reason many women are not as familiar with their genitalia, and that researchers assume these sex differences explain why boys learn to masturbate before girls and do so more often. The word ''vagina'' is commonly avoided in conversation, and many people are confused about the vagina's anatomy and may be unaware that it is not used for urination. This is exacerbated by phrases such as "boys have a penis, girls have a vagina", which causes children to think that girls have one orifice in the pelvic area. Author Hilda Hutcherson stated, "Because many

omen An omen (also called ''portent'') is a phenomenon that is believed to foretell the future, often signifying the advent of change. It was commonly believed in ancient times, and still believed by some today, that omens bring divine messages fr ...

have been conditioned since childhood through verbal and nonverbal cues to think of

heir Inheritance is the practice of receiving private property, titles, debts, entitlements, privileges, rights, and obligations upon the death of an individual. The rules of inheritance differ among societies and have changed over time. Officiall ...

genitals as ugly, smelly and unclean,

hey Hey or Hey! may refer to: Music * Hey (band), a Polish rock band Albums * ''Hey'' (Andreas Bourani album) or the title song (see below), 2014 * ''Hey!'' (Julio Iglesias album) or the title song, 1980 * ''Hey!'' (Jullie album) or the title s ...

aren't able to fully enjoy intimate encounters" because of fear that their partner will dislike the sight, smell, or taste of their genitals. She argued that women, unlike men, did not have locker room experiences in school where they compared each other's genitals, which is one reason so many women wonder if their genitals are normal. Scholar stated that having a vagina meant she would typically be treated less well than her vagina-less counterparts and subject to inequalities (such as

job inequality Occupational inequality is the unequal treatment of people based on gender, sexuality, height, weight, accent, or race in the workplace. When researchers study trends in occupational inequality they usually focus on distribution or allocation patte ...

), which she categorized as being treated like a second-class citizen. Cattien stone yoni

Negative views of the vagina are simultaneously contrasted by views that it is a powerful symbol of female sexuality, spirituality, or life. Author Denise Linn stated that the vagina "is a powerful symbol of womanliness, openness, acceptance, and receptivity. It is the inner valley spirit."

Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...

placed significant value on the vagina, postulating the concept that vaginal orgasm is separate from clitoral orgasm, and that, upon reaching puberty, the proper response of mature women is a changeover to vaginal orgasms (meaning orgasms without any clitoral stimulation). This theory made many women feel inadequate, as the majority of women cannot achieve orgasm via vaginal intercourse alone. Regarding religion, the womb represents a powerful symbol as the ''

yoni ''Yoni'' (; sometimes also ), sometimes called ''pindika'', is an abstract or aniconic representation of the Hindu goddess Shakti. It is usually shown with ''linga'' – its masculine counterpart. Together, they symbolize the merging of microc ...

'' in

Hinduism Hinduism () is an Indian religion or '' dharma'', a religious and universal order or way of life by which followers abide. As a religion, it is the world's third-largest, with over 1.2–1.35 billion followers, or 15–16% of the global p ...

which represents "the feminine potency", and this may indicate the value that Hindu society has given female sexuality and the vagina's ability to deliver life; however, ''yoni'' as a representation of "womb" is not the primary denotation. While, in ancient times, the vagina was often considered equivalent ( homologous) to the penis, with anatomists

Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...

(129 AD – 200 AD) and Vesalius (1514–1564) regarding the organs as structurally the same except for the vagina being inverted, anatomical studies over latter centuries showed the clitoris to be the penile equivalent. Another perception of the vagina was that the release of vaginal fluids would cure or remedy a number of ailments; various methods were used over the centuries to release "female seed" (via vaginal lubrication or female ejaculation) as a treatment for (suffocation of the womb, 'suffocation from retained seed'),

green sickness Hypochromic anemia is a generic term for any type of anemia in which the red blood cells are paler than normal. (''Hypo''- refers to ''less'', and ''chromic'' means ''colour''.) A normal red blood cell has a biconcave disk shape and will have an a ...

, and possibly for

female hysteria Female hysteria was once a common medical diagnosis for women, which was described as exhibiting a wide array of symptoms, including anxiety, shortness of breath, fainting, nervousness, sexual desire, insomnia, fluid retention, heaviness in the a ...

