Posted in Genitals: A User's Guide

Playing Around

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.

Ingredients:

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

Instructions:

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.

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Vulva models made from play dough recipe

 

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:

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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:

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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:

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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:

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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:

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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:

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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:

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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:

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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.

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This time, divide the dough in to two pieces.  With the first piece, make a sausage shape:

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This represents the shaft of the penis.  We can then make a little distinct area by marking out the end:

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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.

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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.

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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:

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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).

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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.

 

Posted in Genitals: A User's Guide

Filling in the Blanks

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Every now and then I see an image of a penis whilst out and about.  Various public places lend themselves particularly to this, such as the back of loo doors or bus seats.   I bet you know exactly what it looks like.  In fact, you’re probably picturing what it looks like now, a sausage shape with two circles for testicles.  If the artist is paying particular attention to detail, you might get some strands of hair sticking out of them, or some ejaculate coming out of the top.

As yet, I’ve never seen a vulva presented in quite the same way.  Occasionally they are seen as a piece of more formally displayed art – The Vulva Gallery is my current favourite maker and curator of such images.  Why is this?  Is it the different social-cultural meaning that the different genitalia have?  Or maybe it’s just not being quite sure what to draw.

With this in mind, here’s my step-by-step guide to drawing vulvas.  I’m not encouraging you to draw on public property, but I’m wishing that more people could.

First, draw a leaf- type shape.

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This is the vestibule, the smooth bit that is usually covered by the labia.

Next, draw two ‘lips’ either side like so:

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These are the labia majora, the fatty pads of tissue that surround the vulva.  If you like, hair can be added here.  They often cover the rest of the bits that we’re going to draw, but which are still external.

Let’s add a bit more detail.  We now need to make two more ‘inner lips’, of the labia minora.

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These can be either hanging out beyond the labia majora, or can nestle within.  When people (incorrectly) talk about a ‘vaginoplasty’ or ‘designer vagina’ they are often referring to labiaplasty , or surgical reduction of this area.

We now need to start adding some detail.  First, let’s add a little round circle.  Let’s go wild and make it red.

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This represents, you’ve guessed it – the clitoris.  Or at least the bit of the clitoris that can be seen externally.  There are a lot of misconceptions about the clitoris.  Suffice to say, the bit that you can see here represents just a small part of the total structure of the clitoris. It is a sensitive area, which contains millions of nerve endings and is often overlooked because its main purpose seems to be sensual with no conventional reproductive function.

Moving on to another often over looked area of the vulva is the first of the two ‘openings’ in to the internal part of the body, the urethra.  Let’s draw another small circle in the vestibule to represent the area where urine comes out, running straight from the ‘storage’ area of the bladder:

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An important point to note is that this is a separate and distinct area from the vagina.   Urine comes out of this.  Babies, periods and discharge from infections of the internal reproductive tract do not.   They come from the second ‘hole’ in the vestibule, the vagina.  Of course, in real life it isn’t a hole that maintains itself and is ‘squashy’, although can accomodate being made larger – e.g. by neonates’ heads, tampons or penises, for example:

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So if it’s a bigger than this, or more squashy, that’s spot on.

You can stop here.  Because it’s often overlooked, I’m going to add some remnants of the hymenal tissue.  Note that in health, this is not a complete covering or seal.

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Voila!  And remember – this is only a schematic.  Vulvas you have seen may look completely different from this AND THAT IS ABSOLUTELY FINE.

Posted in contraception, Genitals: A User's Guide

Learning for Pleasure

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I joined the lovely voluntary organisation Sexplain (‘Bringing sexual and relationship education into the 21st Century’) as a volunteer facilitator based on two things.  The first was an array of terrible personal experiences of Sex Ed over two decades ago during my time at school.  The second was professional surprise at how little people (particularly those with vulvas!) appeared to know about the intimate parts of their own bodies when I started working on a Gynaecology ward.

