By Dr Ho Choon Moy, Consultant Obstetrician & Gynaecologist, Pantai Hospital Cheras
Many women shy away when the word ‘vagina’ is mentioned or discussed. Some call it ‘private parts’; others call it ‘VJJ’, ‘Venus butterfly’, ‘down there’, ‘wee-wee’, ‘pussy’ and other funny names.
Whatever they call it, the area “down there” is only half-familiar to many women, with its mysterious and unspeakable problems. At times, they tend to think their concerns are unique, specific, unsolvable and embarrassing.
As it is a vital part of a woman’s reproductive system, it is important for a woman to know about the vagina and be familiar with its anatomy and functions. With scientific advancements that allow women a longer lifespan of up to 80, 90 or even 100 years, women need to care for their vagina the same way they look after their health and beauty in order to enjoy a better quality life.
Although the vagina is a female organ, men should also know about it to better understand and respect the many changes that women undergo in life.
WHAT IS THE VAGINA?
The vagina originates from a Latin word meaning “sheath”. It is one of the three openings at the woman’s genital area (the other two being the urethra and the anus).
Some people think of the vagina as an opening, but in fact it is a canal – an internal structure. It is actually an elastic fibromuscular tubular canal that begins on the outside at the vulva and extends about 8-10 cm inside, ending at the cervix, or neck of the uterus (womb). The opening to the vagina is located between the bowel opening (anus) and the opening for the bladder (urethra).
The consistency of the vagina is almost like the mucosa lining our mouth, with a pH level that is slightly acidic to help prevent infections. The only difference is that while the surface of the mouth is smooth, the surface of the vagina comprises several layers or wrinkles. These layers expand the surface space of the vaginal walls, allowing it to stretch when necessary.
The common misconception is that the vaginal muscles become ‘loose’ after childbirth or with age. However, it is the pelvic floor muscles that become loose. The vaginal layers collapse and fold back into place when not in use, so they do not loosen after being stretched. Most of the procedures that promise to ‘tighten’ the vagina actually tighten the vulva.
For women who fear that the pelvic floor muscles have become loose, pelvic floor exercises, also known as Kegel’s exercises, are recommended. Pelvic floor exercises also work to improve urinary incontinence in women of all ages.
THE ANATOMY OF THE VAGINA
The vagina is shaped like a flattened tube and its sides collapse on each other. When not in use, it is not a continually open space or “hole” as often wrongly perceived by people.
The vagina has three layers of tissue:
- THE EXTERNAL SURFACE can be seen and touched. It consists of mucous membranes and is layered with mucosa which is similar to the lining of the mouth. Nearly 90 percent of the vaginal nerve endings are located near the opening, which is why it is more sensitive to touch than the inner two-thirds of the vagina.
The opening of the vagina tract is also where the hymen, a thin membrane of connective tissue, is located. The hymen may be torn by penetration, a pelvic examination, injury or certain activities, such as horseback riding or gymnastics. A torn hymen does not necessarily mean that there has been prior sexual activity.
2. THE SECOND LAYER is the muscle layer concentrated mostly around the outer third of the vagina. This muscular tissue enables the vagina to expand and contract, like a balloon; for instance, in childbirth to allow a baby to pass through or to fit snugly around a tampon, a finger or any penile size. The highly elastic vagina automatically expands in both length and width.
3. THE THIRD LAYER is the innermost layer consisting of fibrous tissue that connects to other anatomical structures. The upper two-thirds of the walls of the vagina are not that sensitive to touch as they do not have a great supply of nerve endings.
Knowing what is inside the vaginal tract helps overcome problems when using vaginal products such as tampons, suppositories or contraceptive rings. Putting these products too close to the vagina opening causes discomfort and pain because of the abundant nerve endings.
They need to be pushed further up the vaginal tract, where they do not cause discomfort because of the insensitive nature of the inner parts of the vagina. Women fear that the products will get lost if they push them too deep in. This fear is unfounded, as objects cannot go beyond the cervix, a tiny opening at the end of the vagina tract.
The vagina has several biological functions:
- Menstruation: The vagina enables menstrual blood to flow out of the body.
- Vaginal secretion: The vaginal tissue does not contain any secretory glands but produces fluid when it gets ample blood supply during sexual excitement. This fluid serves to lubricate the vagina for intercourse. Without this lubrication, penetration can be painful and uncomfortable.
- Sexual activity: The nerve endings at the entrance of the vagina provide a pleasurable sensation during sexual activity, with the walls of the vagina self-lubricating to reduce friction and pain. The vagina can lengthen when sexually aroused. The walls of the vagina are composed of soft elastic folds of mucous membrane skin which stretch or contract (with support from pelvic muscles) to the size of the inserted penis.
- Childbirth: During childbirth, the stretchable vagina provides the passage to deliver the baby from the uterus. After the delivery, the vagina contracts or tightens again so that the opening turns back to a mere slit.
- 5. Insertion of tampons: These are a great help for women on the go, especially those with active lifestyles. They are also useful on occasions when you are on holiday, swimming or wearing a tight-fitting outfit.
- 6. Vaginal Ultrasound: An ultrasound conducted through the vagina produces clearer images of the pelvic cavity than that done through the abdomen. It can pick up even very small growths and abnormalities and is among the best way to detect ovarian cancer.
- 7. Administration of medication: The administration of medication through the vaginal route has been practised since the 19th century BC. Today, more medications (such as gels, capsules, foams, vaginal films, medicated tampons, sponges, diaphragms and contraceptive rings) are administered vaginally to achieve systemic effects. The advantages include lower dosage, higher absorption levels, low frequency, bypassing the liver, self-administration and controlled release.
Did you know…
The vagina is naturally self-cleansing. A healthy vagina is colonised by a mutually symbiotic flora of microorganisms that protect it from disease-causing microbes.