. Reported methods for treatment included a

midwife A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...

rubbing the walls of the vagina or insertion of the penis or penis-shaped objects into the vagina. Symptoms of the female hysteria diagnosis – a concept that is no longer recognized by medical authorities as a medical disorder – included faintness, nervousness, insomnia, fluid retention, heaviness in abdomen, muscle spasm, shortness of breath, irritability, loss of appetite for food or sex, and a propensity for causing trouble. It may be that women who were considered suffering from female hysteria condition would sometimes undergo "pelvic massage" – stimulation of the genitals by the doctor until the woman experienced "hysterical paroxysm" (i.e., orgasm). In this case, paroxysm was regarded as a medical treatment, and not a sexual release. The vagina and vulva have been given many vulgar names, three of which are ''

cunt ''Cunt'' () is a vulgar word for the vulva or vagina. It is used in a variety of ways, including as a term of disparagement. Reflecting national variations, ''cunt'' can be used as a disparaging and obscene term for a woman in the United Stat ...

'', ''

twat "Twat" is an English-language vulgarism which means the vulva or vagina, and is used figuratively as a derogatory epithet. In British English, it is a common insult referring to an obnoxious or stupid person regardless of gender; in American ...

'', and ''

pussy ''Pussy'' is a used as a noun, an adjective, and—in rare instances—a verb in the English language. It has several meanings, as slang, as euphemism, and as vulgarity. The most common as a noun, it means "cat", as well as "coward or weaklin ...

.'' ''Cunt'' is also used as a derogatory

epithet An epithet (, ), also byname, is a descriptive term (word or phrase) known for accompanying or occurring in place of a name and having entered common usage. It has various shades of meaning when applied to seemingly real or fictitious people, di ...

referring to people of either sex. This usage is relatively recent, dating from the late nineteenth century. Reflecting different national usages, ''cunt'' is described as "an unpleasant or stupid person" in the '' Compact Oxford English Dictionary'', whereas the

Merriam-Webster Merriam-Webster, Inc. is an American company that publishes reference books and is especially known for its dictionaries. It is the oldest dictionary publisher in the United States. In 1831, George and Charles Merriam founded the company as ...

has a usage of the term as "usually disparaging and obscene: woman", noting that it is used in the United States as "an offensive way to refer to a woman". ''

Random House Random House is an American book publisher and the largest general-interest paperback publisher in the world. The company has several independently managed subsidiaries around the world. It is part of Penguin Random House, which is owned by Germ ...

'' defines it as "a despicable, contemptible or foolish man". Some

feminist Feminism is a range of socio-political movements and ideologies that aim to define and establish the political, economic, personal, and social equality of the sexes. Feminism incorporates the position that society prioritizes the male po ...

s of the 1970s sought to eliminate disparaging terms such as ''cunt''. ''Twat'' is widely used as a derogatory epithet, especially in

British English British English (BrE, en-GB, or BE) is, according to Lexico, Oxford Dictionaries, "English language, English as used in Great Britain, as distinct from that used elsewhere". More narrowly, it can refer specifically to the English language in ...

, referring to a person considered obnoxious or stupid. This source aggregates material from paper dictionaries, including ''Random House Dictionary'', ''Collins English Dictionary'', and Harper's ''Online Etymology Dictionary''. ''Pussy'' can indicate " cowardice or

weakness Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...

", and "the human vulva or vagina" or by extension "sexual intercourse with a woman". In contemporary English, use of the word ''pussy'' to refer to women is considered derogatory or demeaning, treating people as sexual objects.

In contemporary literature and art

The ''

vagina loquens The ''vagina loquens'', Latin for "talking vagina", is a significant tradition in literature and art, dating back to the ancient folklore motif of the "talking cunt". These tales usually involve vaginas talking due to the effect of magic or char ...

'', or "talking vagina", is a significant tradition in literature and art, dating back to the ancient

folklore Folklore is shared by a particular group of people; it encompasses the traditions common to that culture, subculture or group. This includes oral traditions such as tales, legends, proverbs and jokes. They include material culture, ranging ...

motifs of the "talking cunt". These tales usually involve vaginas talking due to the effect of magic or charms, and often admitting to their lack of chastity. Other folk tales relate the vagina as having teeth – ''

vagina dentata ''Vagina dentata'' (Latin for ''toothed vagina'') describes a folk tale in which a woman's vagina is said to contain teeth, with the associated implication that sexual intercourse might result in injury, emasculation, or castration for the man i ...

