The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the

mons pubis In human anatomy, and in mammals in general, the ''mons pubis'' or pubic mound (also known simply as the mons, and known specifically in females as the ''mons Venus'' or ''mons veneris'') is a rounded mass of fatty tissue found over the pubic symp ...

(or mons veneris),

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 ...

, labia minora,

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 ...

, vestibular bulbs,

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 ...

urinary meatus The urinary meatus, (, ) also known as the external urethral orifice, is the opening of the urethra. It is the point where urine exits the urethra in both sexes and where semen exits the urethra in males. The meatus has varying degrees of sensiti ...

, the

vaginal opening In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

, hymen, and Bartholin's and Skene's vestibular

gland In animals, a gland is a group of cells in an animal's body that synthesizes substances (such as hormones) for release into the bloodstream (endocrine gland) or into cavities inside the body or its outer surface (exocrine gland). Structure De ...

s. The urinary meatus is also included as it opens into the vulval vestibule. Other features of the vulva include the pudendal cleft,

sebaceous gland A sebaceous gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest number ...

s, 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 ...

(anterior part of the perineum), and

pubic hair Pubic hair is terminal body hair that is found in the genital area of adolescent and adult humans. The hair is located on and around the sex organs and sometimes at the top of the inside of the thighs. In the pubic region around the pubis bon ...

. The vulva includes the entrance to the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

, which leads to 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 ...

, and provides a double layer of protection for this by the folds of the outer and inner labia.

Pelvic floor muscles 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 ...

support the structures of the vulva. Other muscles of the urogenital triangle also give support. Blood supply to the vulva comes from the three pudendal arteries. The internal pudendal veins give drainage. Afferent lymph vessels carry

lymph Lymph (from Latin, , meaning "water") is the fluid that flows through the lymphatic system, a system composed of lymph vessels (channels) and intervening lymph nodes whose function, like the venous system, is to return fluid from the tissues to ...

away from the vulva to the inguinal lymph nodes. The nerves that supply the vulva are the pudendal nerve,

perineal nerve The perineal nerve is a nerve of the pelvis. It arises from the pudendal nerve in the pudendal canal. It gives superficial branches to the skin, and a deep branch to muscles. It supplies the skin and muscles of the perineum. Its latency is test ...

, ilioinguinal nerve and their branches. Blood and nerve supply to the vulva contribute to the stages of

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 ...

that are helpful in the

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 ...

process. Following the development of the vulva, changes take place at birth, childhood,

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. ...

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 ...

and post-menopause. There is a great deal of variation in the appearance of the vulva, particularly in relation to the labia minora. The vulva can be affected by many disorders which may often result in

irritation Irritation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant. Irritants are typically thought of as chemical age ...

Vulvovaginal health In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hyme ...

measures can prevent many of these. Other disorders include a number of infections and cancers. There are several vulval restorative surgeries known as genitoplasties, and some of these are also used as

cosmetic surgery procedures Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...

. Different cultures have held different views of the vulva. Some ancient religions and societies have worshipped the vulva and revered the female as a goddess. Major traditions 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 ...

continue this. In Western societies, there has been a largely negative attitude typified by the medical terminology of , meaning parts to be ashamed of. There has been an artistic reaction to this in various attempts to bring about a more positive and natural outlook, such as work from British, American, and Japanese artists. While the vagina is a separate part of the anatomy, it has often been used synonymously with vulva.

Structure

The main structures of the vulva are: the

, the

and labia minora, the external parts of the

– the clitoral hood and the glans, the

, the

and hymen, and Bartholin's and Skene's vestibular glands. Other features include the pudendal cleft,

s, the

, and the

Mons pubis

The mons pubis is the soft mound of fatty tissue at the front of the vulva, in the pubic region covering the pubic bone. is Latin for "pubic mound" and is present in both

sex Sex is the trait that determines whether a sexually reproducing animal or plant produces male or female gametes. Male plants and animals produce smaller mobile gametes (spermatozoa, sperm, pollen), while females produce larger ones (ova, oft ...

es to act as a cushion during

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 is more pronounced in the female. The variant term ''mons veneris'' ('mound of Venus') is used specifically for females. The lower part of the mons pubis is divided by a fissure – the pudendal cleft – which separates the mons pubis into the labia majora. After puberty, the clitoral hood and the labia minora can protrude into the pudendal cleft in a variable degree. The mons and labia majora become covered in

Labia

The labia majora and the labia minora cover the vulval vestibule. The outer pair of folds, divided by the pudendal cleft, are the labia majora ( New Latin for "larger lips"). They contain and protect the other structures of the vulva. The labia majora meet at the front at the mons pubis, and meet posteriorly at the

(the anterior part of the perineum) between the pudendal cleft and the

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 ...

. The labia minora are often pink or brownish black, relevant to the person's skin color. The grooves between the labia majora and labia minora are called the interlabial sulci, or interlabial folds. The labia minora (smaller lips) are the inner two soft folds, within the labia majora. They have more color than the labia majora and contain numerous sebaceous glands. They meet posteriorly at the frenulum of the labia minora, a fold of restrictive tissue. The labia minora meet again at the front of the vulva to form the clitoral hood, also known as the prepuce. The visible portion of the clitoris is the clitoral glans. Typically, this is roughly the size and shape of a

pea The pea is most commonly the small spherical seed or the seed-pod of the flowering plant species ''Pisum sativum''. Each pod contains several peas, which can be green or yellow. Botanically, pea pods are fruit, since they contain seeds and d ...

, and can vary in size from about 6 mm to 25 mm. The size can also vary when it is erect. The clitoral glans contains as many nerve endings as the much larger homologous glans penis in the male, which makes it highly sensitive. The only known function of the clitoris is to focus sexual feelings. The clitoral hood is a protective fold of skin which varies in shape and size, and it may partially or completely cover the clitoris. The clitoris is the homologue of 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 ...

, and the clitoral hood is the female equivalent of the male foreskin, and may be partially or completely hidden within the pudendal cleft.

Vestibule

The area between the labia minora where the vaginal opening and the

are located is called the

, or vestibule of the vagina. The urinary meatus is below the clitoris and just in front of the vaginal opening which is near to the perineum. The term ''introitus'' is more technically correct than "opening", since the vagina is usually collapsed, with the opening closed. The introitus is sometimes partly covered by a membrane called the hymen. The hymen will usually rupture during the first episode of vigorous sex, and the blood produced by this rupture has been seen to signify

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 ...

. However, the hymen may also rupture spontaneously during exercise or be stretched by normal activities such as the use of tampons and menstrual cups, or be so minor as to be unnoticeable, or be absent. In some rare cases, the hymen may completely cover the vaginal opening, requiring a surgical procedure called a

hymenotomy A hymenotomy is a medical procedure involving the surgery, surgical removal or opening of the hymen. It is often performed on patients with an imperforate hymen, imperforate or Hymen#Anatomic variations, septate hymen, or other situations where th ...

