The clitoris used to be represented and thought of as a small ‘pea’ like structure, sitting above the urethra (Enright, 2019). It wasn’t until relatively recently when Professor Helen O’Connell fully investigated and modelled the full extent of the clitoris in 1998 (Fyfe, 2018). O’Connell is a Urologist (a type of doctor, who specialises in surgery in areas of the body including the bladder and urethra). She used cadavers to map fully map out the clitoris, demonstrating that it was a much bigger structure. Like this:
It includes structures that are hidden deep to other tissue, such as the corpus cavernosum and the bulbs of the clitoris. As you can see from the diagram the bulbs of the clitoris are very close to the vagina – even more so when a person is aroused, as they become swollen and more erect by blood being diverted to them, just as the penis does (Drake et al. 2010).
There is an excellent and short French cartoon about the structure, function and history of ‘Le Clitoris’- the only organ that is just for pleasure – here.
Drake, R. L., Vogl, A. W. & Mitchell, A. W. M. (2010) Gray’s Anatomy for Students. Second Edition. Canada: Churchill Livingstone Elsevier.
Enright, L. (2019) Vagina a Re-Education. Croydon: Allen & Unwin.
Fyfe, M. (October 2018) Get Clitorate: how a Melbourne doctor is redefining sexuality. The Sunday Morning Herald. Accessed online on 21.03.2019 at [https://www.smh.com.au/lifestyle/health-and-wellness/get-cliterate-how-a-melbourne-doctor-is-redefining-female-sexuality-20181203-p50jvv.html}
Ever heard the term ‘designer vagina’? This generally refers to a certain type of cosmetic surgery, not to the vagina itself but to the ‘inner lips’ (or labia minora) of the vulva. Surgery here involves removing tissue from and reshaping the appearance of the labia minora- in other words to ‘trim’ it. Many people with vulvas have a labia minora that protrudes so that it appears visible – therefore however large this is it is likely to be ‘normal’. Additionally, in young people biological changes occur during puberty that can change the appearance of the inner labia. For this reason it is often recommended by the NHS that those under 18 do not get this type of surgery. However, there seem to cases of children having labiaplasties. According to one report over 200 people received labiaplasty procedures funded by the NHS in 2015-2016. We know that people with visible labia are more likely to think that their genitals look ‘abnormal’ than those without, even though both are equally common (Lykkebo et al, 2017). Some accounts have blamed this on the prevalence of seeing only vulva with neat and invisible labia minora. Whatever the cause, the desire to have this type of surgery seems increasingly common with a 45% rise seen in labiaplasty numbers worldwide between 2015 and 2016.
Pubic hair and body positivity can be a tricky issue. On the one hand, people absolutely have the right to cut, shape, dye, remove or in any other way sculpt their own personal body space! I get how it can be liberating and a way of taking control of your own body and quite literally shaping your intimate identity.
On the other hand, there seems to be a growing repulsion for body hair that isn’t manicured. A dislike for ‘natural’ hair, particularly (but not exclusively) when it comes to vulvas. Some people specifically find it ‘unhygienic‘. This despite the fact that pubic hair, like the hair on your head, has specifically protective functions.
So trim and go as bare as you dare around your nether regions if you want to. But maybe think about why your doing it!
‘Labia Minora’ is latin for ‘smaller lips’. It’s the word used to describe the flaps of tissue that sit inside the larger labia majora (‘large lips’) and surround the innermost structures of the vulva – like the clitoris and the vagina.
Exactly what an individual’s labia minora look like in terms of shape and size vary hugely. Some have fairly minimal tissue, which doesn’t tend to be visible unless the labia majora are spread (i.e. legs akimbo!). Some people have much larger amounts of tissue. When people talk about having cosmetic surgery to the vulva, they often call it a ‘designer vagina’. However, it is surgery to the labia minora (a ‘labiaplasty’ or ‘vulval surgery’) that they are in fact referring to, not surgery to the vagina itself. Some people feel that this type of surgery is almost always unnecessary and related to unfounded fears that people have about larger labia minoras being ‘abnormal’.