'' (

for "toothed vagina"). These carry the implication that sexual intercourse might result in injury, emasculation, or

castration Castration is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses pharmaceut ...

for the man involved. These stories were frequently told as cautionary tales warning of the dangers of unknown women and to discourage

rape Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without their consent. The act may be carried out by physical force, coercion, abuse of authority, or ag ...

. In 1966, the French artist

Niki de Saint Phalle Niki de Saint Phalle (; born Catherine Marie-Agnès Fal de Saint Phalle; 29 October 193021 May 2002) was a French-American sculptor, painter, filmmaker, and author of colorful hand-illustrated books. Widely noted as one of the few female monume ...

collaborated with Dadaist artist Jean Tinguely and Per Olof Ultvedt on a large sculpture installation entitled (also spelled , which means "she-a cathedral") for Moderna Museet, in

Stockholm Stockholm () is the Capital city, capital and List of urban areas in Sweden by population, largest city of Sweden as well as the List of urban areas in the Nordic countries, largest urban area in Scandinavia. Approximately 980,000 people liv ...

, Sweden. The outer form is a giant, reclining sculpture of a woman which visitors can enter through a door-sized vaginal opening between her spread legs. ''

The Vagina Monologues ''The Vagina Monologues'' is an episodic play written in 1996 by Eve Ensler which developed and premiered at HERE Arts Center, Off-Off-Broadway in New York and was followed by an Off-Broadway run in at Westside Theatre. The play explores cons ...

'', a 1996 episodic play by

Eve Ensler V, formerly Eve Ensler (; born May 25, 1953), is an American playwright, performer, feminist, and activist. V is best known for her play ''The Vagina Monologues''.

, has contributed to making female sexuality a topic of public discourse. It is made up of a varying number of monologues read by a number of women. Initially, Ensler performed every monologue herself, with subsequent performances featuring three actresses; latter versions feature a different actress for every role. Each of the monologues deals with an aspect of the feminine experience, touching on matters such as sexual activity, love, rape, menstruation, female genital mutilation, masturbation, birth, orgasm, the various common names for the vagina, or simply as a physical aspect of the body. A recurring theme throughout the pieces is the vagina as a tool of female empowerment, and the ultimate embodiment of individuality.

Influence on modification

Societal views, influenced by tradition, a lack of knowledge on anatomy, or

sexism Sexism is prejudice or discrimination based on one's sex or gender. Sexism can affect anyone, but it primarily affects women and girls.There is a clear and broad consensus among academic scholars in multiple fields that sexism refers primari ...

, can significantly impact a person's decision to alter their own or another person's genitalia. Women may want to alter their genitalia (vagina or vulva) because they believe that its appearance, such as the length of the labia minora covering the vaginal opening, is not normal, or because they desire a smaller vaginal opening or tighter vagina. Women may want to remain youthful in appearance and sexual function. These views are often influenced by the media, including

pornography Pornography (often shortened to porn or porno) is the portrayal of sexual subject matter for the exclusive purpose of sexual arousal. Primarily intended for adults,

, and women can have low self-esteem as a result. They may be embarrassed to be naked in front of a sexual partner and may insist on having sex with the lights off. When modification surgery is performed purely for cosmetic reasons, it is often viewed poorly, and some doctors have compared such surgeries to

female genital mutilation Female genital mutilation (FGM), also known as female genital cutting, female genital mutilation/cutting (FGM/C) and female circumcision, is the ritual cutting or removal of some or all of the external female genitalia. The practice is found ...

(FGM). Female genital mutilation, also known as female circumcision or female genital cutting, is genital modification with no health benefits. The most severe form is Type III FGM, which is infibulation and involves removing all or part of the labia and the vagina being closed up. A small hole is left for the passage of urine and menstrual blood, and the vagina is opened up for sexual intercourse and childbirth. Significant controversy surrounds female genital mutilation, with the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...