. On either side of the back part of the vaginal opening are the two greater vestibular glands known as

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. These glands secrete mucus and a vaginal and vulval lubricant. They are homologous to the

bulbourethral gland The bulbourethral glands or Cowper's glands (named for English anatomist William Cowper) are two small exocrine glands in the reproductive system of many male mammals (of all domesticated animals, they are absent only in dogs). They are homolog ...

s in the male. The lesser vestibular glands known as

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, are found on the anterior wall of the vagina. They are homologues of the male

prostate gland The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and physio ...

and are also referred to as the female prostate.

Muscles

help to support the vulvar structures. The voluntary,

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 ...

, part of the levator ani muscle partially constricts the vaginal opening. Other muscles of the

support the vulvar area and they include the

transverse perineal muscles The transverse perineal muscles (transversus perinei) are the superficial and the deep transverse perineal muscles. Superficial transverse perineal ...

, the

bulbospongiosus The bulbospongiosus muscle (bulbocavernosus in older texts) is one of the superficial muscles of the perineum. It has a slightly different origin, insertion and function in males and females. In males, it covers the bulb of the penis. In femal ...

, and the

ischiocavernosus The ischiocavernosus muscle (erectores penis ''or'' erector clitoridis in older texts) is a muscle just below the surface of the perineum, present in both men and women. Structure It arises by tendinous and fleshy fibers from the inner surface of ...

muscles. The bulbospongiosus muscle decreases the vaginal opening. Their contractions play a role in the vaginal contractions of

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 ...

by causing the vestibular bulbs to contract.

Blood, lymph and nerve supply

The tissues of the vulva are highly vascularised and blood supply is provided by the three pudendal arteries. Venous return is via the external and

internal pudendal vein The internal pudendal veins (internal pudic veins) are a set of veins in the pelvis. They are the venae comitantes of the internal pudendal artery. Internal pudendal veins are enclosed by pudendal canal, with internal pudendal artery and pudendal ...

s. The organs and tissues of the vulva are drained by a chain of

superficial inguinal lymph nodes Inguinal lymph nodes are lymph nodes in the human groin. Located in the femoral triangle of the inguinal region, they are grouped into superficial and deep lymph nodes. The superficial have three divisions: the superomedial, superolateral, and in ...

located along the blood vessels. The ilioinguinal nerve originates from the first lumbar nerve and gives branches that include the

anterior labial nerves The anterior labial nerves are branches of the ilioinguinal nerve. The nerves innervate the mons pubis and labium majus in females. The equivalent nerves in the male are the anterior scrotal nerves. See also * Posterior labial nerves The posteri ...

which supply the skin of the mons pubis and the labia majora. The

is one of the terminal branches of the pudendal nerve and this branches into the

posterior labial nerves The posterior labial nerves are branches of the pudendal nerve. The counterparts in males are the posterior scrotal nerves. See also * Anterior labial nerves The anterior labial nerves are branches of the ilioinguinal nerve. The nerves innervat ...

to supply the labia. The pudendal nerve branches include the dorsal nerve of clitoris which gives sensation to the clitoris. The clitoral glans is seen to be populated by a large number of small nerves, a number that decreases as the tissue changes towards the urethra. The density of nerves at the glans indicates that it is the center of heightened sensation.

Cavernous nerves The cavernous nerves are post-ganglionic parasympathetic nerves that facilitate penile erection and clitoral erection. They arise from cell bodies in the inferior hypogastric plexus where they receive the pre-ganglionic pelvic splanchnic ne ...

from the uterovaginal plexus supply the erectile tissue of the clitoris. These are joined underneath the pubic arch by the dorsal nerve of the clitoris. The pudendal nerve enters the pelvis through the lesser sciatic foramen and continues medial to the internal pudendal artery. The point where the nerve circles the ischial spine is the location where a pudendal block of

local anesthetic A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

can be administered to inhibit sensation to the vulva. A number of smaller nerves split off from the pudendal nerve. The

deep branch of the perineal nerve The deep branch of the perineal nerve (or muscular branches) is a nerve of the perineum. It is a branch of the perineal nerve, from the pudendal nerve. It supplies the superficial transverse perineal muscle, bulbospongiosus muscle, ischiocavernos ...

supplies the muscles of the perineum and a branch of this supplies the bulb of the vestibule.

Variations

There is a great deal of variation in the appearance of female genitals. Much of this variation lies in the significant differences in the size, shape, and color of the labia minora. Though called the smaller lips they can often be of considerable size and may protrude outside the vagina or labia majora. This variation has also been evidenced in a large display of 400 vulval casts called the ''Great Wall of Vagina'' created by Jamie McCartney to fill the lack of information of what a normal vulva looks like. The casts taken from a large and varied group of women showed clearly that there is much variation. Pubic hair also varies in its color, texture, and amount of curl. Researchers from the Elizabeth Garret Anderson Hospital, London, measured multiple genital dimensions of 50 women between the ages of 18 and 50, with a mean age of 35.6:Pdf.

Development

Prenatal development

Development of external sexual organs in the male and female Gray1119

In week three of the development of the embryo,

mesenchyme Mesenchyme () is a type of loosely organized animal embryonic connective tissue of undifferentiated cells that give rise to most tissues, such as skin, blood or bone. The interactions between mesenchyme and epithelium help to form nearly every o ...

cells from the

primitive streak The primitive streak is a structure that forms in the early embryo in amniotes. In amphibians the equivalent structure is the blastopore. During early embryonic development, the embryonic disc becomes oval shaped, and then pear-shaped with the ...

migrate around the

cloacal membrane The cloacal membrane is the membrane that covers the embryonic cloaca during the development of the urinary and reproductive organs. It is formed by ectoderm and endoderm coming into contact with each other. As the human embryo grows and caudal ...

. Early in the fifth week the cells form two swellings called the cloacal folds. The cloacal folds meet in front of the cloacal membrane and form a raised area known as the genital tubercle. The urorectal septum fuses with the cloacal membrane to form the perineum. This division creates two areas one surrounded by the urethral folds and the other by the anal folds. These areas become the urogenital triangle and the anal triangle. The area between the vagina and the anus is known as the clinical perineum. At the same time a pair of swellings on either side of the urethral folds known as the genital swellings develop into the labioscrotal swellings. Sexual differentiation takes place, and at the end of week 6 in the female, hormones stimulate further development and the genital tubercle bends and forms the clitoris. The urethral folds form the labia minora and the labioscrotal swellings form the labia majora. At this time the sexes still cannot be distinguished. The appearance of the external genitalia is similar in male and female embryos until the twelfth week and even then is difficult to distinguish. The uterovaginal canal or genital canal, forms in the third month of the development of the urogenital system. The lower part of the canal is blocked off by a plate of tissue, the vaginal plate. This tissue develops and lengthens during the third to fifth months and the lower part of the vaginal canal is formed by a process of desquamation or cell shedding. The end of the vaginal canal is blocked off by an endodermal membrane which separates the opening from the vestibule. In the fifth month the membrane degenerates but leaves a remnant called the hymen. Organs in the male and female with a shared common ancestry are said to be homologous. The clitoral glans is homologous to the male glans penis, and the

clitoral body 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 openi ...

and the

clitoral crura The clitoral crura (singular: clitoral crux) are two erectile tissue structures, which together form a V-shape. ''Crus'' is a Latin word that means "leg". Each "leg" of the ''V'' converges on the clitoral body. At each divergent point is a corp ...

are homologous to the corpora cavernosa of the

. The labia majora is homologous to the scrotum; the clitoral hood is homologous to the foreskin, and the labia minora is homologous to the

spongy urethra The spongy urethra (cavernous portion of urethra, penile urethra) is the longest part of the male urethra, and is contained in the corpus spongiosum of the penis. It is about 15 cm long, and extends from the termination of the membranous po ...

