In the past, society has treated our anatomy like a taboo subject. Lately, that is changing. You shouldn't be embarrassed about looking at your own vagina. Some are clueless about what the different parts do and what is considered ‘normal'.
To start, there is a wide range of ‘normal'; just like your face is different to almost everyone in the world. That said, some women notice that what they see or feel is different compared with other women or even how things used to be, and they want to know if it can be changed. So let's get right to it and find out what the vagina really is, what is does, and what it is ‘supposed’ to look and feel like.
Technically, the vagina only refers to the vaginal canal inside the body, but the entire female genitalia is often referred to as ‘the vagina’. All the parts you can see in the above picture are considered the ‘outside' or external genitalia, which is also called the ‘vulva’. The ‘inside' or internal genitalia refers to the vaginal canal, which goes from your vulva to the cervix (the entrance to the uterus).
Let's work our way down the picture from top to bottom.
The Clitoris is a pea sized and shaped organ right at the top of your vagina. It is super sensitive and contains more nerves (8000 give or take) than any other part of your body. The clitoris is one of the parts of your vagina that makes you feel good if it is touched or stimulated.
Some women feel like they have enough loose skin on the top or sides of the clitoris that it affects their comfort, self-esteem, or sexual satisfaction. Clitoral hood reduction can address excess tissue. Despite the common fear that sensation will change, in reality, this almost never happens since the nerves to the clitoris come from directly underneath it. This means that removing tissue above and along the sides is safe when performed by someone who is trained and experienced in this procedure.
Clitoral hood reduction can be performed under local anesthesia in the office for around $2000. Excess tissue is removed, and the edges are repaired with absorbable sutures or ‘stitches’. Most patients take 4-5 days off work and do not resume sex until 4-6 weeks later.
Clitoris reduction or pexy (meaning lift) can help when the actual clitoris is enlarged or protruding. But this is a more complex procedure with increased risks of sensation changes, so it is not done as often.
Your urethra is a tube that transports urine from your bladder to your vagina. Think of it like a long straw that helps you go to the bathroom.
After childbirth or with increasing age, some women experience incontinence (leaking urine). When the leakage is severe or associated with a low bladder (called prolapse), surgery is often necessary to fix this. But for women with mild incontinence, a laser procedure can often tighten tissue in the area and improve symptoms.
The procedure typically costs between $500 and $1500 and is done in the office. Most patients have no discomfort and only 2-4 days of light restrictions. The treatment is designed to be repeated every 6 weeks for a total of 3 treatments and then to be repeated yearly to maintain results. Some patients notice significant improvement after even one session.
These are the folds of skin that make up the outer boundary of the vulva. The labia majora's main job is to protect all the other sensitive parts of your vagina. Some women notice prominence of the labia majora in puberty, but more commonly, women see changes after weight loss, pregnancy, or with age.
Reduction of the labia majora can help women who dislike the appearance of the vulva in tight pants, bathing suits, or in the nude. Some patients even seek surgery for relief of recurrent yeast infections and irritation from excess tissue rubbing between the thighs.
Reduction is usually performed in the office and most commonly involves removal of tissue from the inner portion of the labia majora with an incision hidden between the labia minora and labia majora. Cost is around $5000 if the procedure is not done in the operating room, and most patients resume work in 2-4 days, exercise in 2-4 weeks, and intercourse in 4-6 weeks.
Sometimes, what appears to be excess or elongated labia actually results from excess tissue at the mons pubis (the area between the abdomen and the vulva). Occasionally a tummy tuck or mons lift will be a better alternative than directly removing tissue from the labia majora.
For women who don’t have excess labia majora, but instead notice a ‘deflated’ appearance, fat transfer or fillers can “plump” up the appearance. Laser or Ultrasound skin tightening can smooth and slightly tighten the tissue. These treatments are often less expensive than surgery and require less downtime, but they often need to be repeated every year or so to maintain results.
These are the ‘internal lips’ that start at the bottom of your vagina and meet near the clitoris. Like the labia majora, they protect the delicate parts of your vagina. They can even change color and size depending on your mood – just like a mood ring!
Many women find that enlarged or asymmetric labia minora interfere with being able to comfortably wear bathing suits and tight pants. Some are also concerned about discomfort and embarrassment during intercourse due to enlargement or uneven texture or color. Surgical reduction of the labia minora can be performed in the office using numbing cream and local anesthetics for pain control for around $4000-5000. Sutures dissolve on their own, and most patients return to work after a few days and resume sex after 4-6 weeks.
There is a risk of hypersensitivity, which is usually temporary and more rarely, a risk of decreased sensitivity. Most patients are understandably concerned about scarring, but surprisingly few patients look like they have had surgery after about 3 months.
The tightness of the vaginal canal can decrease after childbirth or with age. Also, women can have vaginal dryness or irritation, especially after menopause. Both of these factors can decrease sexual satisfaction for both partners during vaginal intercourse.
For significant stretching of the vagina, surgical tightening is the most effective treatment. This is done under general anesthesia and can cost around $9000. The excess lining of the vagina (called the mucosa) is removed and the muscles are tightening with absorbable sutures before the lining is sewn back together. Time off work varies depending on the type of job, and heavy lifting and sex both need to be avoided for about 8 weeks.
For women who do not have significant looseness or who also have problems with dryness or irritation, CO2 laser procedures are effective for treatment. Typical costs are between $500 and $1500. Most patients have no discomfort and only 2-4 days of light restrictions. The treatment is designed to be repeated every 6 weeks for a total of 3 treatments and then to be repeated yearly to maintain results.
Although it’s not labeled in the picture, the perineum refers to the part of the body in between the vagina and rectum. This is the main group of muscles that are engaged with ‘kegal’ exercises.
After childbirth, some women lose muscle tone or thickness in this area. There are laser and radio frequency treatments that can address this looseness, but many patients will be better served by a surgical procedure to tighten the muscle. Downtime is similar to a vaginal tightening, although this can be done in the office or the OR depending on patient preference. The downtime is similar to vaginal tightening surgery.
Some women do not have muscle weakness, but they do notice a change in the appearance of the area after episiotomy or tear during childbirth. For these patients, removal of excess perineal skin can make them feel much better about the area. This downtime is more similar to surgery on the labia.
Although it isn’t technically part of the female genitalia, some women do become concerned with the appearance of the mons, which is the area over the pubic bone.
If there is excess fat but no extra skin, then liposuction can be used to reduce the size of the area. The incisions are less than ½ inch, and are hidden by underwear. For patients who have excess skin from weight loss, pregnancy or genetics, removal of excess skin can be added to the liposuction. These procedures can be done in the office or the OR, depending on patient preference, so costs can vary from $4000-$8000. Aside from light activity for about 2 weeks, downtime is minimal for most patients.
Do I Need Surgery?
So, since there is such a wide range of normal, very few “need” surgery to improve comfort or reduce skin infections. However, many women want to have surgery to help them feel more confident about their appearance and more comfortable during exercise or sex. If you are interested in any of these procedures, the best step is to find a surgeon who is experienced in multiple techniques and specializes in female genital aesthetics. Searching online to look at reviews as well as evaluating a doctor’s before and after pictures can give you an idea of who to consult with, but meeting a board certified surgeon you trust is the most important factor.