One of the things that I found a little unrelenting about my own school SRE learning experiences was how much the emphasis around sex was ‘not getting pregnant’.  It’s all very well to encourage and teach healthy sexual practices.  However, I feel the message went beyond this.   In my classroom, romantic intimacy amounted to sex and sex meant penetrative, penis-in-vagina sex only.  Pleasure, consent and masturbation were not on the curriculum.  Sex was problematic, dangerous, risky – never ‘fun’ or ‘fulfilling’.  The ultimate hazard was pregnancy and STIs.  Nothing good could come out of sex but if for some reason you found yourself having it, the ultimate consideration was to NOT GET PREGNANT.

It turns out that this world view prepared us badly for adult reality.  We learnt how effective a condom was versus a diaphragm, but not how to procure or negotiate the use of either.   We learnt that STIs cause discharge from orifices that we had only a crude understanding of.

Another classroom illusion that was challenged, by both my personal life and professional experience, was that there is a ‘perfect’ choice of contraception for each person.  For many, contraception can be a compromise, a ‘best match’, or a pragmatic move.  It can take in to account what you feel able to negotiate with a sexual partner.  Or what you can afford or have the time and resources to obtain.  Or choosing something you feel is a bit shoddy, but doesn’t leave you with the terrible side-effects of some methods.

I created ‘contraception top trumps’ because I wanted to look at contraception not as a set of absolutely rational, clear-cut decisions (you fulfil criteria x so you should use y) but as a work in progress.  You can learn about and develop an approach to contraception, depending on what is important to you… and unfortunately there’s an element of luck to the whole thing.

I’ve published a printable pdf of contraception top trumps – I would advise printing four pages to an A4 sheet for large print cards and eight for more portable ones!

The link above is for a smartened up and downloadable version of the top trumps game I published earlier this year here on this blog. One of the lovely things about doing this was the interesting and open conversations this prompted with friends.  For example -the one person who confessed she’d had a blazing row with her GP about removing the hormonal implant because she couldn’t cope with the emotional changes that came once it was fitted and had been told simply to ‘persevere’. Or the friend informed that they couldn’t have the copper coil fitted because ‘she hadn’t had children’.  Or the disbelieving faces that meet you when you look at failure rates of condoms, many peoples’ go-to!   Please download, play, share and learn these with whoever you can and start  your own conversations.

REFERENCES:

All statistics on effectiveness and general information are taken from the NHS contraception guide.

My estimate of 20% effectiveness from ‘a wing and a prayer’ was based on a statistic I saw that said 80% of couples having sex regularly would conceive within one year. So it’s probably a bit low for one single instance of sex.  However, I can’t for the life of me find that and the current online NHS advice on infertility suggests that 84% of such couples would conceive within a year, suggesting a figure of 16%.  Either way, it’s not a great method and is incredibly less reliable than actively doing something.  I just wanted to show that it was not guaranteed that you would get pregnant every time you had sex, even once, which is definitely the impression that I got from Miss Hargreaves in Year 9…

Posted in Genitals: A User's Guide, Uncategorized

An Ode to Sanitary Products

Womb carrying folks usually start menstruation (i.e. regular periods) before the age of 16 years*.  I was much older than this when I began to accurately understand what my anatomy ‘down there’ was like.  I think I had a conception of tampons being a cross between a plug and a sponge.  I guess this isn’t completely wrong, but neither is it completely right as the bleeding’s coming from the cervix, with a vagina being a passage way.

I’ve come across a fair few people who have an aversion to using tampons, partly because they are not confident (or downright uncomfortable) with their anatomy and with the idea of placing something in to their vagina.  Even amongst some of my liberated friends, I am considered a bit of a fringe eccentric for using a mooncup – something I’ve done of the last few years.  About the size of an egg cup and made from soft silicone, it sits in the vagina, just below the cervix and catches blood.  It can then be washed, without contributing plastic to the bin or cotton to sewage waste.

n.b. I’ve recently discovered that ‘mooncup’ is just one of many other brands.  This has somewhat blown my mind.

References:

*Lawrence and Impey (2012) Obstetrics and Gynaecology, 4th Ed.

Posted in Genitals: A User's Guide

It’s What’s Inside that Counts?