. The vestibular bulbs beneath the skin of the labia minora are homologous to the corpus spongiosum, the tissue of the penis surrounding the urethra, and to the

bulb of the penis In botany, a bulb is structurally a short stem with fleshy leaves or leaf basesBell, A.D. 1997. ''Plant form: an illustrated guide to flowering plant morphology''. Oxford University Press, Oxford, U.K. that function as food storage organs durin ...

s are homologous to the

s in males.

Childhood

The newborn's vulva may be swollen or enlarged as a result of having been exposed, via the

placenta The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate mater ...

, to her mother's increased levels of hormones. The labia majora are closed. These changes disappear over the first few months. During childhood before puberty, the lack of estrogen can cause the labia to become sticky and to ultimately join firmly together. This condition is known as

labial fusion Labial fusion is a medical condition of the female genital anatomy where the labia minora become fused together. It is generally a pediatric condition. Presentation Labial fusion is rarely present at birth, but rather acquired later in infancy, s ...

and is rarely found after puberty when oestrogen production has increased.

Puberty

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. ...

is the onset of the ability to reproduce, and takes place over two to three years, producing a number of changes. The structures of the vulva become proportionately larger and may become more pronounced.

Pubarche Pubarche refers to the first appearance of pubic hair at puberty. Pubarche is one of the physical changes of puberty and can occur independently of complete puberty. Pubarche usually results from rising levels of androgen and not estrogens in femal ...

, the first appearance of

develops, firstly on the labia majora, and later spreads to the mons pubis, and sometimes to the inner thighs and perineum. Pubic hair is much coarser than other body hair, and is considered a secondary sex characteristic. Pubarche can occur independently of puberty. ''Premature pubarche'' may sometimes indicate a later

metabolic 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 ...

endocrine disorder Endocrine diseases are disorders of the endocrine system. The branch of medicine associated with endocrine disorders is known as endocrinology. Types of disease Broadly speaking, endocrine disorders may be subdivided into three groups: # Endocrin ...

seen at adolescence. The disorder sometimes known as a ''polyendocrine disorder'' is marked by elevated levels of androgen,

insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism o ...

, and

lipid Lipids are a broad group of naturally-occurring molecules which includes fats, waxes, sterols, fat-soluble vitamins (such as vitamins A, D, E and K), monoglycerides, diglycerides, phospholipids, and others. The functions of lipids include ...

s, and may originate in the fetus. Instead of being seen as a normal variant it is proposed that premature pubarche may be seen as a marker for these later endocrine disorders.

Apocrine sweat gland An apocrine sweat gland (; from Greek ''apo'' 'away' and ''krinein'' 'to separate') is composed of a coiled secretory portion located at the junction of the dermis and subcutaneous fat, from which a straight portion inserts and secretes into the ...

s secrete sweat into the pubic hair follicles. This is broken down by bacteria on the skin and produces an odor, which some consider to act as an attractant sex pheromone. The labia minora may grow more prominent and undergo changes in color. At puberty the first monthly period known as

menarche Menarche ( ; ) is the first menstrual cycle, or first menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fertility. Gir ...

marks the onset of

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 ...

. In prepubertal girls the skin of the vulva is thin and delicate, and its neutral pH makes it prone to irritation. The production of the female sex hormone estradiol (an

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 ...

) at puberty, causes the perineal skin to thicken by

keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. Alpha-keratin (α-keratin) is a type of keratin found in vertebrates. It is the key structural material making up scales, hair, nails, feathers, ho ...

ising, and this reduces the risk of infection. Estrogen also causes the laying down of fat in the development of the secondary sex characteristics. This contributes to the maturation of the vulva with increases in the size of the mons pubis, and the labia majora and the enlargement of the labia minora.

Pregnancy

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 ...

the vulva and vagina take on a bluish colouring due to venous congestion. This appears between the eighth and twelfth week and continues to darken as the pregnancy continues. Estrogen is produced in large quantities during pregnancy and this causes the external genitals to become enlarged. The vaginal opening and the vagina are also enlarged. After

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 ...

a vaginal discharge known as lochia is produced and continues for about ten days.

Menopause

During

, hormone levels decrease, which causes changes in the vulva known as

vulvovaginal atrophy 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 n ...

. The decreased estrogen affects the mons, the labia, and the vaginal opening and can cause pale, itchy, and sore skin. Other visible changes are a thinning of the pubic hair, a loss of fat from the labia majora, a thinning of the labia minora, and a narrowing of the vaginal opening. This condition has been renamed by some bodies as the ''genitourinary syndrome of menopause'' as a more comprehensive term.

Function and physiology

The vulva has a major role to play in the reproductive system. It provides entry to, and protection for the uterus, and the right conditions in terms of warmth and moisture that aids in its sexual and reproductive functions. The external organs of the vulva are richly innervated and provide pleasure when properly stimulated. The mons pubis provides cushioning against the pubic bone during intercourse. A number of different secretions are associated with the vulva, including

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 ...

(from the urethral opening), sweat (from the apocrine glands), menses (leaving from the vagina),

sebum A sebaceous gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest nu ...

(from the

s), alkaline fluid (from the Bartholin's glands),

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 ...

(from the

s), vaginal lubrication from the vaginal wall and

smegma Smegma (Ancient Greek σμῆγμα : ''smēgma'') is a combination of shed skin cells, skin oils, and moisture. It occurs in both male and female mammalian genitalia. In females, it collects around the clitoris and in the folds of the labia min ...

. Smegma is a white substance formed from a combination of dead cells, skin oils, moisture and naturally occurring

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...

, that forms in the genitalia. In females this thickened secretion collects around the clitoris and labial folds. It can cause discomfort during sexual activity as it can cause the clitoral glans to stick to the hood, and is easily removed by bathing.

Aliphatic In organic chemistry, hydrocarbons ( compounds composed solely of carbon and hydrogen) are divided into two classes: aromatic compounds and aliphatic compounds (; G. ''aleiphar'', fat, oil). Aliphatic compounds can be saturated, like hexane, or ...

acids known as copulins are also secreted in the vagina. These are believed to act as pheromones. Their

fatty acid In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, fr ...

composition, and consequently their

odor An odor (American English) or odour (English in the Commonwealth of Nations, Commonwealth English; American and British English spelling differences#-our, -or, see spelling differences) is caused by one or more volatilized chemical compounds ...

changes in relation to the stages 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 ...