(WHO) and other health organizations campaigning against the procedures on behalf of

human rights Human rights are Morality, moral principles or Social norm, normsJames Nickel, with assistance from Thomas Pogge, M.B.E. Smith, and Leif Wenar, 13 December 2013, Stanford Encyclopedia of PhilosophyHuman Rights Retrieved 14 August 2014 for ce ...

, stating that it is "a violation of the human rights of girls and women" and "reflects deep-rooted inequality between the sexes". Female genital mutilation has existed at one point or another in almost all human civilizations, most commonly to exert control over the sexual behavior, including masturbation, of girls and women. It is carried out in several countries, especially in

Africa Africa is the world's second-largest and second-most populous continent, after Asia in both cases. At about 30.3 million km2 (11.7 million square miles) including adjacent islands, it covers 6% of Earth's total surface area ...

, and to a lesser extent in other parts of the

Middle East The Middle East ( ar, الشرق الأوسط, ISO 233: ) is a geopolitical region commonly encompassing Arabian Peninsula, Arabia (including the Arabian Peninsula and Bahrain), Anatolia, Asia Minor (Asian part of Turkey except Hatay Pro ...

and

Southeast Asia Southeast Asia, also spelled South East Asia and South-East Asia, and also known as Southeastern Asia, South-eastern Asia or SEA, is the geographical United Nations geoscheme for Asia#South-eastern Asia, south-eastern region of Asia, consistin ...

, on girls from a few days old to mid-adolescent, often to reduce sexual desire in an effort to preserve vaginal virginity. Comfort Momoh stated it may be that female genital mutilation was "practiced in ancient Egypt as a sign of distinction among the aristocracy"; there are reports that traces of infibulation are on Egyptian mummies. Custom and tradition are the most frequently cited reasons for the practice of female genital mutilation. Some cultures believe that female genital mutilation is part of a girl's initiation into adulthood and that not performing it can disrupt social and political cohesion. In these societies, a girl is often not considered an adult unless she has undergone the procedure.

Other animals

The vagina is a structure of animals in which the female is internally fertilized, rather than by

traumatic insemination Traumatic insemination, also known as hypodermic insemination, is the mating practice in some species of invertebrates in which the male pierces the female's abdomen with his aedeagus and injects his sperm through the wound into her abdominal c ...

used by some invertebrates. The shape of the vagina varies among different animals. In

placental mammals Placental mammals (infraclass Placentalia ) are one of the three extant subdivisions of the class Mammalia, the other two being Monotremata and Marsupialia. Placentalia contains the vast majority of extant mammals, which are partly distinguishe ...

and

marsupials Marsupials are any members of the mammalian infraclass Marsupialia. All extant marsupials are endemic to Australasia, Wallacea and the Americas. A distinctive characteristic common to most of these species is that the young are carried in a po ...

, the vagina leads from the

to the exterior of the female body. Female marsupials have two lateral vaginas, which lead to separate uteri, but both open externally through the same orifice; a third canal, which is known as the median vagina, and can be transitory or permanent, is used for birth. The female

spotted hyena The spotted hyena (''Crocuta crocuta''), also known as the laughing hyena, is a hyena species, currently classed as the sole extant member of the genus ''Crocuta'', native to sub-Saharan Africa. It is listed as being of least concern by the IUC ...

does not have an external vaginal opening. Instead, the vagina exits through the clitoris, allowing the females to urinate, copulate and give birth through the clitoris. The vagina of the female

coyote The coyote (''Canis latrans'') is a species of canis, canine native to North America. It is smaller than its close relative, the wolf, and slightly smaller than the closely related eastern wolf and red wolf. It fills much of the same ecologica ...

contracts during copulation, forming a

copulatory tie Canine reproduction is the process of sexual reproduction in domestic dogs, wolves, coyotes and other canine species. Canine sexual anatomy and development Male reproductive system Erectile tissue As with all mammals, a dog's penis is made up of ...