My weakest area at med school was definitely anatomy. I enjoyed it though. Each week, we would go to the anatomy suite where the cadavers were kept and I would learn another thing I was previously mistaken about. The relationship between what we see and understand on the outside and what and where it is on the inside is often not straightforward.

The stomach, for example, is not the low down bit of the abdomen people hold when they have ‘bellyache’ – that’s more like bowels. This is part of the gut, but with has a distinct and different function. What a lot of people think of as the ‘vagina’ (the passage from the external body to the womb) would actually be better described as the ‘vulva’. In my experience, these misconceptions are rife in ideas about our reproductive organs. Let’s have a look at some of the internal xx anatomy…

Vagina: a passage leading from the outside to internal parts. It’s made up of muscular, stretchy tissue that can deform and accommodate various things (tampons, fingers, foreign objects, a baby…).

Cervix: the lower bit of the womb. Roughly tube shaped and typically around 2-3cm long. It has a hole (the cervical ‘os’) which leads from the vagina to the womb. It can change shape, size and consistency under hormonal control – e.g. getting smaller and opening during childbirth.

Uterus: Or ‘womb’. This is where a baby can grow. Sits just behind the bladder in non-pregnancy. The lining of this cavity is called the ‘endometrium’. It is the endometrium thickening and then shedding that is experienced as periods. The top bit of the uterus is called the ‘fundus’.

Fallopian tubes: connect the uterus to the ovaries. Also called the ‘salpinges’ or a ‘salpinx’. Each one ends in a ‘fimbria’. This is a little fringe of tissue that helps convey eggs in to the tubes from the ovaries.

Ovaries: whitish lumps of tissue where eggs are released from. They also produce hormones so have an important endocrine role.

All of these structures sit quite low down in the abdomen. Sometimes problems that feel like they are coming from this reproductive tract can be mistaken for problems with the bowel and vice versa. We’ll have a look at some of these problems another time…

Posted in Genitals: A User's Guide

A Hymn to the Hymen

The inspiration for this one came from a pub conversation.  It’s time for…

Firstly…

The hymen is a often described as a ‘membrane’.  It is membranous tissue, but this can lead to some confusion-

This is called an ‘imperforate hymen’.  The main reason it needs treatment (i.e. surgical removal) is that it means that menstral blood cannot drain during a period.

So, as with many aspects of genitals, individuals can be VERY different and this is completely normal.

 

References (a note): 

When I have an idea for something, I usually start by looking at some standard Gynae textbooks and then try to find reliable looking online sources (e.g. NHS, clinical guidelines).  They failed me somewhat on this topic.  I’ve found a teeny tiny amount of information from my textbooks (mainly on imperforate hymen).  This is basically a way of explaining why my main source is a wiki page (here)!

Posted in Genitals: A User's Guide

Bartho-What?!

Now let’s finish our exploration of the vulva with something a little more than skin deep: the bartholin’s glands.  These are two paired glands that lie within the vagina.  Their position is roughly shown here: as the two little blue lumps.  They lie just inside the entrance or ‘introitus’ of the vagina, as shown here.  They can’t be seen directly.  However, sometimes they can become infected and inflammed.  This can cause pain and swelling as pus collects and is unable to drain – a condition known as a bartholin’s cyst or abscess.   Treatment includes antibiotics to target an infection, or drainage and insertion of a ‘word catheter’ – a piece of tubing that can be placed and inflated to prevent pus from reforming and allowing the tissue to heal.

Posted in Genitals: A User's Guide

VuVaLicouS!

Lots of people seem unsure about what makes up typical XX genital anatomy – the uterus, ovaries and vulva ensemble.  Unlike penises, the majority of the bits that ‘do’ something are hidden – either internally or amongst lots of indistinct lumps that are hard to view on self-examination.

Let’s start with the external genitalia – the vulva.  Sometimes people refer to it as the ‘vagina’, although this is the name for a specific part of the vulva.