Sexual arousal

The clitoris and the labia minora are both erogenous areas in the vulva. Local stimulation can involve the clitoris, vagina and other perineal regions. The clitoris is the human female's most sensitive erogenous zone and generally the primary anatomical source of human female sexual pleasure. Sexual stimulation of the clitoris (by a number of means) can result in widespread

and, if maintained, can result in

. Stimulation to orgasm is optimally achieved by a massaging sensation. Sexual arousal results in a number of physical changes in the vulva. During arousal

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 ...

increases. Vulva tissue is highly vascularised; arterioles dilate in response to sexual arousal and the smaller veins will compress after arousal, so that the clitoris and labia minora increase in size. Increased vasocongestion in the vagina causes it to swell, decreasing the size of the vaginal opening by about 30%. The clitoris becomes increasingly erect, and the glans moves towards the pubic bone, becoming concealed by the hood. The labia minora increase considerably in thickness. The labia minora sometimes change considerably in color, going from pink to red in lighter skinned women who have not borne a child, or red to dark red in those that have. Immediately prior to an

, the clitoris becomes exceptionally engorged, causing the glans to appear to retract into the clitoral hood. Rhythmic

muscle contraction Muscle contraction is the activation of tension-generating sites within muscle cells. In physiology, muscle contraction does not necessarily mean muscle shortening because muscle tension can be produced without changes in muscle length, such as ...

s occur in the outer third of the vagina, as well as the uterus and anus. Contractions become less intense and more randomly spaced as the orgasm continues. The number of contractions that accompany an orgasm vary depending on its intensity. An orgasm may be accompanied by

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 ...

, causing liquid from either 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 ...

to be expelled through the urethra. The pooled blood begins to dissipate, although at a much slower rate if an orgasm has not occurred. The vagina and vaginal opening return to their normal relaxed state, and the rest of the vulva returns to its normal size, position and color.

Distance between vagina and clitoral glans

The distance of the frenula clitoridis at the clitoral glans from the

located in the

, the so-called CUMD (clitoral-urinary meatus distance), is measured. In the 1920s, Marie Bonaparte conducted surveys among women to find out whether they get an

during coitus. The causes of lack of sexual arousal were known to be aversion or psychological inhibitions. Among the test subjects, there were women who, with a man they loved and desired, "felt the greatest pleasure at certain tender touches", but were nevertheless not sufficiently aroused during coitus. Bonaparte examined the distance between the

and the

in 200 women. In 69% of the women, the CUMD was 1.25 to 2.25 cm, most of whom experienced the sexual act as satisfying. In 10% of the women, the CUMD was 2.5 cm, 21% measured 2.75 to 3.5 cm. All the women with a large gap stated that they did not experience satisfying pleasure from penile penetration, although some were very sensitive to "precise stroking by the man". Bonaparte concluded from this an anatomical causal connection between a large CUMD and "vaginal frigidity" explaining why only women with the clitoral glans close to the vagina (so that it is continuously touched by the penis) were able to experience "the highest sexual pleasure" during coitus. File:Vulva Dettol 3.jpg, Glans clitoridis with small distance to the opening File:Intercourse Woman on Top 2.jpg, Contact of the clitoral glans with the penis with small CUMD File:Vulva - CUMD 2.jpg, Glans clitoridis with medium distance to the opening File:Penile-vaginal intercourse 3 - painting.png, Lack of contact of the clitoral glans with the penis File:CUMD - Marie Bonaparte Table 1.png, Classification of the 200 women into CUMD categories File:CUMD - Marie Bonaparte Table 2.png, Selection of women studied and interviewed A study by

Carney Landis Carney may refer to: * Carney (surname) Places In the United States * Carney, Maryland * Carney, Michigan * Carney, Montana * Carney, Oklahoma * Carney, West Virginia * Carney, Pennsylvania In the Republic of Ireland * Carney, County S ...

and colleagues in 1940 includes statements to this effect: "On the physical side orgasm capacity is related to clitoris-meatus distance." (Landis et al. 1940). In 2011,

Kim Wallen Kim or KIM may refer to: Names * Kim (given name) * Kim (surname) ** Kim (Korean surname) *** Kim family (disambiguation), several dynasties **** Kim family (North Korea), the rulers of North Korea since Kim Il-sung in 1948 ** Kim, Vietnamese f ...

and

Elisabeth Lloyd Elisabeth Anne Lloyd (born September 3, 1956) is an American philosopher of science specialising in the philosophy of biology. She is currently Distinguished Professor of History and Philosophy of Science and Medicine - as well as Adjunct Professor ...

reviewed Bonaparte's research and confirmed an inverse correlation between CUMD and orgasm through intercourse. In methods taught since the 1970s by

Betty Dodson Betty Dodson (August 24, 1929October 31, 2020) was an American sex educator. An artist by training, she exhibited erotic art in New York, before pioneering the pro-sex feminist movement. Dodson's workshops and manuals encourage women to masturba ...

, the

of the woman during vaginal intercourse is to be ensured by the woman independently stimulating her vulva and clitoris continuously with her

hand A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each "h ...

s or possibly with a vibrator. According to Kim Wallen, the CUMD says nothing about a happy sex life, rather that a large gap gives couples an opportunity "to be a bit more inventive in how they have sex."

Clinical significance

Irritation

Irritation and itching of the vulva is called

pruritus vulvae Pruritus vulvae is itchiness of the vulva, which is the counterpart of pruritus scroti, and may have many different causes. Patch testing may be used to diagnose the cause. Causes This condition is a symptom of an underlying condition more of ...

. This can be a symptom of many disorders, some of which may be determined by a patch test. The most common cause of irritation is

thrush ''The Man from U.N.C.L.E.'' is an American spy fiction television series produced by Metro-Goldwyn-Mayer Television and first broadcast on NBC. The series follows secret agents, played by Robert Vaughn and David McCallum, who work for a secret ...

, a fungal infection.

measures can help to prevent many disorders including thrush. Infections of the vagina such as

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 ...

and of the uterus may produce vaginal discharge which can be an irritant when it comes into contact with the vulvar tissue. Inflammation as

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 ...

, and

vulvovaginitis 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 ...

can result from this causing irritation and pain. Ingrown hairs resulting from pubic hair shaving can cause

folliculitis Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. A ...

where the

hair follicle The hair follicle is an organ found in mammalian skin. It resides in the dermal layer of the skin and is made up of 20 different cell types, each with distinct functions. The hair follicle regulates hair growth via a complex interaction between h ...

becomes infected; or give rise to an inflammatory response known as pseudofolliculitis pubis. A less common cause of irritation is genital lichen planus another inflammatory disorder. A severe variant of this is ''vulvovaginal-gingival syndrome'' which can lead to narrowing of the vagina, or vulva destruction. Many types of infection and other diseases including some

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 ...

s may cause irritation.

Sexually transmitted infections

Vulvar organs and tissues can become affected by different infectious agents such as

and

virus A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea. Since Dmitri Ivanovsky's 1 ...

es, or

infested ''Ticks'', also known as ''Infested'', is a 1993 direct-to-video horror film directed by Tony Randel and starring Peter Scolari, Seth Green, Rosalind Allen, Ami Dolenz, Alfonso Ribeiro, and Clint Howard. Plot Drug dealer Jarvis Tanner uses ster ...

parasite Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson has ...

s such as

lice Louse ( : lice) is the common name for any member of the clade Phthiraptera, which contains nearly 5,000 species of wingless parasitic insects. Phthiraptera has variously been recognized as an order, infraorder, or a parvorder, as a result o ...

and

mite Mites are small arachnids (eight-legged arthropods). Mites span two large orders of arachnids, the Acariformes and the Parasitiformes, which were historically grouped together in the subclass Acari, but genetic analysis does not show clear evid ...

s. Over thirty types 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 ...

can be

sexually transmitted Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral sex ...