This week, artist Laura Dodsworth’s latest piece hit the news. This is a collection of photographs of 100 vulvas. One of the reasons this is great is that it taps into and challenges taboos around vulval genitalia. One of the misconceptions very publicly elicited was the language and terms use- Dodsworth correctly uses ‘vulva’ to refer to the externally visible parts of this type of genitalia:
That ignorance around this exists became very evident, very quickly. One twitterer tried to ‘correct’ it. I’m doing so, he used the term ‘vagina’ which, although a common mistake, refers to the passage between the cervix (entrance of the womb) and outside of the body. These bits can be photographed, but it’s rather tricky and involves specialist equipment!
Rounding off the year, let’s have a look at penises! We (the societal ‘we’) tend to be a bit more familiar with the constituent parts than we are with vulvas…
Glans: This is the tip or ‘head’ of the penis.
Foreskin: This is a fold of skin that covers the glans of the penis. It can be removed, either at birth or later in life, for either medical or cultural reasons in a process called circumcision. Rates of this practice vary across the world and it isn’t as common in the UK as in other parts of the world.
Urethra: The opening of the penis. Semen, urine and discharge can leave the body here. As with discharge from the vagina, this can be normal. Changes in the discharge (e.g. smell or colour), especially when accompanied by other symptoms (pain, itchiness) can however indicate something’s not quite right and might need checking out.
Shaft: This is the main bit of the penis. Internally are found the tubes that carry urine and semen out of the body, as well as blood vessels supplying the penis – this is part of the mechanism that causes the penis to become hard and bigger during an erection.
The average penis size is 9 cm when not erect, although there is a fairly large and health variation in this.
We seem to sometimes fall in to the habit of talking about ‘discharge’ from the vagina as if it’s always bad thing- for example as a sign of an infection. It can be easy for forget that it’s also a healthy part of how this bit of your vulva works. The vagina produces a mucousy discharge that helps keep it clean and protects from infection. But what is it ‘meant’ to look like?! Healthy discharge should be:
SMELL – not strong and/or unpleasant.
COLOUR – clear or white.
CONSISTENCY – thick and sticky or slippery and wet.
It’s perfectly normal for it to vary a bit with age and during different bits of the menstral cycle, but as long as it’s within these parameters, it’s all perfectly normal… so now you know!
Thrush is one of the causes of unusual vaginal discharge. Usually not ‘offensive’ smelling, it is often described as ‘cottage cheese’ – it has that kind of lumpy and white quality. Or like the chest of the bird thrush, which is speckled and light compared to the rest of its body!
Unlike other causes of abnormal discharge, it is not a sexually transmitted infection. STIs are spread from person to person, through direct contact such as skin-to-skin or bodily fluids (saliva, mucous, semen, blood, etc). Thrush however, is an overgrowth of a type of fungal yeast (candida albicans) that ordinarily lives in other parts of the body, without causing an infection.
As well as the discharge, it is usually accompanied by an itching feeling. Thrush proliferates in damp parts of the body. As well as being able to cause infection in the vagina, in can therefore cultivate under the foreskin of the penis, or in skin folds around the rest of the body.
Vaginal thrush is treated with a cream, a pessary (i.e. a ‘tablet’ that comes with a device to be put straight in to the vagina), an oral tablet or combinations of these. In the UK, this treatment is available ‘over the counter’ – you can go to a pharmacy and get it without a prescription. However, it’s a good idea to go to your GP if it’s the first time you’ve had thrush. They can then check that this is what it is. It’s important to get further medical help if you’ve had regular infections or tried the treatment before and it isn’t working. You may also need to see your doctor if you have other medical complications as well.
The information here is adapted from an exercise from Sexplain UK, used as part of their SRE lessons. In short, it involves using play dough to build genitals. This exercise can be used to teach people about external genitalia (both penises and vulvas). As an arts and crafts activity, it can be fun and engaging and help to give something concrete to talk around in terms of things like physiology, variation and health. I have also included the recipe I use for homemade play dough.
To make your dough.
