Vulva: An Overview

The vulva is the external portion of the female genital anatomy. Also known as the pudendum, the vulva includes the clitoris and inner and outer flaps known as the labia majora and labia minora. These flaps protect a woman’s sexual organs, urethra, vestibule, and vagina.

The vulva can be subject to a range of health issues, including vulvar cancer, bacterial infections, and a number of sexually transmitted diseases (STDs).

This article discusses the anatomy and function of the vulva. It describes normal variations from person to person and explains health problems that may affect this part of the body.

Vulva Anatomy

Anatomically speaking, the vulva is a blanket term for all of the structures of the external female genitals. Here’s a closer look of these structures.

Mons Pubis (pubic mound)

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

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

Labia Majora (outer labia)

Named for the Latin terminology for “larger lips,” this feature consists of two prominent folds of skin that cover other parts of the reproductive system including:

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

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

Labia Minora (smaller lips)

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

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

As these folds link together, they form what’s called the frenulum of the labia minora. This part of the body is engorged during sexual arousal.

Clitoris

This clitoris is an essential sex organ for people with vaginas. It’s divided into the glans clitoris and the body of the clitoris, both of which sit on an underlying tissue called the corpus cavernosum.

This tissue becomes flushed with blood during arousal. It merges together to protrude to the exterior of the vulva to form the glans clitoris.

On the sides, the two ends of this tissue form the crus or “legs” of the clitoris and its body. In turn, the glans clitoris—which has many arteries and nerves—is the visible, protruding portion of the clitoris.

Vestibular Bulbs

These two bulbs are formed of erectile tissue and arise near the back side of the body of the clitoris. Running along the middle edge of the crus of the clitoris, these features run toward the urethra and the vagina.

At this point, the vestibular bulbs split and surround the side borders of these features. 

Vulva Vestibule

This is the area between the two labia minora. Its upper end arises just beneath the clitoris and ends at the rear fold of the labia minora.

This smooth surface contains the openings of both the urethra and the vagina. Its borders, called Hart’s lines, are formed by the edges of the labia minora. 

Bartholin’s Glands

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

Skene’s Glands

Also known as the lesser vestibular glands, these sit on either side of the urethra.

Urethra

This extension of the bladder—which allows urine to exit the body—is a tube-like structure.

Vagina

Running from the cervix to the external surface via the vulva vestibule, the vagina is a muscular, elastic tube. The opening of this organ is partially covered by the hymen, a thin membrane of skin. This opening lies at the back of the opening of the urethra.

Partial Female Reproductive System

Anatomical Variations of the Vulva

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

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

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

Largely, though, functionality is unaffected by these differences.

Congenital Variations

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

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

Function of the Vulva

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

• The vulva is involved in the excretion of urine. The vulva houses the urethra, which delivers urine from the bladder out of the body. 
• It is a key player in sexual activity. During arousal, several parts become flushed with blood, including the labia minora and majora, the clitoris, and the vestibular bulbs. This changes the shape of the vagina, stimulates sexual pleasure, and works to bolster lubrication for sexual intercourse.
• The vulva supports reproduction. Physiological changes also work to promote chances of conception, secreting female hormones to mix with male semen deposited in the vagina to allow an opportunity to fertilize the egg.   
• The vulva can change during menstruation, specifically the skin thickness of the vulva. Some people with vaginas experience pain in the vulva but the cause (and function) remain unclear. 

Associated Conditions

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

Infections

• Chlamydia arises due to a bacterial STI. It can be asymptomatic but also may lead to symptoms of burning discharges, pain, and inflammation in the urethra and cervix. If untreated (typically with antibiotics), this can lead to pelvic inflammatory disease (PID) and potential complications of ectopic pregnancy or infertility in people with vaginas.
• Gonorrhea is often present alongside chlamydia. Symptoms of the Neisseria gonorrhoeae bacterial infection are similar, as is the risk of PID. Antibiotics can be used to treat this condition.  
• Syphilis is the result of infection by Treponema pallidum bacteria. Symptoms may not emerge right away but include fever, skin rashes and sores, and genital lesions (similar to warts). Inflammation and swelling of the lymph nodes can also occur. Brain lesions and neurological problems can occur if left untreated (usually with penicillin).
• Herpes Simplex 1 & 2 is known as genital herpes and can lead to lesions on the vulva. There is no cure, but symptoms come and go and flare-ups can be managed.  
• Human Papillomavirus (HPV) flares up noticeably as cauliflower-shaped lesions—genital warts—on the vulva or genital region. These arise due to a viral infection and typically resolve on their own. In some cases, the warts become chronic and can lead to cancer. 
• Human Immunodeficiency Virus (HIV) This viral infection attacks and can compromise the immune system. HIV can progress to acquired immunodeficiency syndrome (AIDS), a condition characterized by the presence of other, opportunistic infections, many of which impact the vulva. There is no cure for HIV. However, pharmaceutical therapies can keep the virus in check.
• Hepatitis B & C are inflammations of the liver that can lead to cirrhosis or other dangerous conditions. While a vaccine for hepatitis B exists, there is none for the other form. There is also no cure for this class of disease. Sexual contact is a common cause of infection.
• Urinary tract infection (UTI): A very common condition, UTI is a bacterial infection of the urethra. This leads to symptoms like increased need to urinate, pain during urination, and cloudy and foul-smelling urine, among others. Highly treatable, this is often the result of the bacteria Escherichia coil.
• candidiasisVaginal : Also known as vaginal yeast infection, this fungal infection causes vaginal itching and soreness, pain during sexual intercourse, pain or discomfort during urination, and/or abnormal discharges from the vagina. While most cases are relatively mild, some can develop into more serious infections and lead to cracking, bleeding, and inflammation.

Skin Conditions

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

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

Other Vulva Conditions

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

• Bartholin cyst and abscess: Occasionally, a cyst can form in the Bartholin’s glands, affecting its ability to secrete necessary hormones. If this cyst is infected, it can continue to grow to form an abscess.  
• Imperforate hymen: This rare case is characterized by the hymen not allowing substances through. In girls who have started menstruating, this causes blood and other substances excreted during periods to get caught. Treatment involves perforating the region to drain it.
• Atrophic vulvovaginitis: This is known as genitourinary syndrome of menopause, with skin and other changes affecting the vulva due to changes in estrogen levels. Estrogen creams can help.
• Vulvar carcinoma: Cancer of the vulva is rare, with the most common form being squamous cell carcinoma. It can arise due to HPV, or malignancy can follow the progression of lichen sclerosus.

What Are Symptoms of Vulva Conditions?

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

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

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

Tips for Keeping the Vulva Healthy

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

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

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

Tests

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

That said, testing and examination of this part of the body can be challenging, especially in the absence of symptoms. Here's a look at common tests.

Vulvar Biopsy

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

This is a test in which a small portion of tissue is removed and examined for the presence of cancer or pre-cancerous cells under a very strong microscope. In selecting an area to examine, healthcare providers may use a special device called a colposcope to magnify it.

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

Darkfield Microscopy

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

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

HPV Testing

In cases of HPV that arise as genital warts on the vulva, a healthcare provider may need to perform testing for the presence of the virus in cell samples from the area. Most such tests are performed on samples taken from the cervix, however.

Herpes Testing

If the sores from genital herpes appear on the vulva, they can be swabbed and tested. That said, this disease can be hard to diagnose between outbreaks.

Urinalysis

A wide range of health conditions are assessed using urine samples, including diabetes, liver health, and pregnancy.

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

Summary

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

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

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