, and many of these affect the genitals. Most

STIs The Space Telescope Imaging Spectrograph (STIS) is a spectrograph, also with a camera mode, installed on the Hubble Space Telescope. Aerospace engineer Bruce Woodgate of the Goddard Space Flight Center was the principal investigator and crea ...

do not produce symptoms or symptoms may be mild and not be indicative of an STI. The practice of

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 ...

can greatly reduce the risk of infection from many sexually transmitted pathogens. 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 (either male or female condoms) is one of the most effective methods of protection.

Bacterial Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...

infections include:

chancroid Chancroid ( ) is a bacterial sexually transmitted infection characterized by painful sores on the genitalia. Chancroid is known to spread from one individual to another solely through sexual contact. However, there have been reports of accidenta ...

– characterised by genital ulcers known as

chancre A chancre ( )chancres
thefreedictionary is a painless

granuloma inguinale Granuloma inguinale is a bacterial disease caused by ''Klebsiella granulomatis'' (formerly known as ''Calymmatobacterium granulomatis'') characterized by genital ulcers. It is endemic in many less-developed regions. It is also known as donovano ...

showing as inflammatory

granuloma A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious ...

s often described as nodules;

syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...

–the primary stage classically presents with a single chancre, a firm, painless, non-itchy ulcer, but there may be multiple sores; and gonorrhea that very often presents no symptoms but can result in discharge. Viral infections include human papillomavirus infection (HPV) – this is the most common STI and has many types. Genital HPV can cause genital warts. There have been links made between HPV and vulvar cancer, though HPV most often causes

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 ...

. Genital herpes is mostly

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 ...

but can present with small

blister A blister is a small pocket of body fluid (lymph, serum, plasma, blood, or pus) within the upper layers of the skin, usually caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection. Most blisters are filled wi ...

s that break open into ulcers.

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 ...

is mostly transmitted through sexual activity, and the vulva in some cases can be affected by sores. A highly contagious viral infection is molluscum contagiosum which is transmissible on close contact and causes water warts. Parasitic infections include

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 ...

, pediculosis pubis, and

scabies Scabies (; also sometimes known as the seven-year itch) is a contagious skin infestation by the mite ''Sarcoptes scabiei''. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally, tiny burrows may appear on the skin ...

. Trichomoniasis is transmitted by a parasitic

protozoan Protozoa (singular: protozoan or protozoon; alternative plural: protozoans) are a group of single-celled eukaryotes, either free-living or parasitic, that feed on organic matter such as other microorganisms or organic tissues and debris. Histo ...

and is the most common non-viral STI. Most cases are asymptomatic but may present symptoms of irritation and a

discharge Discharge may refer to Expel or let go * Discharge, the act of firing a gun * Discharge, or termination of employment, the end of an employee's duration with an employer * Military discharge, the release of a member of the armed forces from serv ...

of unusual

. Pediculosis pubis commonly called ''crabs'', is a disease caused by the crab louse an

ectoparasite Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson has ...

. When the pubic hair is infested the irritation produced can be intense.

Scabies Scabies (; also sometimes known as the seven-year itch) is a contagious skin infestation by the mite ''Sarcoptes scabiei''. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally, tiny burrows may appear on the skin ...

, also known as the "seven year itch", is caused by another ectoparasite, the

Sarcoptes scabiei ''Sarcoptes scabiei'' or the itch mite is a parasitic mite that burrows into skin and causes scabies. The mite is found in all parts of the world. Humans are not the only mammals that can become infected. Other mammals, such as wild and domesti ...

'', giving intense irritation.

Cancer

Malignancies Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...

can develop in the glabrous and hair-bearing parts of the vulva. Based on the cellular origin and

histology Histology, also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...

, vulvar cancers are classified into

squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

melanoma Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye ( ...

s, basal cell carcinomas,

adenocarcinoma Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or ...

sarcoma A sarcoma is a malignant tumor, a type of cancer that arises from transformed cells of mesenchymal (connective tissue) origin. Connective tissue is a broad term that includes bone, cartilage, fat, vascular, or hematopoietic tissues, and sarcom ...

s and invasive

extramammary Paget's disease Extramammary Paget's Disease (EMPD) is a rare and slow-growing malignancy which occurs within the epithelium and accounts for 6.5% of all Paget's disease. The clinical presentation of this disease is similar to the characteristics of mammary Pa ...

. Squamous cell carcinomas represent the most common variant of vulvar cancers and account for approximately 75%. These are usually found in the labia particularly the labia majora. The second most common vulvar cancer is basal cell carcinoma, which rarely spreads to regional lymph nodes or distant organs. The third most common subtype is vulvar

. Studies have shown that vulvar melanomas appear to have a different tumor biology and mutational characteristics compared to skin

s, which has a direct impact on the medical treatment of vulvar melanomas.

Signs Signs may refer to: * ''Signs'' (2002 film), a 2002 film by M. Night Shyamalan * ''Signs'' (TV series) (Polish: ''Znaki'') is a 2018 Polish-language television series * ''Signs'' (journal), a journal of women's studies *Signs (band), an American ...

and symptoms of vulvar cancer can include:

itching Itch (also known as pruritus) is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasan ...

, or bleeding; skin changes including rashes, sores, lumps or ulcers, and changes in vulvar skin coloration.

Pelvic pain Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis. Common causes in include ...

might also occur especially during

urinating Urination, also known as micturition, is the release of urine from the urinary bladder through the urethra to the outside of the body. It is the urinary system's form of excretion. It is also known medically as micturition, voiding, uresis, ...

and sex. However, a significant proportion remains asymptomatic in early disease stages, often delaying its diagnosis. As such, 32% of women with vulvar melanoma already have regional involvement or distant metastases at the time of diagnosis, which significantly impacts prognosis. Surgery (with or without removal of regional lymph nodes) is usually the primary treatment modality. Typically, a wide-local excision is performed, in which the tumor is excised including a safety-margin of healthy tissue to ensure its entire removal, which is confirmed by a pathologist. In more advanced disease, a (partial)

vulvectomy Vulvectomy refers to a gynecological procedure in which the vulva is partly or completely removed. The procedure is usually performed as a last resort in certain cases of cancer, vulvar dysplasia, vulvar intraepithelial neoplasia, or as part of ...

may need to be performed in order to remove some or all of the vulva. Advanced-stage melanomas can be treated with

checkpoint inhibitor Checkpoint inhibitor therapy is a form of cancer immunotherapy. The therapy targets immune checkpoints, key regulators of the immune system that when stimulated can dampen the immune response to an immunologic stimulus. Some cancers can protect the ...