. Birds, monotremes, and some reptiles have a part of the oviduct that leads to the

. Chickens have a vaginal aperture that opens from the vertical apex of the cloaca. The vagina extends upward from the aperture and becomes the egg gland. In some jawless fish, there is neither oviduct nor vagina and instead the egg travels directly through the body cavity (and is fertilised externally as in most

fish Fish are aquatic, craniate, gill-bearing animals that lack limbs with digits. Included in this definition are the living hagfish, lampreys, and cartilaginous and bony fish as well as various extinct related groups. Approximately 95% of li ...

and

s). In insects and other

invertebrate Invertebrates are a paraphyletic group of animals that neither possess nor develop a vertebral column (commonly known as a ''backbone'' or ''spine''), derived from the notochord. This is a grouping including all animals apart from the chordate ...

s, the vagina can be a part of the oviduct (see

insect reproductive system Most insects reproduce oviparously, i.e. by laying eggs. The eggs are produced by the female in a pair of ovaries. Sperm, produced by the male in one testis or more commonly two, is transmitted to the female during mating by means of external genit ...

). Birds have a cloaca into which the urinary, reproductive tract (vagina) and gastrointestinal tract empty. Females of some waterfowl species have developed vaginal structures called dead end sacs and clockwise coils to protect themselves from

sexual coercion Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without their consent. The act may be carried out by physical force, coercion, abuse of authority, or agai ...

.Brennan, P. L. R., Clark, C. J. & Prum, R. O. Explosive eversion and functional morphology of the duck penis supports sexual conflict in waterfowl genitalia. Proceedings: Biological Sciences 277, 1309–14 (2010). A lack of research on the vagina and other female genitalia, especially for different animals, has stifled knowledge on female sexual anatomy. One explanation for why male genitalia is studied more includes penises being significantly simpler to analyze than female genital cavities, because male genitals usually protrude and are therefore easier to assess and measure. By contrast, female genitals are more often concealed, and require more dissection, which in turn requires more time. Another explanation is that a main function of the penis is to impregnate, while female genitals may alter shape upon interaction with male organs, especially as to benefit or hinder

reproductive success Reproductive success is an individual's production of offspring per breeding event or lifetime. This is not limited by the number of offspring produced by one individual, but also the reproductive success of these offspring themselves. Reproduct ...

. Non-human

s are optimal models for human biomedical research because humans and non-human primates share physiological characteristics as a result of

evolution Evolution is change in the heritable characteristics of biological populations over successive generations. These characteristics are the expressions of genes, which are passed on from parent to offspring during reproduction. Variation ...

. While menstruation is heavily associated with human females, and they have the most pronounced menstruation, it is also typical of

ape Apes (collectively Hominoidea ) are a clade of Old World simians native to sub-Saharan Africa and Southeast Asia (though they were more widespread in Africa, most of Asia, and as well as Europe in prehistory), which together with its siste ...

relatives and

monkey Monkey is a common name that may refer to most mammals of the infraorder Simiiformes, also known as the simians. Traditionally, all animals in the group now known as simians are counted as monkeys except the apes, which constitutes an incomple ...

s. Female macaques menstruate, with a cycle length over the course of a lifetime that is comparable to that of female humans. Estrogens and

progestogen Progestogens, also sometimes written progestagens or gestagens, are a class of natural or synthetic steroid hormones that bind to and activate the progesterone receptors (PR). Progesterone is the major and most important progestogen in the body. ...

s in the menstrual cycles and during premenarche and postmenopause are also similar in female humans and macaques; however, only in macaques does keratinization of the epithelium occur during the

follicular phase The follicular phase, also known as the preovulatory phase or proliferative phase, is the phase of the estrous cycle (or, in primates for example, the menstrual cycle) during which follicles in the ovary mature from primary follicle to a ful ...

. The vaginal pH of macaques also differs, with near-neutral to slightly alkaline median values and is widely variable, which may be due to its lack of lactobacilli in the vaginal flora. This is one reason why, although macaques are used for studying HIV transmission and testing

microbicides An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals ar ...

, animal models are not often used in the study of sexually transmitted infections, such as trichomoniasis. Another is that such conditions' causes are inextricably bound to humans' genetic makeup, making results from other species difficult to apply to humans.

References

External links

''Vagina'', Anatomical Atlases, an Anatomical Digital Library (2018)
* * {{Authority control Human female reproductive system Mammal female reproductive system Women and sexuality Women's health Anatomy Gynaecology