2 cups plain flour
1 cup of salt
2 teaspoons cream of tartar
1 tablespoon of vegetable oil
2 cups of boiling water
Something to colour the dough with (optional) such as food dye, paint powder, or a crushed soft pastel
Put all of the ingredients except for the water and colouring in to a large mixing bowl. Boil water and add this to the mix whilst still very hot. Mix immediately using a wooden spoon. Once the mixture is cool enough to handle, put some flour on a surface and lightly knead the mixture for a short time. If you are adding colouring, now knead this in until the dough is roughly all the same shade throughout.
Make sure the dough is left uncovered until it is cool, then cover in an airtight container. It should last for about a week. This recipe makes enough for about twelve people if doing the exercise below.
So, all foetuses have the same general genital structures, regardless of what sex they will become. They then typically (but not always) differentiate in to either a penis or vulva. These are the external genitalia (i.e. the bits you can see).
We’ll look at vulva first, as this is the one people tend to find a bit trickier.
Take your ball of play dough and divide it in to four pieces. With one of these quarters, make a left or diamond shape:
This is the vestibule of the vulva.
Next, take another quarter and roll it in to a sausage shape, about the length of one side of the vestibule and attach it to one side:
This is the labia majora, the fatty tissue that covers the whole vulva and tends to be covered in hair after puberty. Complete it by making another sausage to attach to the other side:
Next, divide the last quarter in to two. With one piece, make a smaller sausage to attach inside one side of the labia majora. This can be flattened if you like:
This is the labia minora. In about half of people with vulvas, the ‘inner lips’ of the labia minora sit outside of the bigger ‘outer lips’ of the labia majora. Let’s complete these. As with the labia majora, it’s not a problem if they aren’t exactly symmetrical:
Next, let’s make a very important structure: the clitoris. Either take a little ball of extra dough, or pinch a piece off from your existing structure:
The bit we can see here only represents the external part – it extends to be a much bigger structure internally. The clitoris is made of very sensitive tissue, with lots of nerve fibres. Some people find it arousing or stimulating when touched gently.
To complete, let’s make the ‘holes’ in the vulva. Get people to guess how many ‘holes’ the vulva contains (guesses I’ve heard range from one to twenty!). For this model, we’ll be looking at two (you can explain that some people talk about a third, the anus, which is actually outside/below the vulva). The first is about a third of the way down and can be marked with a finger or a pencil:
Get students to guess its name – the urethra, and it’s function – carries urine away from the body. It is separate from the next hole we’re going to make. This hole is nearer the bottom of the vestibule and can be marked by making a hole all the way through:
Again, you can get people to guess the name (vagina) and point out that this is the name people often use (incorrectly) to refer to the vulva. You can talk about things that come out of the vagina – i.e. blood (periods), babies and discharge (either healthy or a sign of otherwise, such as thrush or bacteria).
Next, we’ll make a model of a penis.
This time, divide the dough in to two pieces. With the first piece, make a sausage shape:
This represents the shaft of the penis. We can then make a little distinct area by marking out the end:
This is the glands of the penis, which tends to be more sensitive than the shaft. Next we can make a hole in the end (with a pencil or finger). This is the urethra or the penis. Three things can come out of this – urine, ejaculation or discharge.
Give people the option of making a foreskin – pinch off a little bit of dough and fashion in to a thin rectangle to cover the glans. This is a good point to talk about hygiene – e.g. washing with water and changes during puberty, as well as circumcision.
Next, we’ll finish off with making the testicles (scrotum). There is a good chance that students will already have made them with the other half of the dough by making two balls and attaching these to the base of the penis:
This is fine and validate this. Also explain that you can make them from a ‘teardrop’ shape and attach that. You can talk about the misconception that ‘balls drop’ (i.e. they get bigger and hang lower after puberty, but don’t actually ‘drop’ further out of the body).
It can be a nice idea to get the students to look at and reflect on how different all of the bits are. Lots of them seem to ask what ‘normal’ is – this can be a good place to point out that this is something that is highly individual.
We often talk (briefly) about the concept of it being possible to be biologically ‘intersex’ – i.e. it is possible to have someone who doesn’t have external genitalia that fall neatly in to either of these categories.
It can also lead on nicely to talking about internal genitalia and reproductive functions.