Other

Labial fusion Labial fusion is a medical condition of the female genital anatomy where the labia minora become fused together. It is generally a pediatric condition. Presentation Labial fusion is rarely present at birth, but rather acquired later in infancy, s ...

, also called ''labial adhesion'', is the fusion of the labia minora. This affects a number of young girls and is not considered unduly problematic. The condition can usually be treated using

creams Cream is a dairy product composed of the higher-fat layer skimmed from the top of milk before homogenization. In un-homogenized milk, the fat, which is less dense, eventually rises to the top. In the industrial production of cream, this process ...

, or it may right itself with the release of hormones at the onset of puberty. Vulvodynia is chronic pain in the vulvar region. There is no single identifiable cause. A subtype of this is

vulvar vestibulitis Vulvar vestibulitis syndrome (VVS), vestibulodynia, or simply vulvar vestibulitis, is vulvodynia localized to the vulvar vestibule. It tends to be associated with a highly localized "burning" or "cutting" type of pain. Until recently, "vulvar vesti ...

but since this is not thought to be an inflammatory condition it is more usually referred to as ''vestibulodynia''. Vulvar vestibulitis usually affects pre-menopausal women. A number of skin disorders such as lichen sclerosus, and

lichen simplex chronicus Lichen simplex chronicus (LSC) is thick leathery skin with exaggerated skin markings caused by sudden itching and excessive rubbing and scratching. It generally results in small bumps, patches, scratch marks and scale. It typically affects the ...

can affect the vulva.

Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension ...

of the vulva is an uncommon form of metastatic Crohn's disease which manifests as a skin condition showing as hypertrophic lesions or vulvar

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 ...

es. Papillary hidradenomas are

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 ...

that can ulcerate and are mostly found on the skin of the labia or of the interlabial folds. Another more complex ulcerative condition is

hidradenitis suppurativa Hidradenitis suppurativa (HS), sometimes known as acne inversa or Verneuil's disease, is a long-term dermatological condition characterized by the occurrence of inflamed and swollen lumps. These are typically painful and break open, releasing ...

which is characterised by painful cysts that can ulcerate, and recur, and can become chronic lasting for many years. Chronic cases can develop into

s. An asymptomatic skin disorder of the vulval vestibule is

vestibular papillomatosis Vestibular papillomatosis (VP) are normal small bumps in the genital area of females. They appear in multiple numbers, are rounded and are not painful, itchy or uncomfortable. They are analogous to pearly penile papules, which occur in males. The ...

which is characterised by fine, pink projections from either the epithelium of the vulva or from the labia minora. Dermatoscopy can distinguish this condition from genital warts. A subtype of

psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...

, an

autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. At least 80 types of autoimmune diseases have been identified, with some evidence suggesting that there may be more than 100 types. Nearly a ...

, is inverse psoriasis in which red patches can appear in the skin folds of the labia.

Childbirth

The vulvar region is at risk for trauma during

. During childbirth, the vagina and vulva must stretch to accommodate the baby's head (approximately ). This can result in tears known as

perineal tear A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most com ...

s in the vaginal opening, and other structures within the perineum. 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 ...

(a pre-emptive surgical cutting of the perineum) is sometimes performed to facilitate delivery and limit tearing. A tear takes longer to heal than an incision. Tears and incisions may be repaired using sutures that may be layered. Among the methods of hair removal evaluated for pre-surgeries, pubic hair shaving known as ''prepping'', was seen to increase the risk of surgical site infections. No advantages have been demonstrated in the routine shaving of pubic hair prior to childbirth.

Surgery

Genitoplasties are plastic surgeries that can be carried out to repair, restore or alter vulvar tissues, particularly following damage caused by injury or cancer treatment. These procedures include vaginoplasty which can also be performed as a

cosmetic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...

. Other cosmetic surgeries to change the appearance of external structures include labiaplasties. Some of these procedures, vaginoplasties and labiaplasties, are also carried out as sex reassignment surgeries. The use of cosmetic surgeries has been criticized by clinicians. The American College of Obstetricians and Gynecologists recommends that women be informed of the risks of these surgeries. They refer to the lack of data relevant to their safety and effectiveness and to the potential associated risks such as

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

, altered sensation,

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 ...

, adhesions, and

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

ring. There is also a percentage of people seeking cosmetic surgery who may be suffering from body dysmorphic disorder and surgery in these cases can be counterproductive.

Society and culture

Altering the female genitalia

In some

cultural practice Cultural practice is the manifestation of a culture or sub-culture, especially in regard to the traditional and customary practices of a particular ethnic or other cultural groups. The term is gaining in importance due to the increased controver ...

s, particularly in the African Khoikhoi and

Rwanda Rwanda (; rw, u Rwanda ), officially the Republic of Rwanda, is a landlocked country in the Great Rift Valley of Central Africa, where the African Great Lakes region and Southeast Africa converge. Located a few degrees south of the Equator ...

cultures, the labia minora are purposefully stretched by repeated pulling on them and sometimes by attaching weights.

Labia stretching Labia stretching, also referred to as labia elongation or labia pulling, is the act of lengthening the ''labia minora'' (the inner lips of the female genitals) through manual manipulation (pulling) or physical equipment (such as weights).

is a recognised, familial cultural practice in parts of Eastern and Southern Africa. This is a desired and encouraged practice by the women (starting at puberty) in order to promote better sexual satisfaction for both parties. The achieved extensions can hang down below the labia majora for up to seven inches. Children in the African diaspora practise this too, so it occurs within immigrant communities in, for example, Britain, where a

BBC #REDIRECT BBC #REDIRECT BBC #REDIRECT BBC Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board ex ...

report labelled it a hidden form of

child abuse Child abuse (also called child endangerment or child maltreatment) is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to a ...

The girls are subject to familial and social pressure to conform. In some cultures, including modern Western culture, women have shaved or otherwise removed the hair from part or all of the vulva. When high-cut swimsuits became fashionable, women who wished to wear them would remove the hair on either side of their pubic triangles, to avoid exhibiting

. Other women prefer to retain their vulva hair. The removal of hair from the vulva is a fairly recent phenomenon in the United States, Canada, and Western Europe, usually in the form of

bikini waxing Bikini waxing is the removal of pubic hair using a special wax, which can be hot or cold, that adheres to hairs and pulls them out when the wax is removed quickly from the skin, usually with a cloth strip. While the practice is mainly associ ...

Brazilian waxing Bikini waxing is the removal of pubic hair using a special wax, which can be hot or cold, that adheres to hairs and pulls them out when the wax is removed quickly from the skin, usually with a cloth strip. While the practice is mainly associ ...

, but has been prevalent in many Eastern European and Middle Eastern cultures for centuries, usually due to the idea that it may be more hygienic, or originating in prostitution and pornography. Hair removal may include all, most, or some of the hair.Helen Bickmore; ''Milady's Hair Removal Techniques: A Comprehensive Manual''; Thomson Delmar Learning; 2003; French waxing leaves a small amount of hair on either side of the labia or a strip directly above and in line with the

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

called a ''landing strip''.