This is my version of a typical textbook diagram:

To orientate yourself, imagine that the person you’re looking at is lying on their back, bottom on a surface below and legs akimbo.  You are standing at the foot end, looking ‘into’ the vagina and at the vulva from here.  The person’s bum is at the bottom of the picture and any hair covering the vulva at the top of this image.  Without pretty sound gymnastic skills and an ingenious mirror system, it is unlikely that anyone has ever seen their own vulva from this angle.  However, it is the view that a doctor or nurse (for example) would obtain to do a gynaecological exam, which is probably why it gets used in diagrams so often.

The bits that make up the vulva are as follows:

Clitoris: A bundle of sensory nervous tissue.  It can feel good to touch or otherwise stimulate here.  In Alice Walker’s novel ‘The Colour Purple’, Shug refers to her clitoris as her ‘little button’ that gives her pleasure.

Urethra: An opening for urine to pass from.  A tube (sometimes with a bag) called a ‘catheter’ can be passed here to drain wee in some circumstances.

Labia Majora: The ‘big lips’ – the bigger folds of tissue that cover the front of the vulva.  If a person with a vulva were standing up, walking around, this is probably the only bit you could make out.  All other bits mentioned here would be hidden by it and the legs.

Labia Minora: The ‘little lips’ – smaller folds of tissue surrounding the inner part of the vulva.  Although there is relatively less tissue here than the labia majora, there is a huge amount of variation in the size and shape of the labia minora between individuals.  Surgery to reduce the amount of tissue here is called ‘labiaplasty’ and it is usually this that people mean when they refer to ‘designer vaginas’.  This area is not really called the vagina though…

Vagina: This is the passage in to the body and the rest of the reproductive tract (i.e. the cervix and womb).  A penis (or other objects!) can go in and believe it or not a baby can come out of here.

The area within the labia minora in to which the urethra and vagina open up can be called the vestibule.  The area between the vulva and the anus is called the perineum.

Posted in Genitals: A User's Guide

Your Whostsaname

Genitals.  Everyone has them.  Sometimes they have weird and wonderful bits.  Do you know where to find a raphe of a penis?  How about the bartholin’s glands?  Occasionally we don’t seem to know how to use them, or what they are for.  Sometimes they go wrong.  Ever feel like we should be handed a manual?  You know – ‘Genitals: A User’s Guide.’  Maybe it could be issued sometime before puberty.  That’s what I’d like to create over the next few months – ‘Genital’s: A User’s Manual’.   With words and pictures.

Let’s start with the basics.  The external genitalia.  For a lot of people there are two basic flavours:  the penis ( and it’s sidekick the scrotum or testicles) or the vulva get up. Note that I don’t (and won’t) use the words ‘male’ and ‘female’ to delineate these two.  Chromosomal and genetic sex is separate from gender identity – people of both and any gender can have either genitalia.  Also, it is possible for people to be born with genitalia that do not fit in to this penis/ vagina divide – again, more on that later.

We tend to be pretty familiar with the basic components of penises – the pole and two balls, depicted for generations on the walls of public loos.  A little more mysterious seems to be the vulva.  People often refer to this as a ‘vagina’.  Technically though, vagina is the name for the hole bit – the bit that connects the outside world to the inside (more detail on that next week). The vulva is the word used to describe all of the external parts.

Here are a very small collection of words that we use for genitals in English.  I think it’s important to have the vocabulary to describe genitals if we’re going to talk about them in more detail.  Enjoy – and let me know (@SquiSquaSque) if you’ve got any favourite words for ‘down there’ that I haven’t included.

Posted in Genitals: A User's Guide

Does My Labia Majora Look Big In This?

Today I was at a teaching session for trainee Obstetrician/Gynaecologists.  At one point, these words were uttered:

“If a woman’s been told by her boyfriend that her vulva looks abnormal, it’s YOUR job, especially YOU [points to the two men in the room] to say that you’ve seen far more than him & it ISN’T.”

Insecurities about genitals is the idea behind The Great Wall of Vagina (dull accuracy announcement: it’s actually vulvas, not vaginas, but still great).

There is a huge amount of variation in how external genitalia look.  Humans have a great variety in height, build and skin tone.  We are all so different that we find it remarkable when we find someone whose face is a little like ours.  Why would this be any different in your nether regions?