Islam Islam (; ar, ۘالِإسلَام, , ) is an Abrahamic religions, Abrahamic Monotheism#Islam, monotheistic religion centred primarily around the Quran, a religious text considered by Muslims to be the direct word of God in Islam, God (or ...

teaching includes

Muslim hygienical jurisprudence Purity ( ar, طهارة, ''ṭahāra(h)'') is an essential aspect of Islam. It is the opposite of ''najāsa'', the state of being ritually impure. It is achieved by first removing physical impurities (for example, urine) from the body, and then ...

practice Practice or practise may refer to: Education and learning * Practice (learning method), a method of learning by repetition * Phantom practice, phenomenon in which a person's abilities continue to improve, even without practicing * Practice-based ...

of which is the removal of pubic hair. Christina and Nefertiti piercings

Several forms of genital piercings can be made in the vulva, and include the Christina piercing, the Nefertiti piercing, the

fourchette piercing A fourchette piercing is a female genital piercing. It is a piercing done at the rear rim of the vulva, in the area of frenulum labiorum pudendi. Many people do not have a pinchable flap of skin in the area, and are not suited for this piercing. ...

, and

labia piercing Labia piercings are one type of female genital piercing. This piercing can be placed either through the labia minora or the labia majora. They are one of the simpler and more common genital piercings performed on women, and are often pierced in sy ...

s. Piercings are usually performed for aesthetic purposes, but some forms like the clitoral hood piercing might also enhance pleasure during sex. Though they are common in

traditional cultures In sociology, traditional society refers to a society characterized by an orientation to the past, not the future, with a predominant role for custom and habit. Such societies are marked by a lack of distinction between family and business, with the ...

, intimate piercings are a fairly recent trend in Western society. Other forms of permanent modifications of the vulva for cultural, decorative or aesthetic reasons are genital tattoos or scarification (so-called "hanabira"). Female genital surgery includes

laser resurfacing Photorejuvenation is a skin treatment that uses lasers, intense pulsed light, or photodynamic therapy to treat skin conditions and remove effects of photoaging such as wrinkles, spots, and textures. The process induces controlled wounds to the sk ...

of the labia to remove wrinkles, labiaplasty (reducing the size of the labia) and vaginoplasty. In September 2007, the American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion on these and other female genital surgeries, including "vaginal rejuvenation", "designer vaginoplasty", "revirgination", and " G-spot amplification". This opinion states that the safety of these procedures has not been documented. The ACOG and the ISSVD recommend that women seeking these surgeries need to be informed about the lack of data supporting these procedures and the potential associated risks such as infection, altered sensation,

, adhesions, and scarring. With the growing popularity of female cosmetic genital surgeries, the practice increasingly draws criticism from an opposition movement of cyberfeminist activist groups and platforms, called the

labia pride movement Labia pride (also termed labia liberation, vulvaversity and similar) is the promotion of a raised awareness of the appearance of female genitalia and the breaking of taboos surrounding the vulva, as carried out by Feminist movements and ideologies ...

. The major point of contention is that heavy advertising for these procedures, in combination with a lack of public education, fosters body insecurities in women with larger labia in spite of the fact that there is normal and pronounced individual variation in the size of labia. The preference for smaller labia is a matter of a fashion fad and is without clinical or functional significance. The most prevalent form of non-consensual genital alteration is that of

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 ...

. This mostly involves the partial or complete removal of genital organs. Female genital mutilation is carried out in thirty countries in Africa and Asia with more than 200 million girls being affected, and some women (as of 2018). Nearly all of the procedures are carried out on young girls. The practices are also carried out globally among migrants from these areas. Female genital mutilation is claimed to be mostly carried out for cultural traditional reasons.

Etymology

The word ''vulva'' is

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 ...

for "womb". It derives from the 1540s in referring to the womb and female sexual organs, from the earlier ''volvere'' meaning to turn, roll or revolve, with further derivatives such as used in volvox, and volvulus (twisted bowel). The naming of the female (and male) genitals as , meaning parts to be ashamed of, dates from the mid-17th century. The naming influenced the general perception of the vulva and this is shown in depicted gynaecological procedures. The examiner shown in the ''Obstetrical examination'' dated 1822, is adopting the compromise procedure where the woman's genitals cannot be seen.

Terminology

In 2021, a study in the UK showed that few are able to label the structure of the vulva correctly. There are many sexual slang terms used for the vulva.

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 ...

, a medieval word for the vulva and once the standard term, has become a

vulgarism In the study of language and literary style, a vulgarism is an expression or usage considered standard language, non-standard or characteristic of uneducated speech or writing. In colloquial or Lexical definition, lexical English, "vulgarism" or "v ...

, and in other uses one of the strongest offensive and abusive

swearwords Profanity, also known as cursing, cussing, swearing, bad language, foul language, obscenities, expletives or vulgarism, is a socially offensive use of language. Accordingly, profanity is language use that is sometimes deemed impolite, ru ...

in English-speaking cultures. The word has been replaced in normal usage by a few

euphemism A euphemism () is an innocuous word or expression used in place of one that is deemed offensive or suggests something unpleasant. Some euphemisms are intended to amuse, while others use bland, inoffensive terms for concepts that the user wishes ...

s including

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 ...

(vulgar slang) and fanny (UK) which used to be a common

pet name A hypocorism ( or ; from Ancient Greek: (), from (), 'to call by pet names', sometimes also ''hypocoristic'') or pet name is a name used to show affection for a person. It may be a diminutive form of a person's name, such as ''Izzy'' for I ...

. In the UK these terms have other non-sexual meanings that lend themselves to '' double entendres'', such as pussy which is used as a term of endearment for a pet cat – pussy cat. In North American informal use the term pussy can also refer to a weak or effeminate man, and fanny is a term used for the buttocks. Other slang terms are muff, snatch,

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 crotch. Vagina is often used as a synonym for vulva even though it is a separate part of the anatomy.

Religion and art

Some cultures have long celebrated and even worshipped the vulva. During the

Uruk period The Uruk period (ca. 4000 to 3100 BC; also known as Protoliterate period) existed from the protohistoric Chalcolithic to Early Bronze Age period in the history of Mesopotamia, after the Ubaid period and before the Jemdet Nasr period. Named after ...

( 4000–3100 BC), the ancient

Sumer Sumer () is the earliest known civilization in the historical region of southern Mesopotamia (south-central Iraq), emerging during the Chalcolithic and early Bronze Ages between the sixth and fifth millennium BC. It is one of the cradles of c ...

ians regarded the vulva as sacred and a vast number of Sumerian poems praising the vulva of

Inanna Inanna, also sux, 𒀭𒊩𒌆𒀭𒈾, nin-an-na, label=none is an List of Mesopotamian deities, ancient Mesopotamian goddess of love, war, and fertility. She is also associated with beauty, sex, Divine law, divine justice, and political p ...

, the goddess of love, sex, and fertility, have survived. In

Sumerian religion Sumerian religion was the religion practiced by the people of Sumer, the first literate civilization of ancient Mesopotamia. The Sumerians regarded their divinities as responsible for all matters pertaining to the natural and social orders. Ove ...

, the goddess

Nin-imma Ninimma was a Mesopotamian goddess best known as a courtier of Enlil. She is well attested as a deity associated with scribal arts, described in modern publications as a divine scholar, scribe or librarian by modern researchers. She could also se ...

is the divine personification of female genitalia. Vaginal fluid is always described in Sumerian texts as tasting "sweet" and, in a Sumerian bridal hymn, a young maiden rejoices that her vulva has grown hair. Clay models of vulvas were discovered in the temple of Inanna at

Ashur Ashur, Assur, or Asur may refer to: Places * Assur, an Assyrian city and first capital of ancient Assyria * Ashur, Iran, a village in Iran * Asur, Thanjavur district, a village in the Kumbakonam taluk of Thanjavur district, Tamil Nadu, India * Assu ...

Some major

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 ...

traditions such as

Shaktism Shaktism ( sa, शाक्त, , ) is one of several major Hindu denominations, wherein the metaphysical reality is considered metaphorically a woman and Shakti ( Mahadevi) is regarded as the supreme godhead. It includes many goddesses, al ...

, a goddess-centred tradition, revere the vulva and vagina under the name

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 ...

. The

goddess A goddess is a female deity. In many known cultures, goddesses are often linked with literal or metaphorical pregnancy or imagined feminine roles associated with how women and girls are perceived or expected to behave. This includes themes of s ...

Devi Devī (; Sanskrit: देवी) is the Sanskrit word for 'goddess'; the masculine form is ''deva''. ''Devi'' and ''deva'' mean 'heavenly, divine, anything of excellence', and are also gender-specific terms for a deity in Hinduism. The conce ...

is worshipped as the supreme deity. The yoni is a representation of the female deity and is found in many temples as a focus for prayer and offerings. It is also represented symbolically as a

mudra A mudra (; sa, मुद्रा, , "seal", "mark", or "gesture"; ,) is a symbolic or ritual gesture or pose in Hinduism, Jainism and Buddhism. While some mudras involve the entire body, most are performed with the hands and fingers. As wel ...

spiritual practice A spiritual practice or spiritual discipline (often including spiritual exercises) is the regular or full-time performance of actions and activities undertaken for the purpose of inducing spiritual experiences and cultivating spiritual developme ...

s, including

yoga Yoga (; sa, योग, lit=yoke' or 'union ) is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India and aim to control (yoke) and still the mind, recognizing a detached witness-consciou ...

. Sheela na gigs are figurative carvings of naked women displaying an exaggerated vulva. They are found in ancient and medieval European contexts. They are displayed on many churches, but their origin and significance is debatable. A main line of thinking is that they were used to ward off evil spirits. Another view is that the sheela na gig was a divine assistant in childbirth. Starr Goode explores the image and possible meanings of the Sheela na gig and Baubo images in particular, but writes also about the recurring image worldwide. Through hundreds of photographs, she demonstrates that the image of a female displaying her vulva is not specific to European religious art or architecture, but that similar images are found in the visual arts and in mythical narratives of

es and

hero A hero (feminine: heroine) is a real person or a main fictional character who, in the face of danger, combats adversity through feats of ingenuity, courage, or Physical strength, strength. Like other formerly gender-specific terms (like ...

ines parting their thighs to reveal what she calls, "sacred powers." Her theory is that "the image is so rooted in our psyches that it seems as if the icon is the original cosmological center of the human imagination." Origin-of-the-World

' ("Origin of the world") painted by

Gustave Courbet Jean Désiré Gustave Courbet ( , , ; 10 June 1819 – 31 December 1877) was a French painter who led the Realism movement in 19th-century French painting. Committed to painting only what he could see, he rejected academic convention and t ...

in 1866 was an early Realist painting of a vulva that only became exhibited many years later. The painting was commissioned by Ottoman diplomat

Halil Şerif Paşa Halil Şerif Pasha, transliterated variously as Khalil Sherif Pasha ( sq, Halil Sherif Pasha, 20 June 1831 – 12 January 1879), was an Ottoman-Egyptian statesman, diplomat and art collector, who lived during the Tanzimat period. His collec ...

. The woman used as the model for the painting was probably Halil's lover

Constance Quéniaux Constance Adolphine Quéniaux (9 July 1832 – 7 April 1908) was a dancer and courtesan at the Paris Opera Ballet. She is the presumed model for Gustave Courbet's painting ''L'Origine du monde'', in which a woman is seen explicitly displaying her g ...

. However another potential model is

Marie-Anne Detourbay Marie-Anne Detourbay (18 January 1837 – 21 January 1908) was a French demimonde and salon-holder. She was a famous courtesan during the Second Empire, and also hosted a literary salon which had some influence during the Second Empire and the Th ...

, who was also a lover of Halil Şerif Pasha. Japanese sculptor and

manga Manga (Japanese: 漫画 ) are comics or graphic novels originating from Japan. Most manga conform to a style developed in Japan in the late 19th century, and the form has a long prehistory in earlier Japanese art. The term ''manga'' is u ...

artist

Megumi Igarashi , who uses the pseudonym , is a Japanese sculptor and manga artist who creates works that feature female genitalia and are often modeled after her own vulva. Rokudenashiko considers it her mission to reclaim female genitalia as part of women's bod ...

has focused much of her work on painting and modelling vulvas and vulva-themed works. She has used molds to create

diorama A diorama is a replica of a scene, typically a three-dimensional full-size or miniature model, sometimes enclosed in a glass showcase for a museum. Dioramas are often built by hobbyists as part of related hobbies such as military vehicle mode ...

s – three-dimensional models of her vulva with the hope of demystifying the female genitals. An

art installation Installation art is an artistic genre of three-dimensional works that are often site-specific and designed to transform the perception of a space. Generally, the term is applied to interior spaces, whereas exterior interventions are often called ...

called '' The Dinner Party'' by feminist artist,

Judy Chicago Judy Chicago (born Judith Sylvia Cohen; July 20, 1939) is an American feminist artist, art educator, and writer known for her large collaborative art installation pieces about birth and creation images, which examine the role of women in history ...

, portrays a symbolic history of famous women. The dinner plates each depict an elaborate vulval form and they are arranged in a triangular vulva shape. Another installation was made by British artist Jamie McCartney who used the casts of four hundred vulvas to create ''The Great Wall of Vagina'' in 2011. The vagina casts are life-size. Explanations written by the project's sexual health adviser accompany these. The purpose of the artist was to "address some of the stigmas and misconceptions that are commonplace".

Additional images

File:Vulva-handsign-Yoni-mudra.svg, Vulva handsign used as a

yogic Yoga (; sa, योग, lit=yoke' or 'union ) is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India and aim to control (yoke) and still the mind, recognizing a detached witness-consciou ...

File:NAMA Phallus ailé.jpg, Attic red-figure lid depicting three vulvae and a winged penis File:Mahadev temple (2).jpg, Yoni at Mahadev temple

References

External links

* *
'V' is for vulva, not just vagina
by Harriet Lerner discussing common misuse of the word "vagina"
Vulvar hygiene and Urinary Tract Infections
by Heather Corinna (illustrations; no explicit photos) {{Authority control Mammal female reproductive system Human female reproductive system Pelvis